Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you chose the starting dose of capecitabine?
I never start or get to this dose. At best, US patients will tolerate 1,000 mg/m2 BID x14 days on/7 days off; younger patients typically have better tolerance. There are clear ethinic differences, with Asian patients tolerating this drug better than non-Asians. Western Europeans appear to have bette...
For pediatric patients with iron overload (high ferritin and transferrin saturation), do you perform HFE screening first, or proceed to non-HFE gene sequencing upfront to evaluate for HJV mutation as well?
Because there is no recommended "screening" scenario for iron overload in pediatrics (especially with no family history), the question for me revolves around "why did the patient get tested in the first place?" If it were a routine screen for iron deficiency, which affects millions of children at an...
Are you incorporating TTFields into treatment protocols for locally advanced pancreatic cancer based on the PANOVA-3 study?
Most medical and radiation oncologists I have spoken to believe that TTFields offer benefit based on the PANOVA-3 trial and support routine use once it is FDA-approved. One of the outstanding questions relates to the use of definitive radiation therapy, which was not included in either arm, but is a...
How do you manage perioperative anticoagulation for a patient with a history of recent, surgically provoked VTE?
In most cases, bridging is rarely indicated because the bleeding risk usually outweighs the risk of VTE recurrence during a short (1–2 day) interruption of anticoagulation. However, after a recent VTE (defined as <3 months), the estimated risk of VTE recurrence is high (>15–20% per year) (still low ...
Are there patient populations in whom you would consider using both induction chemotherapy and maintenance pembrolizumab for a patient with locally advanced cervical cancer?
Would consider for patients with multiple pelvic and high pa bulky nodes where risk of distant mets is extremely high, with the goal to treat with systemic intent, and if good response and no mets, proceed to definitive chemo-RT.
What strategies can we use to help patients receiving Dato-DXd report symptoms earlier, with the goal of early intervention to prevent progression to higher grade side effects?
Educating and encouraging patients to report toxicities as early as possible is key to recognizing and preventing higher-grade toxicity. When feasible, having oncology nurse navigators/ancillary staff check in with patients during the first few cycles of treatment (C1D14 to C3D1) can be helpful, giv...
How do you approach systemic therapy for metastatic prostate cancer in geriatric patient when progressed to mCRPC on ADT alone?
This is an important question and requires a careful balancing of scientific and medical knowledge versus clinical skill. (1) The first key issue is the context of the question -- what is meant by "frail", what has caused the "frailty", and what is the anticipated life expectancy of the patient. If ...
How do you manage chronic radiation laryngeal edema for patients treated with RT for a larynx primary in the past?
I agree with @Dr. First Last's response above. I think it is important to differentiate between laryngeal edema resulting from RT and persisting as a sub-acute toxicity, as opposed to a patient who was treated in the past for larynx cancer and then develops laryngeal edema unexpectedly. In the forme...
Does anyone have experience obtaining sunvozertinib in the second-line setting for patients with EGFR exon 20 insertion mutations?
I have not. Though FDA-approved for months, the drug has not been available for dispensation. Dizal has not had a US presence and has not yet established a distribution partnership. Currently available in China - hoping for access in the US any day now.
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...