Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat a young woman of child bearing age group diagnosed with primary CNS lymphoma?
The first step is to check HIV serology to ensure that the patient is HIV negative as HIV+ve patients would need to antiretroviral therapy promptly along with chemotherapy or the prognosis is dismal. If patient is young and fit the initial approach is similar in both HIV +ve and -ve patients. Assumi...
Would you give adjuvant chemotherapy to a post-menopausal woman with strongly ER/PR positive locally advanced lobular carcinoma with >3 axillary LNs?
If she has no medical contraindication to chemotherapy, yes. And assuming she has no contraindication to treatment with an anthracycline, I would favor an AC-T sequence, in either order (my preference is to give the taxane first, which is usually less toxic and causes less or no stem cell damage tha...
Do somatostatin based therapies have any role in treating neuroendocrine tumors that are silent on octreotide scanning ?
Possibly...there seems to be an association between the intensity of uptake and response to somatostatin analogs (SSAs) in patients with G2/G3 NETs. Almost all express somatostatin receptors (SSTRs) to some degree. The big question is how you assess for the presence of receptors. Octreoscans have lo...
How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?
At our facility, we have treated a significant number of patients with low grade lymphoma isolated to a single fixed site within the GI tract with excellent long term results. It is worth considering a dose of 2400 rads to the involved site.
What is your threshold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant?
My thresold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant is the same as with other patients - transfuse for plts<10 unless febrile or if any bleeding complications, at which time the threshold would be higher.
Is there a role for PD-1 inhibitors for metastatic or locally recurrent cutaneous squamous cell carcinomas after failure of first line therapy, EGFR inhibitors?
Yes. response rate close to 50%. Look at ASCO abstract from 2017 phase 1 looking at new PD-1 inhibitor in treat this disease
Would you do ALND for low ER pos (1-10%), Her2 + patient with positive sentinel lymph nodes?
The question whether an axillary lymph node dissection is therapeutic or diagnostic has not been completely addressed. Data is supportive that a complete lymph node dissection is not necessary in a ER+lower risk group of women undergoing a lumpectomy with radiation For HER2 positive patients and w...
Do you have a preference for a CDK4/6 inhibitor for first line metastatic HR positive breast cancer in combination with faslodex?
I do not have a preference for a CDK 4/6 inhibitor when given with fulvestran for metastatic ER+/Her-2 - breast cancer. Both palbociclib and abemaciclib are approved in combination with fulvestrant. There are differences in terms of dosing, schedule, and side effects. But, these features don't sugge...
Do you have any concerns about enhanced radiation toxicity with any of the novel agents used to treat multiple myeloma?
I agree with Dr Vesole.
How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?
Since patients are already metastatic, systemic progression is the deadliest threat to these patients, so systemic therapy is most important. It will help select out patients with favorable biology that may benefit from aggressive local treatment. The trial that showed a PFS benefit sequenced system...