Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When considering the use of DOACs in APLS, does the number of positive APLS antibodies influence your decision?
The number of antibodies is an important consideration.On the one end of the spectrum, I would not recommend any DOACs in a triple positive APLS (especially with arterial thrombosis). Having said that, I would not change treatment in a triple positive APLS patient if they were started on DOACs in th...
Do you always initiate hypercoagulable work up in a patient with recurrent stroke?
As always, this is a more complex problem than it appears. A history of both prior other thrombosis and family history of thrombosis is essential. Are there good reasons for the stroke and/or has it been worked out in past including carotid disease, atrial fibrillation, underlying malignancy, valvul...
Do you always initiate hypercoagulable work up in a patient with recurrent stroke?
As always, this is a more complex problem than it appears. A history of both prior other thrombosis and family history of thrombosis is essential. Are there good reasons for the stroke and/or has it been worked out in past including carotid disease, atrial fibrillation, underlying malignancy, valvul...
How will you treat a young man with recurrent cryptogenic strokes with no identifiable cause, with MTHFR A1298C homozygous mutation and normal homocysteine level?
The genetic variant you report seems to be a SNP that, while it has been reported to be statistically associated with various diseases in GWAS studies, is not pathogenic. SNPs that are significant in GWAS studies have very small effect sizes that can be measured when considered in thousands of peopl...
Can lupus anticoagulant be positive despite a normal aPTT?
aPTT is one of the assays that may be abnormal in the presence of lupus anticoagulant, but not always. Usually, when screening for lupus anticoagulant, there will be a "special" aPTT assay used that is a bit more sensitive to detect lupus anticoagulant. There are several different aPTT-based assays ...
Do you give adjuvant chemotherapy/trastuzumab to a premenopausal woman with a pT1aN0 HR+, Her2+ breast cancer?
Existing data are from convenience cohorts, but generally don't support infusional therapy for T1aN0 HER2+ tumors, who seem to do well with DRFS well above the usual threshold for intervention of 8-10%. An analysis from the MDACC database included about 250 untreated T1a-bN0 HER2+ tumors with long-t...
Is DLL3 expression necessary for tarlatamab efficacy in small cell lung cancer?
Yes- tarlatamab is a bispecific T-cell engager targeting DLL3, and thus, DLL3 expression is needed. Given the widespread expression in SCLC in approximately 90% of cases, testing for DLL3 expression prior to administering drug therapy is not required.
How do you modify the hemoglobin goal and ESA dosing for patients with sickle cell anemia and ESKD on hemodialysis?
In sickle cell patients, I coordinate care with the patient's hematologist. I will reduce the hemoglobin goal to 8-10 g/dl, and if patients have a history of crises, closer to 10 g/dl, I may choose 7-9 g/dl. ESA requirements seem to be higher in sickle cell patients, so I would start with 100 units/...
Would you consider bevacizumab for a patient with SCLC who has asymptomatic brain metastasis progression after CNS radiation while on maintenance immunotherapy?
I am assuming SCLC is small cell. I wouldn't do it now that we have agents such as tarlatamab, which has better CNS penetrance. Adding bevacizumab to atezo does have a rationale and theoretical benefit. The CeLEBrATE study, which was recently published, showed synergy between chemo, atezo, and bev, ...
For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?
It depends - favorable/unfavorable, distribution of disease, co-morbidities, gender, family history, etc. I don't treat pediatric patients, so the comment below applies strictly to young adults.If a patient has early-stage, favorable HL per GHSG criteria (no risk factors), then 2 cycles of ABVD + 20...