Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your first line treatment of choice for advanced (stage IIIA) follicular lymphoma, histologic grade 1-2 in an otherwise young healthy patient in 2019?
When do you offer consolidative tandem autologous stem cell transplantation for high-risk multiple myeloma?
This is a great deal of debate regarding the question of tandem transplant. In the original IFM 94 study, only patients not achieving a VGPR benefited from a tandem transplant. However, that was in the era of pre-novel therapies. More currently, the BMT CTN 0702 (STAMINA) trial did NOT show a benefi...
Is there a role for ruxolitinib in essential thrombocythemia?
There have been two larger publications supporting the use of ruxolitinib in ET. However, it is only useful in certain situations after standard therapies like hydroxyurea and pegylated interferon. Certainly, if a patient is symptomatic with cytokine-related symptoms, heading towards post-ET MF, or ...
When do you consider upfront surgery for locally advanced (T4) sinonasal CA?
I usually favor upfront induction chemotherapy for the unresectable cases or if upfront surgery has the risk of unacceptable morbidity. We then evaluate the role of surgery based on histology. For most histologic sub-types of sino-nasal malignancy, we favor primary surgical resection (salivary gland...
What would be your next treatment in a postmenopausal woman with metastatic ER+ lobular cancer with progression on palbociclib/letrozole with multiple liver metastasis?
I will assume this patient achieved median PFS and DOR as seen in first line studies with AI/CDKi prior to her progression. Some options for next line treatment include:1) Fulvestrant single agent2) Fulvestrant + everolimus / Exemestane + Everolimus3) Fulvestrant + alternate CDKi (preferably on tria...
How do you choose between adjuvant PCV vs temozolomide in high risk oligodendroglioma with IDH mutation and 1p/19q co deletion?
In our practice, we typically offer procarbazine/lomustine (with or without vincristine) to all patients with high risk oligodendroglioma, IDH mutated, 1p/19q codeleted. Temozolomide based on the Stupp regimen is used as an alternative when there are specific concerns for PCV related toxicity or str...
Would you recommend EBRT/brachythrapy for any patients with stage III- IV uterine ca in light of GOG-258 data?
GOG-258 will certainly change management approach. The recurrence pattern between the two arms (higher distant mets in chemo RT arm and higher locoregional recurrence in chemo alone arm) suggests that sequencing of treatment may also matter. Our current approach is to have chemotherapy first and con...
Which patients with metastatic hormone sensitive prostate cancer would you treat with enzalutamide or apalutamide (instead of abiraterone or docetaxel)?
Current studies in mHSPC combining docetaxel or abiraterone or enzalutamide or apalutamide suggest that the standard of care for patients who present with de novo high volume metastatic disease has now changed from single ADT (gonadal androgen suppression) to one of the combinations. At this point i...
Which patients age < 50 with OncoType score < 11 do you offer ovarian suppression?
For T1-2N0 very low risk disease the TAILORx data demonstrated a less than 5% risk of distant recurrence regardless of clinical risk. (Sparano et al NEJM 2019) The majority of premenopausal were given tamoxifen alone. The absolute difference between tamoxifen and OFS/AI in such a low risk group woul...
Is immunotherapy the next best option for a patient with metastatic translocation-associated renal cell carcinoma (TFEB rearrangement) after progression on 1st line sunitinib and 2nd line everolimus/lenvatinib?
One of the challenges we all deal with every day is making clinical decisions in the absence of real evidence to guide us. Translocation-associated renal cell carcinoma (TFEB rearrangement) is of course a very rare entity and any inference regarding response or lack-thereof to any therapeutic interv...