Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage trastuzumab emtansine peri-operarively?
T-DM1 hasn't been shown to impair wound healing, etc. The biggest concern would be simple thrombocytopenia, so I just check CBC prior to the surgery and try to have that scheduled and the week 2 or 3 point after treatment where plts are less likely to be affected. I am assuming this question refers ...
In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?
I am not aware of any direct clinical evidence that addresses this question. That said, I would be very reluctant to treat with G-CSF in the setting of HLH. G-CSF is an inflammatory cytokine that might aggravate HLH. Moreover, since the mechanism of neutropenia in HLH is thought to be increased neut...
How would you approach synchronous early stage NSCLC adenocarcinoma and locally advanced symptomatic squamous head and neck cancer that is deemed nonresectable upfront?
I would appropriately stage both cancers. If there is no mediastinal involvement, and head and neck is locally advanced- would favor local treatment of lung cancer (surgical or SBRT- expect quick recovery and no delays) while planning for concurrent chemo radiation to head and neck. Further details...
What factors do you look at while deciding between a daratumumab-based quadruplet induction versus standard triplet induction such as VRd for newly diagnosed MM?
This is becoming an increasingly thorny issue. A few guidelines to keep in mind:1) Dara-VRd has only been studied (thus far) in transplant-eligible patients. So this discussion of Dara-VRd vs. VRd is hard to apply to patients without intent for transplant. 2) When you look at the CASSIOPEIA and GRIF...
What adjuvant therapy would you recommend for a T3N0, grade 3, undifferentiated sarcoma of the mandible with positive margins that is not amenable to re-resection?
From a radiation standpoint, I would offer adjuvant radiation therapy. Given positive margin, would image to make sure no gross disease. If microscopic positive margin, I would go to 66-70 Gy.
How would use of adjuvant pembrolizumab after nephrectomy for ccRCC impact your treatment choice for metastatic recurrence?
I think treatment selection after recurrence/metastases will depend on the timing after adjuvant pembrolizumab has been completed. If it's about 9 months or more, I think re-challenge with pure IO/IO combination is fair, especially if a patient tolerated pembrolizumab well. If it's within 3-6 months...
In what setting would you omit neoadjuvant radiation in favor of neoadjuvant chemotherapy alone for a T3N0 upper rectal adenocarcinoma?
The benefit of radiation for clinically staged T3N0 upper rectal cancers is unclear. Overall, the benefits of neoadjuvant radiation seem to be for lower rectal cancers. The main concern, in this case, is that clinical staging may underestimate pathological staging, as benefit from (neo)adjuvant radi...
What is your strategy to help prevent paclitaxel-related neuropathy?
There are no proven strategies for prevention of CIPN and the use of these supplements is not recommended. Some supplements such as acetyl carnitine can actually worsen neuropathy outcomes and some supplements such as B12, vitamin C, and others may negatively interact with chemotherapy and worsen di...
Would you offer adjuvant chemoRT to a patient who underwent neck dissection for a T0N1M0, p16+ head and neck squamous cell carcinoma?
Yes. At least the RT. Chemo would depend on the extent of neck disease. Multiple nodes and/or level 4, add chemo.
At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?
In a patient with ITP, I would certainly feel comfortable dosing aspirin 81mg daily at a platelet of 50,000 or greater. As you know, the risk of bleeding in a patient with ITP is less than would be expected at a particular platelet count because the circulating platelets in ITP are young and large. ...