Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any role for neoadjuvant chemotherapy in renal leiomyosarcoma?
Contributing factors in this decision would include size, feasibility of organ preservation, and patient's PS/organ function. The regimen with some activity would include the combination of doxorubicin and dacarbazine.
For patients with myeloma on an IMiD, how do you decide on the dosages of aspirin or anticoagulants in VTE prophylaxis ?
The phase III trial by Palumbo et al., PMID 21282540 is still the only prospective randomized trial of VTE prophylaxis in MM with "standard" thromboembolic risk patients eligible for IMiD treatment. In this study, administration of 40 mg enoxaparin was compared with fixed dose of 1.25 mg warfarin...
Would you consider addition of docetaxel to abiraterone and ADT in metastatic hormone senstive prostate cancer patients who progress on ADT and abiraterone?
The question is incorrectly phrased, when a patient progresses on ADT and Abi they are not hormone sensitive. In patients with high risk metastatic prostate cancer, I would not add docetaxel to abi and ADT yet as OS data has not matured. However, I do sequence them in a select group of high risk pat...
Would you treat a patient with non-clear cell renal cell carcinoma with nivolumab and ipilimumab?
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
For perihilar cholangiocarcinoma that has been deemed unresectable by hepatobiliary surgeons, a good consideration is to have the patient evaluated for liver transplantation. The Mayo Clinic protocol allows tumor mass of <3cm, no nodal disease, and vascular involvement is allowed. Depending on the f...
How does the updated classification system of gliomas impact your recommendations for radiation?
Minesh Mehta and @Dr. First Last, Miami Cancer Institute In 2021, the World Health Organization (WHO) introduced significant new changes to the classification of tumors of the central nervous system (CNS) in their 5th edition (WHO CNS5) (Louis et al., PMID 34185076). This step was the first of many ...
For metastatic prostate cancer, when would you add carboplatin to docetaxel or cabazitaxel?
There is no clear consensus on this topic. However, I consider carboplatin plus docetaxel or cabazitaxel in men with the following features who are fit for chemotherapy and wish to be aggressive in their care, based on Paul Corn's MD Anderson trial (PMID 31515154): Aggressive variant phenotypic feat...
For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?
In this scenario, I prefer zoledronic acid every 3 months with renally adjusted dose. In my experience, the risk of hypocalcemia seems higher with denosumab. Calcium/vitamin D supplementation would be important as well. The every 3 month dosing is an advantage over denosumab, which would have to be ...
How do you approach adjuvant comprehensive breast or chest wall RT for locally advanced breast cancer on a CDK 4/6 inhibitor?
Prospective data in this setting is limited. Retrospective and preclinical data with palliative RT and CDK 4/6 inhibitors have shown mixed results, with some showing skin and lung toxicities and others not. Adjuvant trials allowed concomitant use, but have not reported separately. My bias for PMRT i...
How do you manage drug-induced thrombocytopenia when the implicated drug is essential?
I feel obliged to answer this one as a question of medical sociology as much as a direct medical question, because "essentialness" is nearly always in the eye of the beholder, and I have not personally been in the position of the hematologist who has to confront this question with an interventional ...