Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
What is your approach to mitigating the infection risk with bispecific antibodies in multiple myeloma?
As of June 2023, anybody who says they have a definite answer to this is misleading you. We are unfortunately learning as we go, and LOTS of loose ends to be tied up. I'd argue everybody in this setting should already be on universal VZV prophylaxis (e.g., acyclovir), and I'd also argue that most of...
When treating an intact whole breast with hypofractionated radiation, how do you approach boost dosing in the case of a close margin?
In the Plenary session of the 2012 San Antonio Breast Cancer Symposium, Dr. John Yarnold reviewed all of the updates of the UK START and Royal Marsden HFRT trials and discussed the fact that 40 Gy in 15 fractions had become the standard for the UK's National Institute for Health Care and Excellence ...
Can you give Pluvicto with concurrent palliative EBRT?
Short answer: Yes, you can, and I do not modify my dose. I have no issues with this and have done it multiple times for patients who need more immediate symptom relief (pain, bleeding, etc.).Why? Because Pluvicto is a medium energy isotope with a relatively short path length of around 2 mm. Even nea...
Would you radiate the thoracic duct for bilateral chylothorax in a hematologic malignancy with no discrete adenopathy?
We have done for adenopathy, which relieves obstruction and thus helps with drainage, but we don’t know how it would help in this situation.
Would you radiate the thoracic duct for bilateral chylothorax in a hematologic malignancy with no discrete adenopathy?
We have done for adenopathy, which relieves obstruction and thus helps with drainage, but we don’t know how it would help in this situation.
How are you approaching patient selection and timing of RNA-based NGS, in light of the approval of zenocutuzumab for NRG1 fusion–positive advanced cholangiocarcinoma?
My standard has been to do all DNA, RNA, and IHC through a single vendor. I test all newly diagnosed patients with cholangiocarcinoma. I always do tissue and liquid biopsy NGS. If tissue biopsy is not feasible because of sample quantity/quality, then another biopsy will be the way to go to obtain, e...
Would you add immunotherapy to FOLFOX if the patient is not a FLOT candidate for neoadjuvant gastric cancer, extrapolating data from the MATTERHORN study?
While it is always somewhat perilous to extrapolate from a proper study to lesser situations, this seems quite reasonable. It seems highly unlikely that the removal of Taxotere from a fluoropyrimidine-oxaliplatin-based regimen would render immunotherapy less effective in gastric cancer. In the MATTE...
In which patients do you utilize a breast MRI as part of the initial workup for breast cancer?
I'm not a fan of routine MRI in the work-up for early-stage breast cancer, but I do agree with the fairly standard list of selective indications mentioned previously. I also obtain an MRI when there is a significant discrepancy between standard imaging and physical exam. Examples would be: One or a...
Do you check LDH levels for patients with CLL who are asymptomatic and on surveillance?
I personally include LDH as part of my routine chemistry panel monitoring of CLL in surveillance for several reasons. Often, patients with CLL can show up with new anemia; in such cases, the differential diagnosis is autoimmune hemolytic anemia versus disease progression. An elevated, new LDH level ...