Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is there any way to safely treat patients with mCRPC with 177-Lu PSMA who are on hemodialysis?
For the most part, no. Not unless you're a big academic medical center with a robust multidisciplinary team willing to tackle the significant logistical challenges associated with this scenario.I'm aware of no literature in this scenario specifically for Pluvicto, but we can look at the radiopharmac...
Do you need renal biopsy before SBRT for RCC suspicious cancer?
Yes. The teaching is usually that ≈ 20% of small renal masses (<4 cm) are benign, and this rate goes down as size increases (Thompson et al., PMID 19286217). Features such as contrast enhancement, tumor location, and sex can help to improve the malignant risk potential of these lesions, but no combi...
How would you change the regimen for a patient receiving neoadjuvant TCHP or node positive HR+/HER2+ breast cancer who develops a severe allergic reaction to docetaxel?
I would favor replacing docetaxel with nab-paclitaxel and continue carboplatin along with trastuzumab and pertuzumab, as the data would suggest that in HER2+ breast cancer, the taxanes are more important than anthracyclines (as seen in BCIRG-006 and TRAIN-2) and that the taxanes offer synergy with H...
Would you expect a reduced neutrophil count in individuals with a partial duffy null phenotype?
The Duffy null phenotype's impact on neutrophil counts is "all or none". Approximately one-third of patients with the Duffy null phenotype Fy (a-b-) will have a neutrophil count below the usual lower limit of normal. The range of neutrophil counts in individuals with Fy (a+b-) and Fy (a-b+) is exact...
For a patient treated with abiraterone for first line metastatic prostate cancer, would you still use a combination of abiraterone/olaparib at a subsequent progression?
No, there is no evidence for this, and in the absence of benefit, I would use single agent olaparib in HRD+ patients only, particularly BRCA2 patients. Ongoing trials like the CASPAR trial will address this question. In addition, there are ongoing trials testing PARP/AR combinations in men with mHSP...
What adjuvant therapy would you offer to a young patient with resected margin-negative stage III extrahepatic cholangiocarcinoma?
I would strongly consider using the @Dr. First Last SWOG 0809 trial of chemotherapy and chemoRT adjuvantly - this is assuming you have a radiation oncologist who is also supportive. This is more positive data than the BILCAP study, which showed a *very* modest effect of adjuvant capecitabine Primros...
When do you recommend initiation of targeted therapies in active RA with history of malignancy?
In patient with RA and a history of malignancy, I generally recommend the same therapy that I would recommend in the absence of a malignancy history. This is consistent with the most recent ACR guidelines for the management of RA (Fraenkel et al., PMID 34101387). Consistent with FDA labeling, I'd ge...
Would you ever recommend testosterone replacement for men with incomplete T recovery after ADT for prostate cancer?
I have been hesitant to agree to supplemental testosterone after prostate cancer treatment, especially within the first few years. Prostate biopsies during that time often show atypical cells that are suspicious or adenocarcinoma with treatment effect. Androgens are pro-survival and the full effects...
What is your approach to IV fluid management for the treatment of hypercalcemia of malignancy?
At this point, I believe one can use either saline or lactated Ringer's. There is some evidence that low-chloride-containing solutions have advantages in general, which may well be the case, but we need more data on that. The amount of calcium in LR is very small and should not make a difference (1....
How would you manage a patient with metastatic NSCLC and high-level MET amplification who achieved a near CR on tepotinib but is unable to tolerate dose-reduced tepotinib?
This is one of the more challenging situations I face in the clinic. Peripheral edema is the most notorious side effect of MET TKIs, with an insidious onset of 6-9 weeks after initiation of therapies like capmatinib or tepotinib [Sakamoto and Patil, PMID 36924573; Lin et al., PMID 40386723]. You hav...