Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How, if at all, are you modifying your practice and clinical workflow for patients receiving checkpoint inhibitors with data showing improved outcomes for patients receiving infusions earlier in the day?
The paper supporting the 'early morning' approach has been retracted, and arguments against this are being actively pursued for full publication. Recently, data were presented at AACR as well. The half-life of these molecules is quite long (in the range of weeks), which raises a question against the...
Do you always use platinum/5-FU as the chemo backbone with pembrolizumab for recurrent/metastatic H&N cancer?
I prefer to use carbo/taxol with pembrolizumab as well but there is no data to support this and I am having a hard time getting insurance providers to approve. It would be amazing if we can use Mednet platform to create guidelines that might help this cause. Also, I tend to do chemo+pembro for all p...
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?
Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.Background:The duration of therapy for primary maintenance PARPi should be tailored based on the ass...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
How do you counsel patients about the likelihood of improvement in kidney disease after anti-cancer treatment is initiated in a patient with malignancy associated membranous nephropathy?
There are numerous case reports to support that if the patient has a paraneoplastic MN then the expectation is that the renal lesion will respond to cancer directed therapy.
What is the appropriate concurrent chemoradiation regimen to treat unresectable stage IIB lung adenocarcinoma?
Historically, many locally advanced NSCLC trials have included patients with unresectable stage II disease. While those patients comprised only a few % of the study population, I think it is largely reasonable to extrapolate findings from stage III NSCLC patients to patients with unresectable stage ...
For stage III NSCLC treated with definitive intent chemoRT, how do you decide to proceed with surgery vs consolidation immunotherapy?
When we initially evaluate a patient with locally advanced NSCLC, we make the decision upfront about whether the patient will be managed surgically or not, and then we stick to that plan as long as everything proceeds as expected. So someone treated with definitive intent would get durvalumab (shown...
What is your preferred next line of therapy for a fit patient with unresectable, refractory osteosarcoma who has progressed after MAP, local radiation, and IE?
Cabozantinib also showed activity per CABONE trial. Compares favorably to other TKIs.