Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use immunotherapy in patients with HIV and a positive viral load?
Current guidelines do not recommend universal HIV screening before starting immune checkpoint inhibitors (ICIs). However, if HIV is known or suspected, patients should ideally be on antiretroviral therapy (ART) before initiating immunotherapy.Safety:Retrospective data from the CATCH-IT Consortium (E...
What experience do you have with paralysis or myasthenia-like symptoms developing on temozolomide?
This is not an established toxicity of temozolomide and would warrant further investigation.
How would you treat a patient with rectal cancer with a positive margin on resection after receiving TNT?
I'm assuming that this patient received the typical ~4 months of FOLFOX followed by capecitabine/XRT of TNT, and that by the lack of responses, this suggests this situation is quite challenging! Despite the high risk of recurrence, in someone who has had prior radiotherapy and chemotherapy, I don't ...
Do you choose to include or omit growth factor support in the treatment of Hodgkins lymphoma?
I typically do not use "up front" growth factor support unless my patient is frail. If symptomatic neutropenia develops during therapy I will add growth factor support at that time. For the patient with asymptomatic neutropenia I will continue therapy and individualize the decision for the addition ...
Do you choose to include or omit growth factor support in the treatment of Hodgkins lymphoma?
I typically do not use "up front" growth factor support unless my patient is frail. If symptomatic neutropenia develops during therapy I will add growth factor support at that time. For the patient with asymptomatic neutropenia I will continue therapy and individualize the decision for the addition ...
How do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?
I would certainly treat the ITP with hematology involvement if necessary but would continue to monitor for lupus or similar CTDs. I have seen patients present with an ITP-like picture for years before lupus declared itself eventually. It may take years. I would also check a UA for proteinuria. This ...
When do you consider consolidation chest radiation in a patient with stage IV non-small cell carcinoma of the lung who has had good response to systemic therapy?
It's a really great question, and it comes up a lot in our tumor boards and general practice. There are a couple of paradigms that I use to help me think through when and how to do it. I would say the data here for the use of RT is mixed, and either gives you freedom to do a variety of things or giv...
Would you recommend adjuvant chemotherapy for a patient with subcentimeter pancreatic adenocarcinoma incidentally found during a Whipple resection for high risk IPMN?
Short answer is yes, I do. IPMNs with a foci of invasive carcinoma are at risk for recurrence. The prognosis is generally felt to be more favorable than with conventional PDAC, but that may be due to a higher percentage of them being found at an earlier stage. (E.g. ~25% IPMN-associated carcinomas d...
Would you recommend adjuvant cisplatin/gemcitabine or nivolumab in a patient with muscle invasive bladder CA who proceeded to radical cystectomy first?
This is an excellent question and one we are seeing more and more in clinics these days now that the FDA has approved nivolumab for adjuvant therapy for patients with locally advanced urothelial carcinoma at high risk of recurrence after radical resection. This is based on data from CheckMate 274 wh...
If you are using talquetamab as bridging before BCMA CAR-T therapy, when do you assess for response and/or stop the talquetamab?
I’m not fond of the talq approach based on personal experience, but the data looks quite good. Most patients only get about 2-3 full doses before cells are ready. I aim to get step-up dosing completed and then move to 0.8 mg/kg every 2 weeks. That is generally enough to obtain a durable and deep eno...