Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you use particular cutoffs of troponin and BNP that you deem indicative of a hemodynamically significant/high-risk PE, or do you see any abnormal value as indicative?
Biomarkers are contributory variables in a multivariable assessment of any patient with pulmonary embolism. In light of the multiple factors that influence biomarker levels in a given patient, it is challenging to define one-size-fits-all cut points for meaning. It is also important to recognize tha...
Would you recommend discontinuing testosterone replacement in a male patient in his 60s with newly diagnosed favorable intermediate-risk prostate cancer who is declining surgery and will receive definitive radiation?
Historically, we (as a field) have viewed TRT as the opposite of ADT and therefore inherently problematic. I am not convinced this is logical. ADT has RCT evidence to support it, whereas withdrawing TRT has not been as cleanly studied. Let's say we stop TRT, and this drops their testosterone to 150 ...
How do you talk with your patients regarding radiographic expectations on surveillance CT after lung SBRT?
In general, especially when I have a discussion about the 3-month follow-up scan and tell patients that the lesion may likely be stable in size, which is often normal, and not to panic. There may also be post-radiation changes that make it more difficult to initially interpret. I think this highligh...
What is your standard approach for patients with platinum and ICI refractory small cell lung cancer?
For many years, my standard approach has be either topotecan or paclitaxel. I actually prefer paclitaxel over topotecan for patients with rapid progression after first line therapy. In refractory patients, the RR with topotecan in trials is only about 10% (which seems about right from my practice), ...
How would you treat an elderly patient with Stage IIA cHL with 3 nodal sites of involvement who has a contraindication to bleomycin?
With the publication of the SWOG Cancer Research Network's collaboration with the National Clinical Trials Network, Protocol S1826 results allow a definitive recommendation of nivolimab plus doxorubicin, vinblastine, and dacarbazine (N-AVD) as the treatment of choice for this patient.
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
In patients with inflammatory arthritis (RA, psoriatic arthritis) and a history of MGUS are there any concerns regarding use of biologics?
There is no absolute contraindication to any particular biologic used to manage active RA in a patient with MGUS. The literature does point out a small potential risk associated with tocilizumab in terms of development of myeloma influenced by the IL-6 pathway (and I would tend to extend that potent...
How do you counsel patients with newly diagnosed advanced cancer on smoking cessation?
Unless the patient has a significant chance of living for more than a year or two, I can’t imagine that the difficulty of quitting smoking is really justified for that patient.
In a patient with early-stage HR+ breast cancer receiving neoadjuvant chemotherapy, does the presence of a transtibial osseointegrated amputation implant increase the risk of infection during chemotherapy-induced neutropenia?
Having a foreign object attached to a body does increase infection risk. However, this risk has to be weighed against the magnitude of benefit from chemotherapy in terms of reducing the risk of breast cancer recurrence and improving the chances of overall survival. I feel that in breast cancer patie...