Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?
Great question. This comes up often. For males, they can continue to take their CML TKI and conceive a child. Of course, this is much more complicated for women as they should not be pregnant while taking a TKI. I would say that if the patient is having difficulties conceiving, he should undergo a ...
Would you consider avoidance of AC and proceeding to surgery in a cT2N0 TNBC patient who achieves a significant clinical response to carboplatin, paclitaxel, and pembrolizumab as part of the KEYNOTE-522 regimen?
Full disclosure -- I trained in breast cancer at UCLA, where we generally avoid anthracyclines. The main downside of adding an anthracycline to a taxane-based regimen is the elevated risk of leukemia, myelodysplasia, and congestive heart failure or weakening of the heart long-term. I use neoadjuvant...
How do you approach borderline non-regional mediastinum lymph nodes when treating locally advanced esophageal cancer?
I basically consider any nodal disease in the mediastinum from esophageal cancer to be operationally regional disease and would include those areas in the radiation fields if feasible. The comment about the nodes being borderline positive is an ambiguity that cannot be resolved in a forum like this....
What schedule and type of antiemetics do you provide for patients receiving PCV for co-deleted oligodendrogliomas?
I give 16 mg ondansetron and 20mg dexamethasone one hour prior to CCNU/lomustine on day 1 and then 8mg dex on days 2 and 3. I do always prescribe ondansetron q8h as needed and give them compazine to have as well, as needed, q6h. I've honestly had most patients not need anything further, but if they ...
Which patients with resectable Stage IB-IIIA NSCLC would most benefit from using neoadjuvant chemoimmunotherapy as per CheckMate 816?
CheckMate 816 enrolled patients with EGFR/ALK wildtype stage IB (>/= 4cm) through IIIA NSCLC, with recent approval from FDA based on improved event-free survival endpoint as well as pathologic complete response rates seen with the combination chemoimmunotherapy compared with standard chemotherapy al...
Would you give ADT + docetaxel -> darolutamide for a low risk castrate sensitive metastatic prostate cancer patient given ARASENS results?
ARASENS was designed during the era of docetaxel plus ADT emerging as the standard of care for men with mHSPC irrespective of disease volume, based on the improved OS observed in STAMPEDE for a largely de novo mHSPC patient population, where there was no heterogeneity observed for the OS benefit in ...
How would you manage a patient with essential thrombocythemia and persistent pruritus despite adequate control of CBC with hydroxyurea and aspirin?
First, I'd make sure to exonerate any other causes of itching. Second, would make sure that supportive treatments like good skin care, anti-histamines, anti-depressants have been tried. I'd then consider if this patient truly has ET, as itching is more common in PV. Ruxolitinib is approved for patie...
Which cisplatin regimen is preferred for concurrent chemoradiation for definitive treatment of muscle invasive bladder cancer?
I tend to use 35 - 40 mg/m2 once weekly, ideally on Mondays (I think that SN1806 is using 35 mg/m2 weekly).
Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?
Yes, very commonly. The traditional thought is that histological architecture is needed to diagnose lymphoma. However, with flow-cytometry, we can diagnose all types of NHL. We always try to get a lot of aspirations (more than 7-10 passes) from the lymph nodes or mediastinal masses to prepare a good...
Do you stop PPI when starting patients on immunotherapy?
Proton pump inhibitors (PPI) are commonly used in cancer patients and may affect the gut microbiome by altering gut pH. The gut microbiome plays a critical role in modulating the therapeutic effects of immune checkpoint inhibitors. PPI use in patients treated with immunotherapy has been associated w...