Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Assuming approval, in which patients would you choose Belzutifan + Lenvatinib (LITESPARK-011) for advanced RCC, with progression after IO therapy?
LITESPARK-011 is an interesting study as it relates to current standard practice. Presently, lenvatinib/everolimus is a well-established and potent treatment option. Each clearly contributes towards the clinical benefit observed in most patients. For instance, in the study NCT01136733 (Motzer et al....
What is your response to the question, "Is this terminal?"
Thanks for this question, it's really important. This question comes up in two distinct scenarios: when a person is first diagnosed and when a person is nearing the end of her life. Let's talk about them in sequence. 1). At diagnosis: When a person is first diagnosed, this question is part of "getti...
What are the best labs to trend improvement in HLH?
Unfortunately, there is not one specific laboratory test to definitively trend responses to HLH directed therapy. In general, our approach is to obtain baseline inflammatory labs including CBC with differential, ferritin, soluble IL2 receptor (sIL2r), triglycerides, coagulation studies (PT/PTT) incl...
Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?
I agree with the answer here by Dr. @Dr. First Last. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, i...
Would you offer live vaccines (e.g., MMRV/measles) to patients on bispecific antibodies for multiple myeloma?
I agree with the answer here by Dr. @Dr. First Last. There are a lot of nuances, though. In regard to giving the vaccine safely and effectively, the best strategy is not to wait until patients have multiple relapses and are on bispecific therapy to vaccinate. Given the recent outbreaks of measles, i...
When would you continue atezolizumab/bevacizumab beyond progression in advanced HCC?
The key parameters I use when considering treatment beyond progression for a patient on atezolizumab bevacizumab are clinical symptoms as compared to baseline, performance status as compared to baseline, and underlying hepatic function as compared to baseline. If there is worsening in any of these a...
How would you approach adjuvant therapy in a patient with HR+ breast cancer with a high RS (>25) given the current COVID-19 pandemic?
The starting point for consideration of adjuvant chemotherapy is to quantify the risk of a distant recurrence. For estrogen receptor positive, HER2 negative breast cancer, Oncotype Dx RS data are critical for understanding the risk of a distant recurrence1 as well as endocrine and chemotherapy respo...
How do you approach initial anticoagulant selection in hemodynamically stable hospitalized patients with newly diagnosed pulmonary embolism?
Low-molecular-weight heparin demonstrates the greatest benefit in patients with cancer-associated pulmonary embolism, intermediate-risk PE, and those requiring outpatient management. While LMWH shows superior efficacy and safety compared to unfractionated heparin across most patient populations, cer...
For transplant-ineligible aplastic anemia planned for immunosuppression, how do you approach duration and tapering of cyclosporine and eltrombopag?
One of the most common mistakes in the management of AA is premature tapering of cyclosporine or tacrolimus. If there is a complete remission, and by that I mean normalization of counts, not complete remission as defined in some papers (e.g., ANC 1000, Plts 100,000, Hb 10 as in de Latour et al., PMI...
How do you manage a nodal recurrence of an early stage glottic laryngeal cancer previously treated with definitive radiotherapy?
As a general rule, patients with post-RT recurrences that are resectable should undergo surgery rather than re-irradiation, unless surgery is expected to be associated with substantial risk or functional deficit (in which case the patient should be consulted about the risks of each modality). In the...