Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What dose do you use to palliate multiple myeloma in a vertebral body?
For ISS Stage 1 MM patients who are going to have an OS of over 10 years, I generally prefer a more protracted regimen of 25 Gy in 10 fractions for improved durability of pain control. I typically only treat the symptomatic VB only and use inverse planning. If there is gross epidural disease or cord...
Would you consider using DOACs as a bridge to warfarin instead of heparin or LMWH?
I would feel very comfortable bridging with apixaban, given its relatively short half-life and fairly quick absorption. I think it is very similar to bridging with Lovenox. More importantly, it usually takes at least 24 hours until heparin IV gets to therapeutic levels - it is often too high or too ...
Does plasma donation cause iron deficiency?
It really shouldn't but small amounts of blood are lost with the pheresis machine so it may occur with frequent donation. I would make sure to check from time to time. There are only marginal amounts of Fe in plasma so infrequent donations are unlike to cause iron deficiency.
How do you approach patients with partially occlusive thrombus in the splenic vein posterior to the pancreatic cancer lesion?
I am not a surgeon, but in the absence of other vessels affected, anticoagulation is not absolutely necessary. In these cases, patients can develop varices, specifically gastric varices and they can be at risk of bleeding. So that risk should be considered when/if offering anticoagulation. If bleedi...
How would you treat severe, symptomatic splenomegaly in a patient with ET/MF who has progressed through all approved JAK inhibitors and is not a candidate for alloSCT?
Refractory symptomatic splenomegaly to JAK inhibition is thankfully not common but does occur and requires consideration of both pharmacologic and non-pharmacologic strategies.Clinical trials should first be explored but if none are available or the patient is ineligible, then you can consider hypom...
How would you treat severe, symptomatic splenomegaly in a patient with ET/MF who has progressed through all approved JAK inhibitors and is not a candidate for alloSCT?
Refractory symptomatic splenomegaly to JAK inhibition is thankfully not common but does occur and requires consideration of both pharmacologic and non-pharmacologic strategies.Clinical trials should first be explored but if none are available or the patient is ineligible, then you can consider hypom...
How would you manage liver-metastatic pancreatic neuroendocrine tumor after progression on a somatostatin analogue, chemotherapy, immune checkpoint blockade, and embolization?
The optimal sequencing of systemic therapy beyond somatostatin analogs (SSAs) in patients with pancreatic NETs (pNETs) remains to be determined. Assuming that regional therapy is not feasible, there are several options such as capecitabine/temozolomide (CAPTEM), everolimus, sunitinib, and PRRT. The ...
How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?
If physiologic concentrations of testosterone are not exceeded and the hematocrit is monitored to avoid a pathologic level of erythrocytosis, the risk for thrombosis from testosterone GAHT does not appear to in excess of the general population. I would refer you to the following two articles that pr...
How do you treat clear cell renal cell carcinoma with metastatic recurrence while on adjuvant pembrolizumab?
My colleagues and I recently tried to address this question in a review paper in the Kidney Cancer Journal which is worth a read. In the absence of prospective data in this space, we provide recommendations for clinicians based on existing evidence and constructed a potential algorithm to consider....
What is your approach to symptomatic superficial thrombosis of the pelvic veins occurring in the immediate postpartum period?
I would strongly consider anticoagulation in this scenario given the high risk of thrombosis in the postpartum period.Generally, there is a low threshold to place patients on prophylactic dose anticoagulation for six weeks postpartum (personal history of thrombosis, inherited thrombophilia) given th...