Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you incorporate CAR-T cell therapy for DLBCL in transplant-eligible patients?
The role of sequential therapy including CARs vs high dose chemotherapy + ASCT post primary induction failure/relapse in large cell lymphoma is a matter of active research. Given the present FDA indication of CARs is in relapsed/refractory large cell lymphoma after failure of at least 2 lines of pri...
How do you incorporate CAR-T cell therapy for DLBCL in transplant-eligible patients?
The role of sequential therapy including CARs vs high dose chemotherapy + ASCT post primary induction failure/relapse in large cell lymphoma is a matter of active research. Given the present FDA indication of CARs is in relapsed/refractory large cell lymphoma after failure of at least 2 lines of pri...
How should medical oncologists and dermatologists communicate about patients with at least Stage IIB/III cutaneous melanoma regarding neoadjuvant immunotherapy?
Only melanoma patients with stage III or resectable stage IV disease should be treated with standard-of-care neoadjuvant immunotherapy. These patients should see a medical oncologist first (and no longer last, as is the current process). I would recommend that the schedulers at your institution be e...
Does stopping anagrelide affect fibrosis in patients with ET who develop post-ET myelofibrosis?
Anagrelide is a phosphodiesterase (PDE) III inhibitor, developed initially as a platelet antiaggregant, but was found to have platelet lowering activity at concentrations lower than its platelet antiaggregant activity. Thus, it was consequently marketed to reduce thrombocytosis in MPN patients. It i...
What is the drug of choice in order of preference for neuropathy associated with different agents used for breast cancer treatment?
Unfortunately, many of the large trials have not identified a strategy that is effective for CIPN. It is important to tell patients to avoid some supplements. Studies have shown that acetyl-l-carnitine can make the symptoms worse. There is some evidence that exercise may result in decreased symptoms...
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...
Does pre-chemotherapy extent of nodal involvement impact your decision to offer adjuvant radiation in cN1, ypN0 triple-negative breast cancer?
There are few data on this subject. The group at the Netherlands Cancer Institute in Amsterdam created what they called the "MARI" approach for such patients (Koolen et al., PMID 28524246). In brief, they performed an axillary ultrasound and marked the largest suspicious node with a radioactive seed...
Would you recommend an allogenic stem cell transplant in an older patient > 50 with Ph negative acute lymphoblastic leukemia who is MRD negative after induction?
In general, I would not routinely recommend allogeneic hematopoietic cell transplantation (HCT) for Ph- acute lymphoblastic leukemia (ALL) that is in MRD-negative remission this early in their treatment. This sort of response demonstrates significant chemosensitivity. Therefore, I would favor contin...
Would you recommend an allogenic stem cell transplant in an older patient > 50 with Ph negative acute lymphoblastic leukemia who is MRD negative after induction?
In general, I would not routinely recommend allogeneic hematopoietic cell transplantation (HCT) for Ph- acute lymphoblastic leukemia (ALL) that is in MRD-negative remission this early in their treatment. This sort of response demonstrates significant chemosensitivity. Therefore, I would favor contin...
How do you sequence chemotherapy with radiotherapy for advanced endometrial cancer?
Unfortunately, we don’t even know for sure if we need RT for stage III disease.GOG 258 showed early concurrent chemo RT is no better than chemotherapy alone (delaying chemo increased distant mets, which probably negated locoregional control benefit of RT). For this reason, chemotherapy has become st...