Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an SCLC patient who manifests a bona fide etoposide allergy on cycle two day one?
Perhaps consider desensitizing; other options include trying irinotecan or paclitaxel in place of Etoposide.
For metastatic colorectal cancer, is it possible for the tumor to be mismatch repair proficient at primary site but mismatch repair deficient at metastatic site?
This is a very interesting question, and most of the time we think the MSI/MMR status between the primary site and the metastatic lesion is consistent. However, some studies suggest there could be some inconsistent results in colorectal cancer patient. In a small study with 40 metastatic colorectal ...
Due to the thrombotic nature of COVID-19, should we be discontinuing tamoxifen temporarily in patients with an active infection?
It is not clear (at least to me) what the thrombogenic potential of COVID-19 is, or in what settings it manifests (i.e., hospitalized patient with an increasing O2 required or intubated, in which there are some preliminary reports, versus the asymptomatic or minimally symptomatic patients). It seems...
What is your TKI preference in patients with chronic phase CML on hemodialysis?
When choosing a TKI for patients on HD, it's important to know that TKIs are unlikely to be dialyzed. TKIs are mainly eliminated via the feces with small amounts eliminated by the kidneys. TKIs with the least amount of renal elimination theoretically should be preferred. Nilotinib and bosutinib have...
How would you approach a patient with T1aN1 breast cancer when the ER/PR/HER2 status cannot be determined by IHC?
This situation is unusual. Was the 2mm on the diagnostic biopsy and no other cancer found on the resected specimen? I would wonder if there is another undetected invasive component still in the breast if they did a lumpectomy and slnb. If the 2mm focus was depleted for IHC, I would try to test recep...
How would you approach giving concurrent chemoradiation for Stage IIIB lung adenocarcinoma in the setting of concurrent Int-2 myelofibrosis which has been stable without cytopenias on ruxolitinib?
That is certainly a rock and a hard place. At this point, it seems as though the lung CA would be the most pressing issue. If the MF is asymptomatic (cytokine related symptoms, there are minimal spleen-related symptoms and there are no cytopenias), I would not start any treatment for the MF until th...
How do you treat metastatic adenocarcinoma of the ampulla of Vater?
True adenocarcinoma of the ampulla of Vater is an extremely rare cancer of the GI tract (<5 pts per million). Consequently, data is mostly derived from retrospective studies or large databases with few clinical trials available, especially with locally advanced and metastatic disease. I personally h...
Would you offer immunotherapy for a patient with a history of kidney transplant on immunosuppression who has clear cell RCC in the native kidney?
While data to address this question remains retrospective in nature, a number of small series suggest a very high solid organ rejection rate (37-41%) and worrisome morality rates in the 40+% range. Fully understanding the potential for survival benefit from ipi/nivo or pem/axi, I would be inclined t...
How would you treat Burkitt Lymphoma during an uncomplicated pregnancy?
For many malignancies, therapy in a pregnant woman can wait until delivery of the child. However, this is not possible in Burkitt's lymphoma, due to its repaid growth rate. After the first trimester, it is relatively safe to give most chemotherapies. However, severe neutropenia with risk of more sig...
Would you continue pembrolizumab in an asymptomatic metastatic NSCLC patient with high PD-L1, who develops granulomatous mediastinal lymphadenopathy biopsy proven as sarcoid?
Sarcoid-like granulomatous reactions have been described with checkpoint inhibitors. It is important to diagnose them when they occur, in order to not confuse these findings with disease progression, especially in a patient with lung cancer. I have had two patients at least show growing mediastinal ...