Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
In your practice, would you consider the all-oral option of decitabine-cedazuridine + venetoclax for an elderly, unfit AML patient, based on the ASCERTAIN-V trial results?
I see the combination of oral decitabine-cedazuridine (ASTX727) + venetoclax as largely being an appropriate option for any patient with newly diagnosed AML that would be otherwise considered for azacitidine + venetoclax. The inclusion criteria for ASCERTAIN-V (Roboz et al., PMID 42235013) and VIALE...
Are there any scenarios you would use CDK 4/6i to treat HR-positive HER2-positive breast cancer in combination with anti-HER2 agents?
There is a strong preclinical data demonstrating that CDK4/6 inhibition reduces the growth of HER2-positive breast cancer cell lines. However, we are still awaiting the results of phase 3 trials testing the addition of CDK4/6 inhibitors to systemic therapy for hormone receptor (HR) positive, HER2 po...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
Do you use anti-microbial prophylaxis when you prescribe ibrutinib?
Traditionally, H.Zoster and PJP prophylaxis was more routinely administered in CLL patients receiving chemoimmunotherapy as these regimens were typically more myelosuppressive as well as immunosuppressive. In the era of the novel BCR receptor agents with the approval of ibrutinib and idelalisib and ...
How would you approach the treatment of metastatic cholangiocarcinoma after progression on gemcitabine/cisplatin, FOLFOX, and pemigatinib?
This is a tough situation. Depending on the patient's performance status and organ function, a clinical trial is strongly recommended. If the patient has FGFR2 fusion or chromosome rearrangement with prior exposure to pemigatinib, resistance mutation (gatekeeper mutation) is likely present and may b...
When do you refer patients back to their PCP for the predominant management of their medical care following completion of oncologic or BMT treatment?
Transitions of care are always challenging, especially for patients with complex medical histories, including cancer or stem cell transplantation. There are many different models for how and when to transition patients back to primary care or shared care. The ongoing, often complex needs of survivor...
How do you counsel patients on semaglutide or tirzepatide in light of potential cancer risks?
Use of GLP 1 RAs has sky-rocketed in recent years due to what seems to be a positive class effect on T2DM, weight loss, renal outcomes, cardiac outcomes and hepatic outcomes. I am not aware of any signals of increased malignancy risk. A brief literature review found meta-analyses showing possible be...