Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat a patient with urothelial cancer and 25% plasmacytoid variant who has a solitary recurrence in rectum 1 year after neoadjuvant chemotherapy and radical cystectomy?
Plasmacytoid urothelial carcinoma has a very high tendency to develop peritoneal carcinomatosis. And although on scan there could be solitary occurrence, on exploration, may be able to see more peritoneal involvement. Thus, systemic therapy would be a more appropriate strategy to treat. Diamantopoul...
What regimen would you recommend for a younger, fit, transplant eligible patient with relapsed IDH1 positive AML?
If there was only one answer! The decision revolves around co-occurring cyto and molecular genetic abnormalities (in addition to IDH1) and the duration of remission in first CR. In general, IDH mutant AML - without other high-risk genetic lesions - is very responsive to all of our treatments whether...
Do you prefer carboplatin or cisplatin with etoposide for stage IV extra-pulmonary neuroendocrine carcinomas with a Ki-67 > 55%?
Etoposide plus platinum (either cisplatin or carboplatin) as the standard first-line regimen for poorly-differentiated NECAs, and as we know this combination has been adopted from SCLC with limited data in extrapulmonary NECA. Both combinations are equally effective, however, the toxicity profile ma...
Would you consider single agent TKI for patient with metastatic renal cell carcinoma who developed biopsy proven giant cell arteritis days after starting immunotherapy?
Clinicians are not infrequently in situations where we need to help guide patients along a decision pathway for which we have little data. The vasculitis in this patient obviously was a pre-existing condition. The first question I would ask is does the patient's RCC need treatment now? If favorable ...
What would be your preferred second line treatment for a frail elderly patient progressing on Rd?
It will largely depend on the degree of frailty. Many of the myeloma therapeutics are well tolerated, even among older adults or those with comorbidities. Factors such as the time spent coming to clinic or to the infusion center matter as well. It is useful to understand the baseline cytogenetic abn...
How would you approach a patient who has developed neutropenia with the combination of trastuzumab/pertuzumab in the adjuvant setting?
I have noted an increase in cytopenias IF the combo is given as Phesgo as compared to IV. I have one patient who had sign cytopenia on Phesgo and did quite well on IV.
Would you offer a complement inhibitor to a minimally symptomatic PNH patient with mild non-transfusion dependent hemolytic anemia?
The context would determine whether this patient should receive complement inhibitor. The first consideration is whether the patient has concurrent aplastic anemia or bone marrow failure. Often, patients with aplastic anemia have a small PNH clone that is not clinically significant and does not caus...
How would you treat a patient with late relapsed metastatic seminoma with only large (>10cm) pulmonary metastases and LDH nine times the upper limit of normal?
From the description, it is not really clear whether this is late relapse after initial surveillance or radiotherapy, versus relapse after chemotherapy. If the former, which is what I think you are presenting, this is a pretty unusual pattern of presentation after surveillance or radiotherapy, and...
How do you approach patients with driver mutation positive, Stage IV NSCLC who don't benefit from upfront first-line TKI?
It depends on the mutation. EGFR mutants after Osimertinib:- If oligometastatic disease: an option is radiation to the oligometastatic spots and continue osimertinib. It is important to re-biopsy as well due to the possibility of small cell transformation. If transformed to small cell, in general, c...
What is the optimal systemic therapy for dedifferentiated chondrosarcoma?
DD Chondrosarcoma typically has a low-grade cartilage component and the transformed, high-grade component often resembles UPS or osteosarcoma. So we treat these tumors a 'la osteosarcoma, acknowledging that this tends to be a disease of the elderly and appropriate dose/regimen modification will be r...