Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you use Boswellia for radiation necrosis?
I reached out to my colleague, naturopath Lise Alschuler, Associate Director of the University of Arizona Fellowship Program in Integrative Medicine program, for her thoughts on this question. Here is her answer:This study by Upadhyay et al. is a well-designed study which builds upon earlier studies...
Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?
In the MCL patients treated on the BRUIN trial, treatment was well tolerated in general with a low rate of treatment discontinuation or dose reduction. As far as cardiac toxicities, no grade ≥3 treatment emergent AEs of hypertension were observed. Atrial fibrillation/flutter (AF) was reported in 6 (...
Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?
In the MCL patients treated on the BRUIN trial, treatment was well tolerated in general with a low rate of treatment discontinuation or dose reduction. As far as cardiac toxicities, no grade ≥3 treatment emergent AEs of hypertension were observed. Atrial fibrillation/flutter (AF) was reported in 6 (...
What is your experience with the modified ramp-up of tarlatamab, where an extra 5 mg is given in the ramp-up phase before increasing to the full dose?
We have not attempted this approach and have had relatively little cytokine release syndrome (CRS) associated with the C1D8 10 mg dosing to suggest that a gentler step-up regimen is required. There are some reports that for patients with medullary thyroid cancer, a modified step-up dosing has been b...
Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?
How radiation therapy (RT) should be incorporated into the management of patients with advanced DLBCL continues to be investigated. In the setting of widespread, non-bulky disease, when a complete response is achieved with systemic therapy, I don't recommend consolidation RT. Though controversial, I...
In a patient with cardiac light chain amyloid who has significant heart failure symptoms, including inotrope dependence at presentation, how much clinical benefit does treatment provide?
In patients with cardiac light chain (AL) amyloidosis who present with significant heart failure symptoms and inotrope dependence, the clinical benefit of treatment is a complex and nuanced issue. This scenario often reflects an extreme end of the disease spectrum. Historically, patients with advanc...
In a patient with cardiac light chain amyloid who has significant heart failure symptoms, including inotrope dependence at presentation, how much clinical benefit does treatment provide?
In patients with cardiac light chain (AL) amyloidosis who present with significant heart failure symptoms and inotrope dependence, the clinical benefit of treatment is a complex and nuanced issue. This scenario often reflects an extreme end of the disease spectrum. Historically, patients with advanc...
How do you manage adjuvant endocrine therapy for pre-menopausal women with locally advanced, weakly positive ER/PR, HER2 negative breast cancer?
Likely very little benefit. Reasonable to try tamoxifen if tolerated.
What would you offer to a patient with musculoskeletal pain from tarlatamab, requiring hospitalization and opioid use?
Bone and muscle pain with tarlatamab can be significant (affecting nearly one-third of patients in clinical trials, I think). A multimodal plan combining opioids with non-opioid analgesics, supportive therapies, and proactive side effect monitoring is often necessary to combat this.The pathway that ...
For patients with a history of pregnancy loss, do you evaluate for PAI-1 polymorphisms as part of a thrombophilia workup?
I do not.The relationship between PAI-1 polymorphisms and thrombosis is complicated, and general guidance suggests against assessing for PAI-1 overexpression as part of a thrombophilia workup. While there is some data to suggest an association between PAI-1 polymorphisms and pregnancy loss, ALIFE2 s...