Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How soon after a VTE would you feel comfortable with a patient undergoing an elective surgery?
Here is my approach: Many factors play a role in decision making such as type of venous thromboembolic event, clot burden, provoked versus unprovoked nature of the event, patient's bleeding and clotting phenotype, associated risk factor such as cancer, etc, type of anticipated surgery, and risk for ...
What is your strategy for having COVID positive patients resume infusions after they have recovered from the infection?
If they are asymptomatic and doing well, we may resume systemic therapy as clinically indicated. I have used either chemotherapy or IO, depending on the case. We follow institutional guidelines but retesting for Covid19 is not required at our center if the patient has recovered and has been asymptom...
In locally advanced EGFR-mutated NSCLC with initial good response to osimertinib, how do you manage local progression of the primary?
In this context, local progression at one site after a good response to osimertinib makes good clinical sense. Given that the next line of therapy is chemotherapy, being able to continue the TKI as long as possible while addressing oligoprogression with RT for local control is appealing. However, we...
Do you still consider isolated skin involvement by primary breast cancer without inflammatory change to be locally advanced stage III disease?
We almost always review these cases at our multidisciplinary case conference and there is debate. These are the lessons I've learned from our team: (1) if the primary tumor is very superficial and directly invades the skin, then it is not stage III and is staged based on tumor size, (2) if there is ...
Would you add chemotherapy to a TKI in treating an elderly patient with de novo CML blast crisis?
Treating CML blast crisis is challenging in any patient and there is no standard of care. Generally, it is recommended to treat with both chemotherapy and a TKI. However, it is most important to adjust treatment to the patient. If a patient is frail and unable to tolerate chemotherapy, I don't think...
Is it safe to treat a recurrent esophageal SCC with definitive chemoradiation after a prior endoscopic mucosal resection?
I would not be concerned about perforation or fistula formation. With an EMR, the resection takes off the mucosa/submucosa and leaves the wall intact. There should be sufficient time from the prior procedure to have full mucosal regrowth and the wall integrity should be well maintained.
How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?
The management of primary refractory stage IV DLBCL is complex and generally not successful. See NCCN Guidelines for details. I would distinguish, however, between those patients who are clinically refractory and those who have clinically responded well but may have residual disease by imaging, i.e....
How would you treat lung adenocarcinoma patients progressing on osimertinib who are not candidates for chemotherapy?
First, I will point out that there are a number of other questions that have come up that touch on this question which I have referenced below. This is certainly a challenging scenario. Obviously, if a patient is not a candidate for chemotherapy, they are likely not a candidate for a clinical trial,...
How late after surgery would you consider prescribing osimertinib as adjuvant therapy in patients with resected EGFRm NSCLC?
Most patients will received adjuvant chemotherapy for 3-4 cycles. Adjuvant chemo typically begins 4-12 weeks after surgery. Therefore, the initiation of adjuvant sequential Osimertinib would typically occur 3 weeks after the last cycle of chemotherapy.
How do you incorporate denosumab into the surgical management of giant cell tumor of bone?
Denosumab forever. Giant cell tumors of bone have a clonal cancer component and then osteoclasts that are hypnotized by the cancer. Denosumab works on the osteoclasts so they quit listening to the cancer and then the whole thing turns to bone. Denosumab does not kill anything and the cancer cells ar...