Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In patients with Stage 0 CLL who are clinically doing well and don't warrant treatment, do you typically obtain the CLL FISH Panel and p53 status?
I do a baseline CLL FISH Panel and p53 status on new patients with stage 0 CLL, less for determining treatment options at the moment, and more for an idea of their natural history. For patients with del17p or 11q, I may monitor more closely than patients with a more predicted indolent course.
In patients with Stage 0 CLL who are clinically doing well and don't warrant treatment, do you typically obtain the CLL FISH Panel and p53 status?
I do a baseline CLL FISH Panel and p53 status on new patients with stage 0 CLL, less for determining treatment options at the moment, and more for an idea of their natural history. For patients with del17p or 11q, I may monitor more closely than patients with a more predicted indolent course.
Would you offer empiric lung SBRT for two growing FDG-avid lung lesions in a patient with severe COPD on oxygen?
This is a good question! The short answer is yes, most likely. Many patients are too high-risk to receive biopsies; this is decided by surgery/pulm/IR. Unless the patient has contraindications to RT or something like severe IPF (where treatment may be worse than the disease), I would likely offer th...
Under what circumstances do you consider an enbloc resection versus biopsy for a lower lumbar spinal column tumor?
Typically, a biopsy is performed prior to en bloc resection rather than “either or.” A biopsy is necessary if there is a differential diagnosis based on imaging, and if the diagnosis will affect management: radiation and chemotherapy alone vs. intralesional resection/debulking and adjuvant therapy v...
Would you consider daratumumab monotherapy as standard of care for smoldering multiple myeloma based on the AQUILA trial?
AQUILA is out! There MIGHT be a survival advantage (p<0.05) to early intervention, but to avoid p-hacking all we have now is a healthy hazard ratio and a confidence interval that juts right up to 1 - it was 0.97. If a patient meets the criteria for this trial, considering Dara makes some sense. I do...
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
What adjuvant therapy would you offer a postmenopausal woman with a new pT2N0 HR+/HER2+ breast cancer primary who is concurrently being treated with anastrozole/ribociclib for well controlled oligometastatic HR+/HER2- disease?
It is always disconcerting when a primary tumor arises in the context of already ongoing therapy. Presumably, this tumor is somewhat resistant. Firstly, I would add in anti-HER2 therapy (there is a broad range of options depending on the patient's details, ranging from single-agent trastuzumab to TH...
Is there greater efficacy of TPO-RA in patients who have undergone a splenectomy?
The clinical trials and real world studies do not suggest that there is a difference in efficacy in general based on splenectomy status. In my experience, I have found that a few highly refractory patients have some improvement in responses to treatment with splenectomy. I do not generally think of ...