Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?
Of note, there are two ongoing clinical trials that should hopefully provide further data on the definitive management of SSPE (NCT01455818, NCT04263038).
Do you use modified FOLFIRINOX preferentially over gem/nab-paclitaxel for first line metastatic pancreatic cancer patients?
Over and beyond patient characteristics, I prioritize mfolfirinox in pancreatic ductal adenocarcinoma patients with (i) known somatic or germ line alterations in DNA Damage Repair genes and (ii) in patients with a high likelihood of such alterations based on clinical/family history (if somatic or ge...
For mild to moderate hemophilia B, do you routinely screen for inhibitors?
Most experts recommend testing for an inhibitor within 6 to 12 months after concentrate therapy, before any major surgery, and if the patient has a poor response to concentrate therapy (lower than the expected level achieved, or shortened half-life). An annual test is also recommended. WFH Guideline...
How do you approach a women with localized HER2+ breast cancer that was HER2+ by FISH but negative (0+) by IHC?
This is challenging, but since HER2 amplification by FISH is defined as HER2 positive by ASCO/CAP guildeines, if the patient is fit for consideration of HER2-directed therapy with chemotherapy, I would still proceed with those regimens.
Is there an optimal bridging radiation dose for aggressive B-cell NHL undergoing CAR T-cell therapy?
The perfect radiation dose for a given patient probably depends on a number of patient and disease-specific factors including tumor biology and genetics, the anatomy of the tumor and adjacent organs at risk, and the radiation technique used. We do not have the ability to recommend such individualize...
How do you approach an ITP patient who responds very well to steroids but the response is short-lived?
Introduce second line therapy. Rituxan pr TPO-RA.
Is there a role for prophylactic tranexamic acid in patients with hematologic malignancy with chemotherapy-induced thrombocytopenia?
There was a recent presentation at the American Society of Hematology testing the use of tranexamic acid in patients with thrombocytopenia in this situation. It did not show benefit. However, we use tranexamic acid if patients have platelet associated bleeding either qualitative or quantitative, and...
How do you manage significant asymptomatic indirect hyperbilirubinemia in patients with hemolytic diseases (SCD, HS, etc.)?
Hello, Indirect bilirubin is from hemolysis, not cholestasis (a few exceptions from rare syndromes), so not associated with stones, and would not expect ursodiol to help. It's a marker of how bad the sickling is - along with LDH, reticulocyte count, and MCHC (which measures cell density, i.e., irrev...
How do you manage occlusive bilateral retinal vasculitis with isolated lupus anticoagulant positivity?
Although I consider myself an expert on retinal vasculitis, I would often solicit help from a physician with expertise in coagulation, especially if that expertise is related specifically to the lupus anticoagulant. A tremendous part of the treatment strategy depends on the location and severity of ...
What are the treatment options for relapsed T-ALL in a patient who was nonadherent with AALL and hyper-CVAD regimens?
Regimens to consider with data for R/R T-ALL include: Nelarabine +/- chemotherapy. There are retrospective data to support adding nelarabine to a chemo backbone (Shimony et al., PMID 36508268 and Shimony et al., PMID 37389830). HMA + venetoclax (Pinton et al., PMID 37889114 and Cao et al., Blood 202...