Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?
IMROZ and BENEFIT trials are interesting in that they are billed as for transplant-ineligible patients, yet frail patients were excluded, so I don't think they give us the answer for how to maintain a frail patient. The best answer for a frail patient is, I believe, the MAIA trial, which gives DRD t...
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
What adjuvant therapy would you offer a postmenopausal woman with a new pT2N0 HR+/HER2+ breast cancer primary who is concurrently being treated with anastrozole/ribociclib for well controlled oligometastatic HR+/HER2- disease?
It is always disconcerting when a primary tumor arises in the context of already ongoing therapy. Presumably, this tumor is somewhat resistant. Firstly, I would add in anti-HER2 therapy (there is a broad range of options depending on the patient's details, ranging from single-agent trastuzumab to TH...
Is there greater efficacy of TPO-RA in patients who have undergone a splenectomy?
The clinical trials and real world studies do not suggest that there is a difference in efficacy in general based on splenectomy status. In my experience, I have found that a few highly refractory patients have some improvement in responses to treatment with splenectomy. I do not generally think of ...
How would you approach treatment for a patient with a residual disease after resection of a solitary jejunal myeloblastic sarcoma?
Myeloid sarcoma (historically- chloroma or granulocytic sarcoma) is simply an extramedullary form of AML. The majority of patients who present de novo with a myeloid sarcoma will either have bone marrow involvement at diagnosis or will develop such metachronously if systemic therapy is not pursued. ...
How would you approach treatment for a patient with a residual disease after resection of a solitary jejunal myeloblastic sarcoma?
Myeloid sarcoma (historically- chloroma or granulocytic sarcoma) is simply an extramedullary form of AML. The majority of patients who present de novo with a myeloid sarcoma will either have bone marrow involvement at diagnosis or will develop such metachronously if systemic therapy is not pursued. ...
What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?
The incidence and the timeframe of the development of radiation myelopathy are influenced by total radiation dose, radiation dose per fraction, time between courses of radiation, and associated chemotherapy or immunotherapy. Older age, the presence of diabetes, and previous exposure to radiation are...
What is your treatment approach for a pediatric patient with H3K27M-mutant diffuse midline glioma following progression after radiation therapy?
First, if the patient is at least six months from initial radiation and has had a reasonable initial response, reirradiation is the best proven treatment for recurrence. We would also encourage enrollment on a clinical trial (the DMG National Tumor Board is a helpful resource for determining for whi...
How, if at all, will you incorporate durvalumab + FLOT in patients with HER2+ resectable gastric/GEJ adenocarcinoma?
Currently, there are no approved biomarker-driven targeted therapies for patients with locally advanced resectable gastric/GEJ adenocarcinoma. While data from the metastatic setting have consistently demonstrated improved outcomes with the addition of HER2-targeted therapies to chemotherapy in HER2-...
How do you manage a cytology-negative pleural effusion that develops after lung RT?
I think most times you can just watch them as long as they are stable and not symptomatic. I see them not infrequently after RT, especially lung SBRT, and find they often find a size they feel comfortable with and don't change much over time. I wonder about their physiology... my impression is there...