Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When should a gallium-dotatate scan be incorporated into the initial evaluation of a patient with a carcinoid tumor of the appendix?
Good question! I would first refer the reader to my two favorite papers on appendiceal NETs (Rault-Petit et al., PMID 29557879; Landry et al., PMID 18645109) to understand and help determine: 1) which patients are at highest risk of lymph node metastasis and thus require a right hemicolectomy, and 2...
How would you counsel a patient regarding possibility of ovarian preservation at time of surgery for malignant mesothelioma initially discovered in a myomectomy specimen and involving peritoneal surfaces?
If the mesothelioma is on the lower grade of the spectrum and the margins negative, I would offer fertility preservation if feasible at surgery. If high grade, I would have a discussion about prognosis with the patient. If all the tumor can be resected with an R0 resection, it should be offered - th...
How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?
HSTCL accounts for <1% of lymphomas. It typically presents in young males, 10-20% of whom are on chronic immunosuppression such as TNF alpha inhibitors. The prognosis for hepatosplenic t-cell lymphoma is grim. Patients can achieve a CR, but relapse quickly with a short median OS. When possible, pati...
How would you treat laryngeal neuroendocrine carcinoma?
It would depend on extent and differentiation. If small cell, chemo RT. No point in surgery because they almost always develop distant metastasizes. If differentiated, it would depend on extent and surgical alternative.
How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?
From the description, it presumes that this is a patient who previously received BEP, high dose chemo with transplant, and "radiotherapy". Not sure whether that represents CNS mets that were radiated. The most important aspect is to be certain marker rise due to progressive cancer. hCG mildly elevat...
Would you consider lymphovascular invasion at the margin to be a positive margin in breast cancer surgery?
LVI is an independent risk factor for local relapse despite adequate treatment. That being said, we don’t chase LVI to get negative margin as it is non contiguous involvement and not contiguous process which warrants any reexcision.
Do you recommend long term anticoagulation for all patients with first time unprovoked VTE?
I consider long term anticoagulation after a first unprovoked proximal DVT or PE in patients with low bleeding risk, especially if they are male. Risk/benefit discussion is employed for patients who have a higher bleeding risk after a first unprovoked VTE event.
How do you proceed with treatment of a patient with stage IIIB NSCLC who progresses DURING treatment with concurrent weekly carboplatin/paclitaxel and radiation?
I have been looking at this question for a little over a week, and struggling to know how to answer this. The relevant trials for a patient with PDL1 somewhere between 0 and 49% (KEYNOTE-189, KEYNOTE-407, KEYNOTE-042, CheckMate 227, and 9LA) would have excluded patients who received either adjuvant ...
When do you utilize lenalidomide in patients with MDS without del(5q)?
Lenalidomide is beneficial in low-risk and int -1 risk MDS patients with anemia even without del 5q in combination with EPO as shown in ECOG 2905 study.List et al., PMID 33439748These low-risk MDS tend to be MDS with refractory anemia and ringed sideroblasts.MDS RS with thrombocytosis tends to be re...
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.