Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?
The lymphocyte variant hypereosinophilic syndrome (L-HES) is a rare form of reactive eosinophilic driven by clonal, phenotypically aberrant T-lymphocytes that secrete IL-5 and other eosinophilopoeitic cytokines. Diagnosis is based primarily on immunophenotyping (flow cytometry) of peripheral blood. ...
How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?
The lymphocyte variant hypereosinophilic syndrome (L-HES) is a rare form of reactive eosinophilic driven by clonal, phenotypically aberrant T-lymphocytes that secrete IL-5 and other eosinophilopoeitic cytokines. Diagnosis is based primarily on immunophenotyping (flow cytometry) of peripheral blood. ...
How do you utilize cytokine panels in your clinical practice?
It's become easier to order cytokine panels that get processed locally in my hospital. However, I think we're still far from knowing how to interpret these or make clinical changes as a result. While it's tempting to think, "If TNF is elevated, I will give the patient a TNF inhibitor, which will mak...
Is it reasonable to offer observation with MRI rather than immediate PCI for patients with limited stage SCLC?
This is an important question with implications for both overall survival (OS) and quality of life (QOL) where level-1 evidence is currently lacking. It is also the subject of an ongoing phase 3 trial (SWOG S1827/Maverick) that randomizes patients with limited-stage (LS) and extensive-stage (ES) SCL...
How do you approach patients with lymph node positive osteosarcoma of the extremities for neoadjuvant chemotherapy?
The treatment for such patients is still the same as for any osteosarcoma. However, I would approach such patients with a mindset of dealing with metastatic disease. The fact that the lymph nodes are positive for osteosarcoma fortels of a poor prognosis (as it makes this a metastatic disease). In ad...
How would you approach a low risk patient <60 yo with platelets <600 K, JAK2 positivity and heterozygosity for factor 5 leiden mutation with no previous thrombosis?
First, some clarification is necessary with respect to the patient's MPN diagnosis because all three MPN can be caused by a JAK2 mutation, but the thrombotic risk is very different in each. Second, this is also a relevant concern because there is no correlation between the platelet count and thrombo...
How would you approach a low risk patient <60 yo with platelets <600 K, JAK2 positivity and heterozygosity for factor 5 leiden mutation with no previous thrombosis?
First, some clarification is necessary with respect to the patient's MPN diagnosis because all three MPN can be caused by a JAK2 mutation, but the thrombotic risk is very different in each. Second, this is also a relevant concern because there is no correlation between the platelet count and thrombo...
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
It depends on the vaccine and prior immunization history. Not all vaccines require an antibody response to be at least partially efficacious. In addition, with any immunocompromised host, reduced effectiveness for all vaccines is expected, but is not a reason to not vaccinate. Serologic testing is h...
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
It depends on the vaccine and prior immunization history. Not all vaccines require an antibody response to be at least partially efficacious. In addition, with any immunocompromised host, reduced effectiveness for all vaccines is expected, but is not a reason to not vaccinate. Serologic testing is h...
Do you follow LFTs in patients on tamoxifen as suggested in the prescribing guidelines?
I check LFTs about every 6-9 months for patients on tamoxifen. In my practice, most patients with an LFT abnormality will have a G1 AST or ALT abnormality when it is discovered. Therefore, this seems to be frequent enough. If LFTs are abnormal, then I hold tamoxifen, and LFTs usually improve or norm...