Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
How do you choose among the available PD-1/PDL-1 inhibitors approved for metastatic bladder cancer?
This is an evolving field. While the thought had been all the drugs were likely equivalent in efficacy (with no head to head trials) this has changed in the past week. Roche had a press release in which they announced the Phase III IMvigor211 study that evaluated atezolizumab in people with locally ...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
The mechanism of action of luspatercept is to trap and remove ligands of the TGF beta superfamily of ligands, specifically the growth and development factors (GDFs) 11 nd 15. This allows more maturation and differentiation of the erythroid precursors, and an increase in red cell production and relea...
How do you treat non-spine bone oligometastases?
Get the MRI. It is proven to reduce inter-observer variability in contouring (Raman et al., PMID 29748100). More philosophically, sometimes you'll see something more, sometimes you won't. But the only way to know is to check. And if this treatment is worth doing, it's worth doing accurately -- espe...
Is the PFS benefit sufficient to adopt up front acalabrutinib plus BR for all patients with MCL?
In my opinion, PFS is not sufficient to adopt BR-acala as a universal treatment, but this can be an important treatment option for many patients. I would offer the BR-acala combo in patients who value maximizing duration of treatment response, recognizing this is a continuous regimen. On the other h...
Is the PFS benefit sufficient to adopt up front acalabrutinib plus BR for all patients with MCL?
In my opinion, PFS is not sufficient to adopt BR-acala as a universal treatment, but this can be an important treatment option for many patients. I would offer the BR-acala combo in patients who value maximizing duration of treatment response, recognizing this is a continuous regimen. On the other h...
How are you approaching multidisciplinary care for patients with newly diagnosed BCG-naive high-risk NMIBC in light of POTOMAC?
We have not incorporated BCG-naïve high-risk NMIBC patients into our Bladder Cancer Multidisciplinary Clinic workflows to date. That being said, we are discussing including a subset of high-risk patients in our Multidisciplinary Clinic as we incorporate the POTOMAC results into our workflows. In our...
Which patients would you treat with relugolix instead of injectable GnRH agonist therapy?
I would consider relugolix for patients with: 1. Intermediate-risk prostate cancer that needs a short course of androgen deprivation therapy 2. Patients with biochemical relapse that would benefit from a short course of ADT and salvage RT2.5 Patient with pre-existing cardiac comorbidities 3. Potenti...
Would you use a hippocampal sparing technique when treating with PCI for a limited stage small cell lung cancer?
This is an important question where the evidence is evolving, and some key trials remain ongoing. Because the data remains in flux, in the ongoing phase 3 SWOG S1827/Maverick trial of MRI surveillance +/- prophylactic cranial irradiation (PCI) for LS and ES-SCLC, where I serve as the PI, hippocampal...
How do you approach treatment of a glioblastoma in pregnancy?
Glioblastoma during pregnancy could be treated safely (to mother and fetus) with certain precautions and modifications. Collaboration and consultation with the patient’s obstetrician are essential. External shielding over the patient’s abdomen during treatment will decrease the external scatter radi...