Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider using HMA in management of polycythemia vera?
The short answer is no. However, it depends on what is going on with the patient and what is meant by refractory? If one is managing symptomatic PV or trying to control counts then hydroxyurea, pegylated interferons, and ruxolitinib are the available options and it is worth mentioning that ropeginte...
In a patient with metastatic HER2 positive breast cancer who has received prior TDM1 in the adjuvant setting for residual disease, would you consider reintroduction of TDM1?
I would consider re-introduction of TDM1 in the subsequent line setting for metastatic, HER2 positive breast cancer as long as disease free interval between completion of TDM1 and breast cancer relapse is has been long enough. I typically think of 1 year or longer between relapse and completion of a...
Is there any role for adjuvant atezolizumab or adjuvant osimertinib in patients who received neoadjuvant chemotherapy for resectable NSCLC?
Most of the neoadjuvant studies using either immunotherapy or targeted therapy before surgery have continued the therapy after surgery in responders. For IO, this has generally been 1 year. For targeted therapy, it may be as long as 3 years.
Are there scenarios in which you would add nimotuzumab to cisplatin based concurrent chemoRT to treat locally advanced head and neck cancer?
Personally, I would not use the combination of nimotuzumab and cisplatin with RT since it is not FDA approved in the United States. There is data to support the combination might be beneficial for patients with locally advanced SCCHN. However, the drug is not commercially available, and most insuran...
Would you recommend adding Debio 1143 to high-dose cisplatin chemoradiotherapy in high-risk locoregionally advanced squamous cell carcinoma of the head and neck?
At this point, I will still refer LAHNSCC patients to the phase-3 clinical trial randomizing patients to placebo vs Debio-1143.
How would you approach a patient with newly diagnosed hepatocellular carcinoma with very high AFP (>100,000) but no clear radiographic evidence of metastatic disease?
This is a challenging situation. Oftentimes, these patients have significant vascular involvement of their tumor. AFP has been shown to correlate with survival and those with markedly elevated (>100,000) have a very poor prognosis (REACH, REACH2, Zhu et al., PMID 33531690). If a patient has known HC...
How long do you give systemic therapies or skin directed therapies to work before changing treatments in patients with diffuse skin limited mycoses fungoides?
It really depends on the patient, the side effects profile. Some systemic therapies are “skin directed” like bexarotene. Also, access to a dermatologist's office for nbUVB is an important factor in making such a decision. I generally don’t recommend topical agents when there is more than 10% eBSA sk...
Would you avoid cisplatin with etoposide in a patient getting chemoradiotherapy for stage III non-squamous NSCLC who has a history of CABG 4 years ago and echocardiogram showing left atrial dilatation?
In short, I would avoid cisplatin here. The main issue with cisplatin is the need for fairly aggressive hydration to avoid nephrotoxicity. Generally, at least 1-2 L IV NS hydration is given, however, some will give up to 3L, in addition to the volume infused with actual treatment (usually diluted in...
Do you routinely offer doxycycline or minocycline prophylaxis for cutaneous reactions to EGFR inhibitors such as cetuximab?
When we use EGFR inhibitor for colorectal cancer, we routinely use the STEPP regimen that showed significant benefits in the phase II study including skin moisturizers, sunscreen, topic steroids, and doxycycline. In the phase II STEPP study, using this pre-emptive treatment significantly decreased s...
What is the role of splenectomy versus systemic therapy in splenic marginal zone lymphoma?
With the introduction of rituximab and other CD20 monoclonals, the role of splenectomy in splenic marginal zone lymphoma is shrinking. There are rare clinical scenarios where I would still recommend splenectomy in splenic marginal zone lymphoma; huge splenomegaly with disabling symptoms, splenic tra...