Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For von Willebrand type 2B, do you expect a decline in platelet count over time as vWF increases with age?
Von Willebrand factor levels increase with age in normal people and in those with type 1 VWD. There is no or a much lesser degree of VWF rise in variants type 2 and 3. I would not expect a significant decrease in the platelet count in a patient with type 2B with increasing age, but if it occurred, ...
At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?
There is no level. I have given IV iron to people with low TSATs and ferritins in the thousands. 200 isn't even close to too high.
Do you avoid ESA use in patients with anemia and chronic kidney disease who also have APLS and risk for thrombosis?
I normally don't. I would make sure the patient is getting anticoagulated if indicated. I don't believe making the hemoglobin closer to normal in the setting of being anticoagulated increases thrombosis risk that much. I would shoot for a hemoglobin goal of 10-11.
How do you approach a recurrence of grade 3 anaplastic astrocytoma after initial treatment with gross total resection followed by RT/adjuvant temozolomide?
As the questioner notes, this is an area where guidelines and published evidence are not as satisfying as we would like, so treatment has to be individualized. In addition, most trials until very recently did not test IDH status or 1p/19q status so the diagnoses may not be the same as people diagnos...
What is your approach to treating limited stage DLBCL of the colon?
Often times patients with CSIE DLBCL of the colon will receive the diagnosis after a hemicolectomy intended to treat presumed colon adenocarcinoma. In such cases, I will routinely offer short-course chemotherapy consolidaton (3 cycles of RCHOP chemotherapy, most commonly; R-da-EPOCH can be considere...
What is your approach to treating limited stage DLBCL of the colon?
Often times patients with CSIE DLBCL of the colon will receive the diagnosis after a hemicolectomy intended to treat presumed colon adenocarcinoma. In such cases, I will routinely offer short-course chemotherapy consolidaton (3 cycles of RCHOP chemotherapy, most commonly; R-da-EPOCH can be considere...
Is there safety data regarding the use of hormonal IUDs in patients with atypical ductal hyperplasia and other high risk, non-malignant breast lesions?
In searching the literature, I find nothing specifically about progestin-based IUDs and women at increased risk of breast cancer. Some studies, however, have found that hormonal birth control methods, including intrauterine devices (IUDs) containing progestin, may slightly increase the risk of breas...
What immunosuppressive agents would be available to patients with a history of melanoma?
Generally, we try to use conventional synthetic DMARDs when possible. However, studies in RA have not shown an increase in de novo melanoma or recurrence of cancers more generally with TNF-inhibitors. So this is an option for patients with RA and melanoma history who are not responding to csDMARDs. ...
How would you treat an MSI-H metastatic cholangiocarcinoma found on liquid biopsy?
This question has come up several times over the years at the Cholangiocarcinoma Foundation Conference. Several case outcomes were presented by numerous colleagues.We are, in fact in the process of finishing up a series on this exact scenario.At present, I have 2 active patients where from the insur...
How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?
I usually treat my triple negative breast cancer patients (whether or not there's a deleterious mutation in the homologous recombination repair pathway, e.g. BRCA1 or BRCA2) with neoadjuvant docetaxel + carboplatin. The addition of carboplatin to taxane-based neoadjuvant chemotherapy regimens was ev...