Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you send Oncotype Dx for a premenopausal patient with a pT2N0 ER/PR+ lobular breast cancer that was diagnosed during the first trimester of pregnancy?
This is a complicated question. I feel as though more information would be helpful. I will try to address specifics that I consider when managing such cases that I hope are helpful. Appreciate others' thoughts as well. First, how sure are we that this patient is N0? I cannot count the number of cli...
Do you give adjuvant chemotherapy to a patient with a completely resected mediastinal pure seminoma?
There will never be “evidence based medicine” to answer this query. If this was known to be a primary mediastinal seminoma, he would have initially received standard chemo for good risk disease, preferably BEP X 3 if under age 50. In my opinion, that would have been preferred over radiotherapy. Argu...
How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?
I would probably also check a 24 hour urine protein electrophoresis with immunofixation to evaluate if any significant and measurable monoclonal proteinuria that would make me more worried about SMM, MGRS, or amyloidosis. Would check urine protein/creatinine ratio to evaluate protein excretion for t...
Are there effective adjunct therapies to relieve tumor flare pain from tamoxifen in the metastatic setting?
The current understanding of tamoxifen flare - could be explained by two mechanisms. One simply induces the necrosis of the tumor by inducing a cytotoxic response. Two, it can actually induce the estrogen mimic phenomenon - which can enhance the metabolism of the tumor itself (or metastatic site). ...
Would you order an OncoType DX test on a <50 year old woman with T2 N1mi HR+ HER2- breast cancer?
Yes. The patient will need chemotherapy as per RxPonder Trial.
How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?
It depends on the DNA repair disorder.
Would you consider continuing a biologic for difficult to control autoimmune disease in a patient with a recent diagnosis of a surgically curable solid malignancy?
There continues to be relative uncertainty regarding the management of biologic therapy in these patients. As treating physicians, this scenario is not uncommon where a decision to continue or stop a biologic has to be made in face of solid malignancy. A detailed review of individual circumstances t...
What treatment would you recommend for a patient with multi-focal angiosarcoma involving the gastrointestinal tract?
My answer would differ for a primary cutaneous angiosarcoma that has spread to the GI tract vs a primary visceral angiosarcoma. Outside of a clinical trial, for a young fit patient with a primary cutaneous angiosarcoma, taxane based chemotherapy would be my preferred option, usually weekly paclitaxe...
How would you treat a patient with low burden metastatic renal cell carcinoma that progressed on cabozantinib who is not a candidate for immunotherapy?
For patients with low volume mRCC and a slow growth rate, I favor treatment with an oligiometastatic disease paradigm. The definition of oligo- disease is not standardized though a numerical cutoff of 5 or fewer metastasis is widely used. It is important to understand that biology is the most critic...
What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?
Treatment of early stage or locally advanced stage NSCLC truly requires a cohesive multidisciplinary team and consistent messaging. Many, if not all, of these cases should be discussed prospectively at a multidisciplinary tumor board. It is also important to set expectations with patients up front a...