Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
Should you consider thromboprophylaxis, even for low-dose lenalidomide maintenance, post-autologous transplantation?
In the event there are no adverse contraindications for the use of thromboprophylaxis, yes, I recommend the use of a minimum of 81 mg of aspirin daily with a low dose of lenalidomide. In this meta-analysis (Chakraborty et al., PMID 31913498), the risk of venous thromboembolism was low with a low dos...
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
The first question in this situation is what is the JAK2 V617F neutrophil quantitative allele burden (NAB)? It must be less than 50% for a diagnosis of essential thrombocytosis (ET). Second, are we dealing with a man or woman? Men with so-called "ET" are much more likely than women to develop myelof...
How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?
The first question in this situation is what is the JAK2 V617F neutrophil quantitative allele burden (NAB)? It must be less than 50% for a diagnosis of essential thrombocytosis (ET). Second, are we dealing with a man or woman? Men with so-called "ET" are much more likely than women to develop myelof...
When do you consider cytoreduction in patients with Essential Thrombocytosis?
I consider cytoreduction for patients with ET if they are at high risk of thrombosis based on the R-IPSET score. For intermediate risk patients, I factor in medical comorbidities and symptoms to help decide to initiate therapy. I don't start cytoreduction based on a platelet count alone. If a patien...
When do you consider cytoreduction in patients with Essential Thrombocytosis?
I consider cytoreduction for patients with ET if they are at high risk of thrombosis based on the R-IPSET score. For intermediate risk patients, I factor in medical comorbidities and symptoms to help decide to initiate therapy. I don't start cytoreduction based on a platelet count alone. If a patien...
Would you add immunotherapy to chemotherapy in the adjuvant treatment of resected small cell lung cancer?
In the absence of data in this space, no. The improvements observed in ES-SCLC in IMpower133 and CASPIAN with the addition of ICI were modest at best. Pending results from ADRIATIC and NRG LU005 for benefits in the limited stage population, but this would still require a leap of faith to the adjuvan...
Is proximal duodenal adenocarcinoma (above the ampulla of Vater) considered biologically similar to colon adenocarcinoma or gastric cancer?
There are differences in their biology, however, duodenal cancers are treated with CRC regimens.
How do you approach frontline treatment for an elderly patient with adult T-cell leukemia-lymphoma (ATL)?
More information is needed. As you know, there are four clinical variants of ATL that differ in clinical presentation, prognosis and need for treatment. Are you dealing with acute, lymphoma-type, or unfavorable chronic-type ATL? If so, for elderly patients (≥70 years), a CHOP or CHOP-like regimen, b...
How do you approach frontline treatment for an elderly patient with adult T-cell leukemia-lymphoma (ATL)?
More information is needed. As you know, there are four clinical variants of ATL that differ in clinical presentation, prognosis and need for treatment. Are you dealing with acute, lymphoma-type, or unfavorable chronic-type ATL? If so, for elderly patients (≥70 years), a CHOP or CHOP-like regimen, b...