Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel a woman with a BRCA1 VUS with a high-risk personal history of breast cancer?
There is real harm to patients by ‘acting’ on the presence of VUS in BRCA1; the majority are reclassified as benign. For those who have access to genetics resources, it is very helpful to discuss these results with certified genetics counselors, and formal post-test counseling for patients is recomm...
How will the PROSPECT trial presented at ASCO 2023 change your current management of early rectal cancer?
I can’t overstate how much credit the Principal Investigator, Dr. @Dr. First Last, deserves for successfully completing the PROSPECT trial. The oncology community, particularly the radiation oncology community, was concerned that omitting radiation would put patients at risk. It was difficult and ch...
How long post operatively do you wait before transitioning from parenteral anticoagulation to oral anticoagulants after pulmonary thromboendarterectomy for CTEPH?
It depends. In straightforward cases, we are pretty aggressive with starting anticoagulation to prevent re-thrombosis after pulmonary thromboendarterectomy. These patients are started on parenteral anticoagulation (with IV heparin) on POD #0, usually within several hours after arriving in the ICU if...
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
I would recommend a DOAC, particularly apixaban, with follow-up imaging in 3 months.
How do you manage immunotherapy-induced myasthenia gravis?
My go-to algorithm is well-represented in the paper by Dr. @Dr. First Last et al. Zubair et al., PMID 36439604
Do you give trastuzumab to women with small, lymph node negative, HER2-positive breast cancer?
Size, hormone receptor status, age, cardiac risk factors and patient opinion matter.HER2 itself is only a moderately strong poor prognostic factor; histologic grade, size, and nodal status carry greater prognostic information. Most T1, N0, HER+ breast cancers, particularly ER+, cancers, had an excel...
How do you manage a patient with low risk MDS who achieves transfusion independence with luspatercept but continues to have fatigue?
This is a challenging question and I'm not sure there's clear data to support a practice one way or another. Anecdotally, I have noticed that when using Luspatercept, it seems to improve hemoglobin reliably and therefore lead to less transfusions, but I have not observed a consistent concordant impr...
How do you manage a patient with low risk MDS who achieves transfusion independence with luspatercept but continues to have fatigue?
This is a challenging question and I'm not sure there's clear data to support a practice one way or another. Anecdotally, I have noticed that when using Luspatercept, it seems to improve hemoglobin reliably and therefore lead to less transfusions, but I have not observed a consistent concordant impr...
How would you approach dose modifications and/or frequency of lenalidomide in patients with advanced renal impairment (eGFR <30)?
Great question - comes up a lot in discussion with community providers. The dosing is dependent on what your target dose would be. If normal dosing was 25 mg and CrCl <30 and not on dialysis, then I follow the package insert "15 mg every other day". If the patient tolerates that ok, I increase to 10...
What genetic testing would you consider for recurrent arterial events (cryptogenic strokes, MI) in patients with limited risk factors?
This would be a case-by-case evaluation with additional history, examination and imaging features. I would take a multidisciplinary approach and also consult with hematology and cardiology. I am assuming all other workups are negative. I would probably repeat APLS labs in 6 weeks with lupus anticoa...