Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?
For all patients, I begin by using a standard risk prediction tool to determine if the patient is appropriate for pharmacologic VTE prophylaxis. At our institution, the Padua risk prediction tool is embedded in our electronic health record/admission set. Clinical guidelines- including those from the...
How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?
According to the recent publication by Cabibbo G, et at, J. Hepatol. 2019, 71, 265–273, yes direct-acting antivirals after successful treatment of early hepatocellular carcinoma improves survival in HCV-cirrhotic patients. No such data or evidence for advanced disease though. in that case, antiviral...
How would you approach a patient with Stage III gastric cancer and poor performance status who had large residual disease (ypT4N1) after neoadjuvant capecitabine and was later found to be MSI-H?
We are flying in the "no data" zone here. The MATTERHORN study, led by Dr. Janjigian et al., is a global 948-patient study in which patients with resectable gastric/GEJ adenocarcinoma received perioperative FLOT +/- perioperative (neoadjuvant/adjuvant) durvalumab. The press release on 6/2/23 showed ...
Would you offer chemotherapy to an elderly patient with MSI-H stage 3 colon cancer who cannot tolerate oxaliplatin?
The current NCCN guidelines already incorporated the ATOMIC study data and added CAPOX or FOLFOX with atezolimumab in addition to CAPOX or FOLFOX as preferred regimens for resected dMMR stage III colon cancer, while still listing single-agent fluoropyrimidine as an option.The interesting part to me ...
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 ...
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 ...
In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?
This is a very difficult case- are you speaking of Ulcerative Colitis or Crohn's disease? If UC - can consider pouch but really depends on the stage of the primary rectal cancer. If neoadjuvant chemoradiation is given, the likelihood of an ileoanal J-pouch functioning appropriately is low. Generally...
How will you use Pola-R-CHP in the frontline treatment of DLBCL?
Given the comparable toxicity profile and the lower rate of treatment failure, the number needed to treat (n=16) is low enough that this is very appropriate to be the new standard of care. Although overall survival was not different, fewer patients treated with the Pola-R-CHP regimen required subseq...
How will you use Pola-R-CHP in the frontline treatment of DLBCL?
Given the comparable toxicity profile and the lower rate of treatment failure, the number needed to treat (n=16) is low enough that this is very appropriate to be the new standard of care. Although overall survival was not different, fewer patients treated with the Pola-R-CHP regimen required subseq...
Which neoadjuvant/adjuvant chemotherapy regimen would you select in a patient with resectable stage IB pancreatic head adenocarcinoma and MDS-SF3B1 on luspatercept (baseline Hgb of 8-9 g/dL)?
Seems a bit unfair that the patient has both! First, I would consider resection upfront to ensure this key step rather than risk additional complications of chemotherapy. Perioperative or total neoadjuvant therapy is not standard for resectable disease yet (pending Alliance trial result). Second, bo...