Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you consider thrombocytopenia a contraindication for fibrinolytic therapy for a massive PE?
If one has access to mechanical thrombectomy devices and operators, they should be considered before systemic thrombolytics unless the massive PE is causing imminent danger to the patient/patient is going to code/die, in which case the risk of dying from said PE is higher than potential bleeding eve...
How do you determine the choice of therapy for platinum resistant ovarian cancer in healthy, good performance status patients?
Platinum-resistant epithelial ovarian cancer is generally defined as relapse less than 6 months following completion of primary or the last platinum-based chemotherapy regimen. Options for therapy include conventional, commercially available drugs or potential clinical trials. If prior genetic testi...
Would you consider adding immune checkpoint blockade to platinum + etoposide for metastatic high-grade large cell neuroendocrine tumor of the GI tract?
The addition of IO to first-line platinum/etoposide would primarily be an extrapolation of data from small cell lung cancer trials while awaiting the results of the ongoing SWOG 2012 trial being led by Dr. David Zhen (NCT05058651). We have hints of limited activity of single-agent checkpoint inhibit...
What is your second line therapy for PDL1 negative metastatic squamous esophageal cancer who did not receive a checkpoint inhibitor in first line setting?
I would not personally consider immunotherapy in any context for such a patient. For the purpose of answering this question, I assume that a "PD-L1 negative" tumor refers to a PD-L1 TPS 0% and CPS 0 tumor.As a quick reminder, the 2 relevant studies in the US for 1st-line immunotherapy in ESCC patien...
In patient with upper esophageal SCC who had partial response to neoadjuvant chemoradiation but deemed not to be a surgical candidate, would you recommend chemotherapy or nivolumab?
Once again, there's no clear answer to these head scratchers. For the purpose of answering this question, I will assume that the patient has a locally persistent tumor s/p definitive chemoradiation and is medically inoperable.In that case, the first issue to consider is whether there is a role for m...
For patients with early stage resected giant cell lung cancer and other less common histologies, are there any specific considerations for adjuvant therapy?
Giant cell carcinomas/pleomorphic carcinomas/sarcomatoid carcinomas are difficult, and typically aggressive entities. In reviewing the literature, there is precious little data to guide the selection of cytotoxic chemotherapy (most reports are pathology studies, some case reports, and unfortunately,...
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Hg 10-11. My main goal is to suppress reticulocytosis and therefore, the production of more sickled cells.
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Hg 10-11. My main goal is to suppress reticulocytosis and therefore, the production of more sickled cells.
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 (...
In a patient with negative Hep B surface Ag, Hep B surface antibody+, and Hep B core antibody+ serologies, do you initiate antiviral prophylaxis (e.g. entecavir) prior to starting rituximab?
I would use entecavir for Hep B reactivation prophylaxis in this case - based on recommendations from AGA 2025 guidelines, which does classify b-cell depleting agents as higher risk for reactivation for both Hep B surface Ag-positive and Hep B surface Antigen neg/core positive patients. It should be...