Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage positive surgical margins after partial nephrectomy for kidney cancer?
If feasible, I would recommend re-excision. This is not always feasible however, and in that case, I would observe. Patients with positive margins do not always recur and thus could spare the patient some toxicity.
How do you approach maintenance therapy for relapsed follicular lymphoma?
In general, patients who received 2 years of maintenance rituximab in first-line settings are unlikely to benefit from more maintenance rituximab in second-line. This is especially true if relapse occurs within 24 months of first-line therapy.A meta-analysis (JNCI 2011) did show a small benefit in o...
How do you treat hiccups in cancer patients?
Personal success has lead me to use Baclofen to control chemotherapy induced hiccups. A single 10 mg dose is usually effective for patients who experience hiccups upon administration of chemotherapy. Occasionally 10 mg q 8 h prn is needed for a few doses. I have seen this side effect and used Baclof...
Would you consider treatment of advanced HCC with checkpoint blockade after progression on sorafenib?
Yes, I would consider checkpoint blockade, particularly a research protocol. HIV status may complicate trial enrollment but would not necessarily be an issue off study. Hepatitis status as a predictive factor for response is interesting and is being currently investigated. In my practice, we conside...
How do you treat GIST with de-differentiation to pleomorphic sarcoma on chronic therapy with imatinib?
Once a GIST, always a GIST. Sarcomas that are driven by a translocation can behave badly but they never ever get rid of their translocation. Possibly by saying the GIST has de-differentiated your pathologist is telling you the GIST looks more aggressive. Or maybe it was never was GIST in the first p...
Should we be using comprehensive panels when testing for hereditary cancer syndromes?
I think the days of single gene testing are limited. Certainly if a deleterious gene has already been identified, family members only need to be tested for that mutation. In rare circumstances when there is a large family with a substantial cancer history that perfectly replicates a known syndrome, ...
Do you counsel patients on the (very small) risk of permanent hair loss with docetaxel?
I have to admit that I didn't recognize permanent hair loss with docetaxel until the legal commercials - the same ones your patients are seeing that are prompting their questions. After careful reflection and discussion with my nursing staff, we can identify 2 patients over 17 years who have not had...
Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?
I can't think of a situation that would justify a "watch and wait" approach to CML. There are a number of effective therapies. Even if a patient has side effects from one TKI, there are others to choose from. What justification is there for not using an effective therapy? What is the rationale? Da...
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
Do you ever discontinue ibrutinib in patients with CLL who have a good response?
For patients who are responding well to ibrutinib and tolerating the drug well, I do not discontinue ibrutinib. The clinical trials of single agent BTK inhibitors have all continued therapy indefinitely, which is a logical approach considering that very few will attain minimal residual disease negat...