Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you check IGHV mutation status in patients with newly diagnosed CLL?
Yes. In the targeted therapy era, there are three factors that continue to have prognostic and therapeutic significance and should be checked: IgHV mutation status p53 aberrancy - requires both FISH for del17p AND mutation analysis for p53 Complex karyotype - can be done on peripheral blood or marr...
What adjuvant chemotherapy would you recommend in an elderly patient with resected stage III colon cancer with MMR deficiency with MLH1 promoter hypermethylation?
This is a great question and actually a quite common situation we see in the clinic. Majority of the dMMR colorectal cancer is actually due to MLH1 promotor hypermethylation (about 75% of all dMMR colorectal cancer) while a small portion of dMMR colorectal cancer is due to Lynch syndrome. These pati...
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
Is there any indication for IVIG in immunocompromised patients with only decreased IgM and/or IgA levels?
Nope. IVIG preparations contain IgG not IgA or IgM. Low serum IgA may or may not be associated with low IgA levels in mucosal surfaces leading to a risk of local infections. Low levels of one or both may be asymptomatic but in the right setting might suggest a need for evaluation of plasma cell dysc...
What GDMT do you recommend for patients with AL amyloidosis and systolic heart failure?
You are correct that cardiac amyloidosis patients do not tolerate most of the GDMT. SGLT2i may be helpful for both diuresis as well as HFpEF, and we do try to start this. Generally, they do not tolerate ARB/ACEI or even beta blockers. We find that torsemide seems to have better GI absorption and thu...
What GDMT do you recommend for patients with AL amyloidosis and systolic heart failure?
You are correct that cardiac amyloidosis patients do not tolerate most of the GDMT. SGLT2i may be helpful for both diuresis as well as HFpEF, and we do try to start this. Generally, they do not tolerate ARB/ACEI or even beta blockers. We find that torsemide seems to have better GI absorption and thu...
What adjuvant treatment would you offer a patient with adenocarcinoma of the mid-esophagus cT2N0M0 who underwent upfront esophagectomy, which showed T2N1 disease with negative margins?
Unfortunately, it's not an uncommon situation for patients to be upstaged following surgery without prior preoperative chemotherapy. This is because imaging modalities and even endoscopic ultrasound have limited sensitivity for detecting lymph node metastases.A related issue is whether patients with...
What are your top takeaways in thoracic cancers from ESMO 2025?
I think that the data regarding Sac-TMT vs. frontline platinum chemotherapy was the most impactful data. With all of the caveats of a China-only study, this is the first time that we have seen an ADC demonstrate a survival advantage in this setting. The other two presentations are less novel, but t...
In general, how do you manage patients with early-stage endometrioid endometrial cancer who have concomitant POLE and TP53 mutations?
Based on published outcome data, double mutation is uncommon, and the outcome is driven by the better of the two mutations. So in the above situations, POLE type and not TP53 type will drive outcome and treatment decisions. That’s why in molecular-based decisions, it is important that the POLE type ...
Similar to the HFA-ICOS risk stratification tool for patients on chemotherapy, are there cardiac risk calculators available for use in patients starting immunotherapy?
No, there are no cardiac risk calculators for patients starting on immune checkpoint inhibitors (ICI). This is primarily because, aside from the use of dual immune checkpoint inhibitor therapy, we have not identified risk factors for ICI-induced myocarditis (Mahmood et al., PMID 29567210). Prior to ...