Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you provide vitamin B12 supplementation to a patient on pemetrexed therapy if their B12 levels are normal or high?
Yes. B12 supplementation has been shown to decrease the risk of paresthesias.
Would you offer adjuvant chemotherapy for platinum eligible patients with pT2pN0 urothelial carcinoma of bladder or UTUC who did not receive neoadjuvant chemotherapy?
I agree with both of my colleagues that adjuvant cisplatin-based combination chemotherapy is unproven for pT2N0 bladder cancer, although the POUT upper tract urothelial carcinoma phase III trial (which demonstrated significantly improved DFS) did recruit >=pT2N0 patients to evaluate adjuvant gemcita...
Do you perform routine interval lung cancer screening in non-smokers who are 1st degree relatives of patients with non-smoking related lung cancers with known EGFR mutations?
I would not. Although there may be a measurable increase in the risk of lung cancer detected in population studies, the absolute risk is probably far below the equivalent of even a low-risk, current or former tobacco user. This is a hard conversation to have with people who believe their risk to be ...
How would you manage JAK2+ polycythemia vera during pregnancy and postpartum?
There are not a lot of data to guide us given the relative rarity of PV in adults of child-bearing age but two published studies may be helpful.An analysis of 129 pregnancies in patients with PV demonstrated that the combination of aspirin plus LMWH had a significantly lower risk of a spontaneous ab...
How would you manage JAK2+ polycythemia vera during pregnancy and postpartum?
There are not a lot of data to guide us given the relative rarity of PV in adults of child-bearing age but two published studies may be helpful.An analysis of 129 pregnancies in patients with PV demonstrated that the combination of aspirin plus LMWH had a significantly lower risk of a spontaneous ab...
Can abiraterone or enzalutamide be substituted for bicalutamide to prevent a flare when initiating ADT with a GnRH agonist for metastatic prostate cancer?
In theory, abiraterone or enzalutamide could potentially help by the mechanism to prevent or abrogate the testosterone flare when starting on GnRH agonists. In practice, however, abiraterone and enzalutamide are more difficult to obtain, need to be dispensed at specialty pharmacies, and require prio...
How would you treat ESRD patients on hemodialysis with recurrent AV fistula thrombosis found with low protein C activity?
I assume that the patient described in the vignette has a negative family and personal history of VTE. PC (and PS) deficiencies are relatively common in ESRD patients. The low levels are thoughts to reflect a combination of true (acquired) reduction and the assay interference rather than true defici...
Do you hold ADT before work up for prostate cancer when ordering advanced imaging such as PSMA PET?
The answer to this question is somewhat context dependent. The influence of ADT on a PSMA PET/CT is likely dependent on the clinical setting in which PSMA imaging is being considered, the duration of ADT prior to imaging, and how a provider plans to use the information to influence his or her treatm...
When do you consider preoperative chemoRT v. chemotherapy in unresectable thymoma or thymic carcinoma?
I believe that the best systemic therapy for thymoma is anthracycline-based (e.g. cisplatin, doxorubicin plus cyclophosphamide (PAC)) as these regimens have historically about a 20-30% higher response rate than non-anthracycline regimens. As such concurrent radiotherapy is not permissible because of...
How do you treat metastatic collecting duct carcinoma of the kidney in the first line setting?
As is the case with all extremely rare neoplams we operate in a nearly completely data free zone. This is a highly aggressive, lethal neoplasm. Cisplatin-based chemotherapy has some, albeit limited activity, thus gemcitabine/cisplatin is reasonable initial therapy if renal function is adequate. I wo...