Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide among AI, full dose tamoxifen and low dose tamoxifen in a postmenopausal woman with DCIS without contraindications to either therapy?
My decision about AI vs tamoxifen is based on comparing the risk/benefit ratio for the specific patient. The cause of mortality in post-menopausal women is primarily cardiovascular disease, with osteoporosis also causing significant morbidity and mortality. Degenerative joint disease adversely affec...
How would you manage a solitary, painful, lytic bony lesion in a patient with negative PET/CT but bone marrow biopsy confirmation of multiple myeloma?
This is a palliative scenario, but the approach may differ based on the clinical circumstances. If Heme Onc is planning on administering systemic therapy, then a short course of palliative RT to expedite pain control would be appropriate. Treatment of many sites (e.g., femur) can be done very quickl...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How do you treat metastatic breast cancer which is HR positive, Her2 negative with PIK3CA+ and high tumor mutational burden (>10) who progressed after prior ET+CDK 4/6 and PIK3CA inhibitor therapy?
I will take an initial stab at this, but I know there are varying thoughts from other clinicians and I'm always interested to learn how others think through this.To start, I'm guessing that you're asking about immunotherapy here, and when you might consider using it. Unfortunately, these patients ha...
In a patient with de novo stage IV breast carcinoma harboring an RB1 Q395* (nonsense) mutation, would treatment with a CDK4/6 inhibitor be appropriate, or should it be avoided due to likely resistance?
Thank you for bringing up this question. As I outlined below, it makes sense based on the evidence available that CDK4/6 inhibitors are less effective or ineffective in patients with tumors harboring Rb LOF mutations. There is, however, little guidance from clinical trials or guidelines to lead us t...
In light of the challenges with non-adherence to oral therapies in breast cancer, how do you monitor patient adherence in your practice?
There are several strategies here. Much of this is around patient education and the clinic team of nurses, physicians, APPs and oncology pharmacists can all support our patients by ensuring there is good understanding of the dosing schedule, potential side effects and how we might manage those, impo...
Do you typically recommend avoiding neupogen during radiation treatments?
It depends on the reason and expected benefit. If myelosuppression is holding up RT for cervical cancer patients, then I would not hesitate to give neupogen to avoid or minimize a treatment break. There would be more benefit to neupogen and continuing RT than a downside. Usually, I would try to give...
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 RCHOPx3-4 cycles.Torka et al., PMID 31945157Lue et...
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 RCHOPx3-4 cycles.Torka et al., PMID 31945157Lue et...