Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you withhold a fluoropyrimidine in a newly diagnosed patient with metastatic colon cancer who had a STEMI and new diagnosis of ischemic cardiomyopathy within the last 3 months?
While the reported incidence of cardiac events is noted above, in practice this is far less likely as a clinical event. Also, as noted, vasospasm is more likely in the younger patient, generally without atherosclerotic heart disease. In the patient with a STEMI, it is most likely safe to use infusi...
What is the appropriate management of severe myalgia during atezolizumab infusion?
Immune related adverse events involving the skeletal muscle following immune checkpoint inhibitor therapy include polymyalgia rheumatica (PMR) like syndrome and myositis. Referral to a rheumatologist is recommended for a severe musculoskeletal adverse event. Myocarditis is not addressed in this brie...
Do you repeat molecular testing at progression in gastric/GEJ tumors or is the initial pathology sufficient for entire treatment course?
As I have addressed elsewhere, yes, I would rebiopsy at the time of progression on any anti-Her2 therapy to confirm persistent Her2 positivity. I try very hard to biopsy a progressive tumor. If this is not possible, ctDNA to assess for persistent ErBB2 amplification is an option, albeit one that is ...
How do you approach the management of GVHD prophylaxis in the setting of severe infection?
GVHD prophylaxis the 1st ~ 3 months after alloSCT is paramount and immunosuppression withdrawal might cause GVHD which can in turn exacerbate or cause infection given the need of corticosteroids to control it. Having said that, case-by-case management is important. As an example, alloSCT using a PTC...
What are your top takeaways from SABCS 2022?
Here are my top 3 presentations (specifically for breast medical oncology) that I would say are most impactful (now or soon), with slides attached. GS3-04 - Capivasertib Phase III (CAPItello-291) Trial – these results will likely change standards for post CDKi progression for HR+/HER2-negative metas...
How do you titrate hydroxyurea in the management of myeloproliferative neoplasms?
It certainly depends on the situation, but for most patients, the default is to start at 500 mg PO daily and make adjustments every 1 to 2 weeks based on the counts to get to the therapeutic targets.
How are you managing patients with recurrent NMIBC with CIS who decline cystectomy with the recent BCG shortage?
https://suonet.org/resources/news/bcg-shortage-addressed-by-urologic-community.aspx
How would you treat margin positive, node positive (pN+) prostate cancer with detectable post-op PSA but negative PSMA-PET after radical perineal prostatectomy?
Ideally, enroll the patient in a clinical trial like NRG GU-008. Off trial, would treat with salvage RT to the prostate bed and lymph nodes with long term (2 years) ADT. You can consider an MRI to see if there's a nodule in the prostate bed to boost, which may be more likely given a positive margin....
How do you manage surveillance imaging for patients with metastatic castration-naive prostate cancer with an initial low PSA?
Low PSA progression is common at the time of radiographic progression in the mHSPC setting, particularly among men treated with potent AR inhibitors. As we recently presented in the ARCHES phase 3 study, while enzalutamide significantly improves rPFS and OS and reduces progression events, among thos...
Would you consider clearing a patient with essential thrombocytosis for a kidney donation?
For brevity, I am assuming that the patient is already medically approved for surgery and organ donation, and I will focus on the clinical significance of the essential thrombocytosis (ET) with regard to both. I am also going to assume that the patient actually has ET, and not masked polycythemia ve...