Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you alter your surveillance plan after achieving local control for patients with breast CA with locoregional recurrence given the higher risk of distant recurrence?
The data regarding best surveillance strategies for patients with locoregional recurrence is limited. Patients who recur with extensive locoregional involvement but are salvaged with systemic and local therapies are at very high risk of relapse. Therefore, for such patients, I am leaning towards sur...
How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Agree with Dr. @Dr. First Last. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
What gemtuzumab regimen and schedule (with standard 7 plus 3) would you use for a newly diagnosed AML patient with favorable genetics?
Per the ALFA-0701 trial, we administer GO (3 mg/m2, capped at 4.5 mg vial) on days 1,4, and 7 of induction therapy with 7+3.
Under what circumstances would you consider outpatient induction for AML?
At some centers, I know that induction with venetoclax and azacytidine/decitabine/low dose cytarabine or liposomal cytarabine/daunorubicin (CPX-351) for patients with newly diagnosed AML has been administered in the outpatient setting. However, in these centers (such as Moffitt Cancer Center), there...
How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?
Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
I would start RT if it means you're going to risk delaying RT start window. Another question is, why are you giving Erbitux for post-op treatment? Can you use another agent?
How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?
I advise patients that there remain many unanswered questions regarding these side effects that will be resolved with longer term use with these agents. Shared decision-making is critical for these discussions. Data available from current extensions of clinical trials for JAKi, additional risk facto...
Is tumor deposit (N1c) alone an indication for adjuvant chemoRT for rectal cancer that did not receive neoadjuvant therapy?
Some patients such as this were undoubtedly included in the early rectal cancer trials [GITSG and Mayo North Central (NCCTG)] that established the role of post-operative chemoradiation for stage II and III rectal cancer. However, accrual numbers were too small for stratification of TN subsets and it...
How do you manage ALK-inhibitor AEs which are low grade but significantly impact patient QOL over time?
How to manage ALK directed therapy adverse events that are low-grade but significantly impair quality of life remains a challenge. Some of these adverse events include fatigue, nausea, rash, and loss of appetite. More often than not, these side effects are not pronounced but over time can impair qua...
How do you approach a patient with discordant mutation testing in liquid vs tissue biopsy for mNSCLC?
The recent advent of liquid biopsy testing for patients with advanced non-small cell lung cancer has generated a tremendous amount of enthusiasm and has altered the diagnostic algorithm for patients. We now have data that shows that liquid biopsies are reliable, are accurate, and can inform treatmen...