Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What options are available for patients with relapsed/refractory AL amyloidosis after Dara-CyBorD, other than clinical trial?
No great answers, unfortunately. Lenalidomide still tends to make me a bit nervous in AL amyloidosis, as does carfilzomib in patients with known cardiac involvement. But pom-based regimens are an option, or carfilzomib-based in the appropriate population.If the patient's BMBx shows t(11;14) by FISH,...
How do you approach management of non-resectable periampullary adenocarcinoma in an elderly patient with otherwise good PS?
The level of evidence is more limited to guide treatment decisions for ampullary/peri-ampullary adenocarcinoma compared to the neighboring pancreas. However, I have generally approached this situation similarly to locally advanced or inoperable pancreas cancer starting with systemic therapy and if t...
What is your process for assessing the "high risk" clinical features in gBRCA+ breast cancer in order to offer olaparib, given varying definitions of risk and recent changes in staging guidelines?
I follow the criteria used in the eligibility for the OlympiA trial to determine who I will offer olaparib to in the adjuvant setting, which is consistent with the ASCO Hereditary Breast Cancer Guideline Rapid Recommendation Update.In patients with gBRCA+ breast cancer who received at least 6 cycles...
What are contraindications for growth factors in patients with hematologic malignancies?
This is a challenging question where little data exist to support a good conclusion. In real world situations, patients with cytopenias and suggestion of TR-MN warrant aggressive antibodies find yourself deciding which is the "best of class" in its nature. John
How do you counsel post-menopausal patients with HR+ breast cancer who are interested in taking medroxyprogesterone?
Assuming the woman is taking this as hormone replacement therapy for menopausal symptoms, I would recommend against this. Based on several analyses of hormone replacement and breast cancer incidence (primary prevention), including the results of the Women's Health Initiative randomized trials, conju...
Do you adjust the dose of ruxolitinib in primary myelofibrosis based on hemoglobin?
This is a tough question. It generally depends on how bad the anemia is. You can expect at least a gram (or more) drop in the hemoglobin when starting ruxolitinib, so baseline hemoglobin is important. Also, assuming that the patient is symptomatic, you would want to reduce the dose as little as poss...
Is there any adjunct therapy to help with tamoxifen-induced leg cramps?
When a patient is complaining of leg cramps, it is important to make sure that the patient is not complaining of signs or symptoms of a deep vein thrombosis. If this is not a concern, one may consider checking electrolytes to make sure no other potential explanation. Otherwise, tonic water can be he...
How have you been incorporating Abemaciclib into the adjuvant management of high risk node positive HR+ breast cancer?
To date, I have used local lab results for Ki-67 and had no issues with insurance coverage. Our breast team has otherwise been attempting to utilize abemacicilib in situations that meet the monarch-E protocol (Patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5...
Is there any role for neoadjuvant chemotherapy for low grade adenosquamous metaplastic TNBC?
Metaplastic breast (about 1% of all breast cancers). These are mostly triple negative and high grade, this is described as "low grade adenosquamous (LGAS)." LGAS is a subset of metaplastic tumors, of low malignant potential (Romanucci et al., PMID 34017612). Excision alone with wide margins (1 cm or...
Would you change chemotherapy to VIP in a young patient with stage IIIB intermediate risk non-seminomatous germ cell tumor with borderline DLCO after one cycle of BEP?
The term “borderline DLCO” needs to be taken into context. The test is not completely reliable and one needs to consider the DLCO result in the clinical setting - has the patient been a heavy smoker, does he have known respiratory disease, does he have any limitation in effort tolerance, and who/whi...