Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?
Yes, I use P2Y12 assays in two distinct settings. Medical management: If a patient on clopidogrel mono/dual therapy has disease progression with ICAD or experiences a recurrent ischemic event, I obtain a P2Y12 assay to assess responsiveness. This helps guide the decision to switch to ticagrelor and ...
How do you approach pathologic review and genomic testing, if indicated, of a spindle cell neoplasm?
Experienced sarcoma pathologists should review cases such as this. The rate of a change in diagnosis upon pathology review at a sarcoma center, after an initial review by a general pathologist, is surprisingly high (Ray-Coquard et al 2012, Annals Oncol). Unless there is a specific diagnostic concern...
Given the 10-year outcomes of UK FAST-Forward presented at ESTRO, how have you expanded the use of ultra-hypofractionation in your practice?
We offer 5 fractions to all early-stage breast cancer patients. If technically suitable, the preferred option is APBI; otherwise, FAST-Forward 26 Gy in 5, ensuring dose homogeneity as specified in the protocol.
How do you approach the discussion about the potential risks of radiation therapy exposure and the development of secondary malignancies for patients with germline BRCA1/2 mutations?
It appears that the risk of secondary malignancies due to radiation exposure does not seem significantly enhanced in gBRCA-m carriers, unlike patients with Li-Fraumeni syndrome (for whom we would attempt to avoid radiation). The data on mBRCA-associated breast cancers would suggest that radiation is...
In patients with muscle-invasive bladder cancer, in what clinical scenarios would you consider neoadjuvant cisplatin-based therapy in light of emerging data on enfortumab vedotin plus pembrolizumab?
Of course, we are still awaiting FDA approval of EV + Pembro in the cisplatin-eligible population, but the data from KEYNOTE-B15 presented at ASCO GU 26 are overwhelmingly positive. KEYNOTE‑B15 (EV‑304) was a randomized phase III trial in 808 cisplatin‑eligible patients with muscle‑invasive bladder ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...
Is it reasonable to treat a solitary plasmacytoma of the lung parenchyma with SBRT?
I have only treated one patient with solitary plasmacytoma of the lung over the past 15 years of doing lung SBRT. It is an extremely rare and unusual disease presentation for myeloma. Given the radiosensitivity of myeloma, I opted for 30 Gy in 5 fractions, which resulted in a completed response in t...
How do you approach a patient with indolent, small-volume, but slowly progressive lung mets from sarcoma?
If small volume without active extrapulmonary disease and amenable to addressing all lesions with SABR, surgery, or a combination of both, I would target all lesions with local therapy. If the above conditions are met, these can often be monitored closely with q3-6 month CT surveillance in the prese...
Under what circumstances would you start steroids for a patient with a new brain tumor prior to biopsy or resection?
Agree. As a corollary, if lymphoma is suspected, do NOT use steroids before diagnostic confirmation unless there are severe symptoms or significant mass effect. If steroids are unavoidable, diagnostic confirmation should be pursued within days due to the lymphotoxic effects of steroids decreasing di...