Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?
I prefer to give ferumoxytol 510 mg X 2 doses of available.
How do you counsel patients with minimally symptomatic factor VII deficiency about procedures and periprocedural management?
Partial Factor VII deficiency is relatively easy to discover (long PT/INR) but the bleeding risk tends to be over-estimated. The available evidence (Peyvandi et al., PMID 22321862) suggests that significant bleeding is uncommon unless the factor VII level is less than about 15% of normal. I would th...
Do you account for the effect of coffee on platelet aggregation studies?
Although recommendations from the International Society of Thrombosis and Haemostasis (ISTH) [1] suggest that individuals should avoid caffeine for at least 2 hours before blood is drawn for light transmission platelet aggregation studies, (and be fasting, be rested for 30 minutes, and avoid smoking...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
For patients with a JAK2 positive myeloproliferative neoplasm, do you always perform a bone marrow biopsy at diagnosis?
A bone marrow biopsy is very helpful at diagnosis for patients with MPN as it can clearly establish a diagnosis. Although many times we can guess a diagnosis by looking at peripheral blood counts, we can often miss pre-MF or overt MF without a bone marrow biopsy. For young patients especially, a bon...
Is it appropriate to dose de-escalate in low risk HPV+ SCC of the oropharynx outside of a clinical trial setting?
I am going to write specifically on de-escalating HPV-OPSCC in the adjuvant setting first, important caveats for adjuvant de-escalation, and then about the general philosophy on de-escalation in clinical trials.Concerning adjuvant treatment, after careful consent, we are de-escalating patients with ...
Do you ever change treatment for metastatic breast cancer with rising tumor markers, but no evidence of progression on imaging?
I do not change treatment based on just tumor markers in advanced breast cancer. When there is significant rise in the level of tumor markers, one should be following the patient closely since this could be an indication of disease progression about to declare itself. There are no well conducted lar...
How would you approach a patient with pancreatic adenocarcinoma who completed 6 months of adjuvant chemotherapy without evidence of disease on imaging but an elevated CA 19-9?
In patients with an elevated CA 19-9 and no obvious evidence of visible disease on routine cross-sectional imaging, a thorough evaluation should first be done to exclude occult metastases. This may include bone scan and/or brain MRI, as indicated. If after a complete evaluation, no visible disease i...
Would you consider omission of PORT for node+ NSCLC with a positive margin in the setting of a high tumor PD-L1 score and plans for immunotherapy?
For gross positive margins (R2), no, adjuvant chemoRT followed by consolidation immunotherapy. For R1, SOC would still say PORT and adjuvant systemic therapy. But let's try to tease it out in a more nuanced way from available data. First PD-L1 high is certainly a check in the plus column for a clini...