Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How should cisplatin be used in head and neck cancer patients with sensorineural hearing loss?
I generally avoid cisplatin entirely in patients with pre-existing sensorineural hearing loss. Instead, I opt for carboplatin-based regimens. If alternative agents are not acceptable (young patient, willing to risk hearing loss for minimal improvement in efficacy, etc.), I carefully consider weekly ...
Do you recommend any alternative schedule for cabozantinib to make treatment compliance easier for patients with metastatic renal cell carcinoma?
There are several considerations to remember when dosing TKIs. The first is that TKIs are not curative in mRCC, so the goal should be to give the patient the lowest possible dose that will control disease while preserving QOL. Also, patient exposure (drug levels) is extremely variable from patient t...
Do you recommend 3 months of chemotherapy, 6 months of chemotherapy, or no chemotherapy along atezolizumab in patients with low risk (T1-3, N1) Stage III dMMR colon cancer?
This is a good question (and a data-free zone). pMMR low-risk stage III disease can be treated with 3 months of CAPOX or 6 months of FOLFOX, based on the IDEA trial. The residual risk of relapse for this entity, after chemotherapy, is ~20%. FOLFOX for 3 months was inferior to 6 months by a few perce...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?
Resected limited stage DLBCL has relatively high risk of recurrence. A recent prospective phase II trial was reported (Yoon et al. Oncotarget 2017) where patients received 3 cycles of RCHOP post resection and had an excellent 2 year PFS of 95%. Another study (Sehn et al. Annals of Oncology 2008 abst...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Years ago, I was consulting with a patient who had moved to the Pacific Northwest after being diagnosed elsewhere with multiple myeloma. After engaging in initial pleasantries and just before I was about to peel away the specifics of her medical history, she stopped me in my tracks. “Did you go to A...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Years ago, I was consulting with a patient who had moved to the Pacific Northwest after being diagnosed elsewhere with multiple myeloma. After engaging in initial pleasantries and just before I was about to peel away the specifics of her medical history, she stopped me in my tracks. “Did you go to A...
What is your approach to locally advanced pancreatic cancer that has not progressed after neoadjuvant chemotherapy +/- chemoradiation but remains unresectable?
NRG GI011 was recently activated across the NCTN and will test ablative radiotherapy in this setting. This is a pragmatic and potentially practice-changing trial. Consider activating it at your center. Here is a nice summary from the PI @Dr. First Lasthttps://www.youtube.com/watch?v=MNsS7pHqZIk.
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
Acknowledging the lack of definitive data, in our group we use G-CSF as primary prophylaxis in adult patients with ALL treated with intensive chemotherapy and hardly ever need to re-administered if they develop FN subsequently. That said, for prolonged neutropenia despite prior G-CSF, we may adminis...
Do you commonly observe acute erythrocytosis in patients with ILD flares being treated with supplemental oxygen and high-dose corticosteroids?
Assuming that this patient does not have erythrocytosis at baseline, my experience is that acute erythrocytosis is not typical. Erythrocytosis caused by hypoxemia typically has a lag of several weeks, even though EPO increases within 48 hours. You commonly see a moderate acute leukocytosis with high...