Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you treat de novo metastatic hormone sensitive prostate cancer presenting with a paraneoplastic syndrome more aggressively?
For these patients, I will likely add a GnRH antagonist early on to drop testosterone quickly. Depending on performance status and other patient characteristics, we still go through the discussion of adding docetaxel, abiraterone, enzalutamide, and apalutamide (I generally add about 3-4 weeks after ...
How will you decide between neoadjuvant CheckMate 816 approach vs adjuvant IMpower010 approach in a fit patient with EGFR negative resectable Stage II-III NSCLC patient with PD-L1 high expression tumor?
In general, our multi-d group believes in neoadj approach to shrink the tumor and apply systemic therapy at the earliest time point. Most neoadj approaches also continue the I/O after surgery if there is a good response. It may be that patients with a complete path response or without ctDNA may not ...
Is it safe to give large fraction stereotactic irradiation for brain metastases concurrently with VEGF inhibitors?
Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?
First, some semantics: Asking if there is a "benefit to transplant" may imply there are randomized controlled trials addressing this question, but none to my knowledge have been performed. The last "donor-no donor" trials done in adults with ALL in first remission largely occurred in the pre-TKI era...
What salvage chemotherapy, if any, would you recommend for a patient with primary refractory DLBCL who progressed after two cycles of R-CHOP?
Primary progressive DLBCL is certainly clinically challenging. After biopsy confirms the diagnosis, how best to proceed depends on many factors including burden of disease, tempo of disease, and patient characteristics. ZUMA-7 establishes axi-cel as superior to the standard approach of platinum-base...
Are BTK inhibitors safe to use in patients with severe renal failure?
To my knowledge, there are no data related to BTKi in patients with GFR <30 nor those on dialysis. However, these drugs (ibrutinib, acalabrutinib, zanubrutinib) are not cleared by the kidney, and in the clinical trials where measured, PK did not change based upon kidney function. Therefore, my pract...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?
There are a number of appropriate options to consider depending on the specifics of the case. Could the patient be eligible for axi-cel? 2L CAR-T is appropriate for fit elderly patients so long as they fit eligibility for CAR-T and have access, and axi-cel is approved for early relapse/refractory pa...
How do you discuss curative vs palliative treatment intent for patients with favorable risk 1p/19q co-deleted oligodendrogliomas?
Although my name is on a publication calling low-grade oligodendroglioma an "incurable disease", this is not a term that I use with patients — even in the case of glioblastoma. We do not have a published 20-year follow-up of RTOG 9802 to see if there is a plateau in PFS. Are we only delaying inevita...
How does tumor stage affect your choice of adjuvant chemotherapy in pancreatic cancer?
I have moved my practice for resectable PDAC (and certainly borderline resectable tumors) almost entirely to neoadjuvant therapy. The SWOG S1505 study (see links below) has shown that either gem/Abraxane or FOLFIRINOX is appropriate. In the adjuvant setting, there is better data for FFX and gem/cis ...