Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the preferred duration of adjuvant aromatase inhibitor therapy in patients with triple positive breast cancer?
The preferred duration in ER+PR+/-HER2+ disease for adjuvant aromatase inhibitors is not specifically defined in guidelines separate from ER+ disease in general. An older study looking at recurrence patterns across HER2+ disease (Park et al., PMID 19956951) showed ER+HER2+ disease had more delayed r...
What duration of ADT do you recommend for a patient with locally treated prostate cancer who undergoes metastasis-directed radiation therapy to a single oligometastatic bone lesion?
While I agree with @Dr. First Last that very small studies like STOMP and ORIOLE suggest that a small subset of men can delay the need for ADT by 1-3 years, this is not level 1 evidence. Most men with oligometastatic HSPC will still progress with metastasis directed therapy alone over a short time h...
Would you recommend adjuvant olaparib in a premenopausal BRCA1+ woman with stage IA pT1bN0 ER/PR+ HER2- breast cancer and a high OncoType score?
This is a data-free zone. Although this patient appears to have a high recurrence risk based on her Oncotype RS, she does not seem eligible for adjuvant olaparib based on her clinical-pathological characteristics. The Oncotype RS was not taken into consideration as part of the eligibility criteria i...
How do you approach an otherwise healthy patient with an incidental 1 mm GIST involving the serosal surface in terms of staging workup, EGD, and surveillance?
An EGD periodically, driven by the reason why the patient needed it in the first place, could guide the interval. I would not subject the patient to CT scans or routine oncology follow-ups.
Are patients with MIBC and bladder neck involvement good candidates for bladder preservation with chemoradiation after maximal, but not complete, TURBT?
Both BCON and BC2001 suggest that a complete TURBT may not be essential for bladder preservation. Incomplete TURBT is a surrogate for a higher stage and predicts poorer outcomes irrespective of the modality used for treatment.Elumalai et al., PMID 36517194
How do you choose between blinatumomab and CAR-T cell therapy for relapsed or refractory pre B-ALL?
Many of the cellular therapy products are limited in indication which can help with making the decision, as well as the plan to go to transplant or not. Blinatumomab would have to be consolidated with HSCT while CAR-T can be curative in about 50% of patients without consolidative HSCT, which would b...
How do you approach prophylactic antibiotics in patients who continue to have recurrent neutropenic fever following chemotherapy for solid tumors despite chemotherapy dose reduction and growth factor support?
This has to be individualized to the patient. It depends on the length of neutropenia, previous infections, and local antibiotic resistance. If the patient develops neutropenic fever after every cycle of chemotherapy and no obvious nidus of infection has been identified, a trial of a fluoroquinolone...
How do you approach prophylactic antibiotics in patients who continue to have recurrent neutropenic fever following chemotherapy for solid tumors despite chemotherapy dose reduction and growth factor support?
This has to be individualized to the patient. It depends on the length of neutropenia, previous infections, and local antibiotic resistance. If the patient develops neutropenic fever after every cycle of chemotherapy and no obvious nidus of infection has been identified, a trial of a fluoroquinolone...
In older male patients with a history of underlying autoimmune disease, what clinical manifestations would prompt you to evaluate for VEXAS Syndrome?
Hello!!!Skin lesions, elevated MCV, elevated inflammatory markers.
How should community oncologists practically counsel patients with aggressive lymphomas on the potential treatment course as they move into 2L/3L therapies?
For those who relapse after first line therapy, treatment recommendations are dependent on the timing of relapse. For those who relapse within 12 months of completing first-line therapy and are fit, I would strongly consider referral to a center with CAR T-cell capabilities. As noted before, 5-year ...