Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you discontinue tamoxifen for endometrial hyperplasia without dysplasia in the adjuvant setting?
I would not. Endometrial hyperplasia is to be expected on tamoxifen, especially in a postmenopausal woman. It is not recommended to do a transvaginal ultrasound or endometrial biopsy without suspicion of tamoxifen. I would not change therapy in the absence of other suspicious findings.
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
The biggest question in these situations is whether the patient truly has iron overload vs. just high ferritin. If iron sat is not elevated, true iron overload is very unlikely. If both ferritin and iron sat are elevated, but they don't have a homozygous C282Y genotype, I make sure that the patient ...
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
The biggest question in these situations is whether the patient truly has iron overload vs. just high ferritin. If iron sat is not elevated, true iron overload is very unlikely. If both ferritin and iron sat are elevated, but they don't have a homozygous C282Y genotype, I make sure that the patient ...
How do you manage the severe adverse drug reaction of central serous retinopathy with MEK inhibitors?
Fortunately, the ICSC-like association of subretinal fluid with MEK inhibitor exposure is usually reversible after cessation of the drug. When working with this class of medications, it is important to coordinate care with the treating oncologist. If a patient presents with subretinal fluid and is o...
Do you continue ovarian suppression for metastatic hormone-positive breast cancer patients who are premenopausal, regardless of line of therapy?
I continue OFS while a patient is on an endocrine therapy, but discontinue OFS if the patient demonstrates resistance to endocrine therapies and transitions to chemotherapy, which typically suppresses ovarian function anyway.
Would you recommend indefinite or extended anticoagulation in any scenario of a provoked clot?
The answer, like most decisions with the duration of anticoagulation after a VTE, is it depends. The provoking factor is key to determining whether anticoagulation continuing beyond the treatment of the acute event is needed. If the provoking factor was a joint replacement surgery, even in the prese...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...
How do you manage reactive thrombocytosis and potentially symptomatic fatigue from JAK2+ P Vera with iron deficiency?
This is a challenging scenario since if you start supplementing iron, you can increase erythropoiesis, raise the hematocrit, require more therapeutic phlebotomies, and end up chasing your own tail. For these reasons, I generally recommend against iron supplementation in PV. Regarding the fatigue and...
How do you manage reactive thrombocytosis and potentially symptomatic fatigue from JAK2+ P Vera with iron deficiency?
This is a challenging scenario since if you start supplementing iron, you can increase erythropoiesis, raise the hematocrit, require more therapeutic phlebotomies, and end up chasing your own tail. For these reasons, I generally recommend against iron supplementation in PV. Regarding the fatigue and...