Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?
I would approach this scenario by considering two main issues. The first issue is what the probability of the patient truly having pN+ disease based on cN+ findings on advanced imaging. There have recently been two trials published from the Netherlands, PEPPER (using 68¸Ga-PSMA-11) and SALT (using 1...
How do you advise a patient with VTE on indefinite anticoagulants regarding the Ad26.COV2.S Johnson & Johnson/Janssen COVID vaccine?
The thrombotic events seen with the Ad26.COV2.S vaccine do not appear to be associated with a prior history of clotting events. It seems to be a different entity, similar to heparin induced thrombocytopenia, with clinical presentation of thrombosis and thrombocytopenia. Muir et al., PMID 33852795The...
How would you treat refractory unresectable pulmonary metastases in high grade synovial sarcoma?
Unfortunately, the outcomes for patients described in this vignette are dismal. Complete pulmonary metastasectomy seems to be the most effective treatment for long-term survival in selected patients but this is usually only achievable in the setting of oligometastatic disease. In the largest series ...
Can adjuvant nivolumab for bladder CA as per Checkmate 274 be extrapolated for the concurrent chemoRT bladder preservation setting?
Great question. Short answer is no. Different scenario and very hard to extrapolate from the adjuvant post radical cystectomy setting. We need dedicated bladder preservation trials, e.g. S1806 and Keynote992. Recommend to accrue in those 2 large phase III trials for patients who opt for bladder pres...
What would you recommend as a subsequent therapy for patients with ROS-1 gene re-arrangement after progression on crizotinib?
Clinical trial (entrectinib, repotrectinib) or lorlatinib
When would you consider neoadjuvant immunotherapy for advanced melanoma?
Neoadjuvant immunotherapy is a reasonable if investigational approach to melanoma. The role of neoadjuvant therapy as an investigative approach lies in its ability to give both efficacy information and Biomarker information. We have published encouraging results with interferons 12 years ago, (Mosch...
What imaging surveillance do you do after SABR of oligo lung metastases?
Since these are metastatic patients I would recommend chest CT scans every 3-4 months for the first and second years. Abdomen and pelvis CT scans could also be done depending on the patient and their disease. I do not recommend PET-CT after SBRT for lung metastases or after SBRT for lung primaries. ...
What are your recommendation for vaccines in patients while on immunotherapy?
It's ok to give.
What is the role for maintenance lenalidomide in elderly patients with DLBCL?
The REMARC study was a phase III trial of maintenance with lenalidomide versus placebo in patients aged 60-80 years old who were in a PR or CR after RCHOP for newly diagnosed DLBCL (Thieblemont et al. JCO 35:2471-2481, 2017.). The results of this large study (650pts) with a median follow up of over ...
Does isolated del(5q) have the same prognostic implications for post-PV secondary myelofibrosis as it does in MDS?
Karyotypic abnormalities are rare in PV and ET. Abnormalities in myelofibrosis (MF) that are associated with an inferior prognosis are: 20q-, 13q-, +9, chromosome 1 translocation/duplication, -Y or sex chromosome abnormality other than –Y. There are few reports of del5q in MPN in general and not eno...