Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What treatment considerations do you make for elderly patients with relapsed/refractory follicular lymphoma?
Treatment options for R/R FL patients depend not only on the condition of the patient but what was received in 1st line and the duration of that line of therapy. Given that if a patient has received chemo-immunotherapy in the frontline setting and had a prolonged remission (> 5 years), then these ag...
What treatment do you recommend for marginal zone lymphoma in a patient who previously received bendamustine and rituximab for MALT?
RCHOP or a BITE; I would use cladribine + GAZYVA with curative intent.
What treatment do you recommend for marginal zone lymphoma in a patient who previously received bendamustine and rituximab for MALT?
RCHOP or a BITE; I would use cladribine + GAZYVA with curative intent.
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
I am a radiation oncologist and palliative care physician.I teach: "the hand that writes the opioids, writes the laxatives - or else it does the disimpaction". Opioid induced constipation is very common, can cause physical and psychological discomfort, and have a major impact on quality of life. It ...
How do you treat metastatic BRAF-mutated small bowel adenocarcinoma in the first-line setting?
This is the optimal approach based on the BREAKWATER data and known activity of FOLFOX. There will never be a specific study for this entity. Sometimes we must extrapolate.
Which GI cancer patients do you use oral contrast in staging CT scans?
We do not use oral contrast for most of our patients and only offer oral contrast CT scans for patients we are concerned about perforation.
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
How would you manage a patient with polycythemia and MPN symptoms (aquagenic pruritus, fatigue) that is JAK2/CALR/MPL negative but peripheral blood NGS positive for IDH2?
I would approach this through the framing of a polycythemia/erythrocytosis workup and then consider MPN-related interventions if a diagnosis is made! This is an excellent review that provides an overview of erythrocytosis investigation (Noumani et al., PMID 38695361). In brief, I would be thinking a...
How would you manage a patient with polycythemia and MPN symptoms (aquagenic pruritus, fatigue) that is JAK2/CALR/MPL negative but peripheral blood NGS positive for IDH2?
I would approach this through the framing of a polycythemia/erythrocytosis workup and then consider MPN-related interventions if a diagnosis is made! This is an excellent review that provides an overview of erythrocytosis investigation (Noumani et al., PMID 38695361). In brief, I would be thinking a...
What is the preferred second-line therapy for HER2-positive patients with esophageal squamous cell carcinoma who have progressed on first line Trastuzumab and Immunotherapy?
I'm assuming we are talking about HER2+ esophageal adenocarcinoma? If that's the case, 2L T-DXd is the way to go. After confirmation of persistent HER2 expression (ctDNA showing positive amplification or rebiopsy with IHC). DESTINY-Gastric04 confirmed the superiority of T-DXd over PAC/RAM in 2L.If y...