Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
If Ianalumab + eltrombopag (VAYHIT2) gains regulatory approval, what would make you consider its use for second-line therapy after glucocorticoid failure/relapse, given its potential hematologic toxicity?
I would consider this in patients who have a more immunoinflammatory phenotype (perhaps with other autoantibodies or with a significant family history of autoinflammatory disease) or in patients who have significant bleeding symptoms and need rapid control of the disease.
How do you approach and manage anorexia and appetite loss in people with advanced cancer?
Anorexia/cachexia is often distressing to patients and families and it is this distress that is the target of many of the interventions for this syndrome as there are, in general, no effective therapies. Patients and families are routinely battling over the lack of eating as this causes further disc...
How would you manage suspected MGRS in a patient refusing a kidney biopsy?
To diagnose MGRS, a biopsy is necessary. If a patient has M protein on serum protein electrophoresis (SPEP) but shows no evidence of paraprotein-mediated kidney disease, this indicates MGUS. In contrast, conditions like PGNMID are also paraprotein-mediated but can be caused by a small clone that is ...
How would you manage suspected MGRS in a patient refusing a kidney biopsy?
To diagnose MGRS, a biopsy is necessary. If a patient has M protein on serum protein electrophoresis (SPEP) but shows no evidence of paraprotein-mediated kidney disease, this indicates MGUS. In contrast, conditions like PGNMID are also paraprotein-mediated but can be caused by a small clone that is ...
What factors influence your decision regarding whether to administer a dose-dense chemotherapy regimen in the adjuvant setting to patients with hormone-receptor postive disease?
Many of the studies included in the analyses treated ER+ cases that we would call lower risk using modern genomic testing with adjuvant chemotherapy. So the observed effect of chemotherapy on recurrence and OS in ER+ disease can vary from study to study, depending on the numbers of low vs high risk ...
How would you approach local therapy (surgery or RT) in a patient with radiographic complete response after chemoimmunotherapy for non-small-cell lung cancer?
Only 1/96 patients (0.6%) of patients on CheckMate 816 had a complete response by RECIST so I don't think our current paradigms are really driving these kinds of responses. Additionally, there is clearly a disconnect between clinical response rates by RECIST (0.6%) and pathologic complete response (...
How do you approach a metastatic mixed non-seminoma germ cell tumor s/p orchiectomy and chemotherapy with normalization of tumor markers and persistent multiple lung metastasis (>1 cm) that cannot be fully resected?
The first question I would ask is, does he have residual radiographic abnormalities in the retroperitoneum? If he does and it hasn't been done yet, I would go to a proper post-chemotherapy RPLND as the first step. The second question is whether we should perform any biopsy of the lung nodules to pat...
Do you utilize ctDNA-based MRD testing after frontline chemotherapy for DLBCL?
I do not, as part of the standard of care, in part because of limitations of the ClonoSEQ assay in this setting, and in part because of a lack of clarity around how best to manage a positive. However, there are a number of sophisticated clinical trials exploring this question prospectively, with a f...
Do you utilize ctDNA-based MRD testing after frontline chemotherapy for DLBCL?
I do not, as part of the standard of care, in part because of limitations of the ClonoSEQ assay in this setting, and in part because of a lack of clarity around how best to manage a positive. However, there are a number of sophisticated clinical trials exploring this question prospectively, with a f...
How would you treat a stage I fully resected double hit DLBCL?
In patients with fully resected DLBCL, I still give chemotherapy. That also applies to double-hit lymphomas. Limited-stage DHL does not seem to have a poorer prognosis than non-DHL, and intensive regimens do not make a difference. I would treat with RCHOP x 3-4 cycles. Torka et al., PMID 31945157 Lu...