Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...
What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?
I would like to rephrase the question since as written, the assumption is that hydroxyurea is a preferred therapy for ET, when any careful reading of the literature will show that there is no proven rationale for using chemotherapy of any sort routinely in ET. There is no association between the pla...
When do you re-image patients with a diagnosis of venous sinus thrombosis?
My practice is to perform early reimaging, typically at around 2 weeks, before transitioning from parenteral anticoagulation to oral anticoagulation. This early reassessment is important as recanalization processes begin early and are linked to clinical outcomes. Subsequent imaging at 6 months is al...
How would you approach a patient with desmoplastic melanoma (pT3N0M0) post resection for adjuvant treatment?
Dr. @Dr. First Last - Could you please clarify if there is ulceration or not? That will help us to know if this is stage IIA or IIB melanoma.If this is pT3aN0Mo disease, then this is stage IIA melanoma and dermatology surveillance is offered. No systemic imaging for surveillance is indicated. No adj...
Is S1800A data sufficient to adopt ramucirumab + pembrolizumab in your clinical practice immediately, or is phase 3 data needed?
The control arms in S1800A were docetaxel + Ram (67%) but the other 33% received single-agent docetaxel, gemcitabine, etc. The primary endpoint was overall survival which was reached, but for what it was worth no difference in PFS. In my opinion, it is possible that the modest survival benefit with ...
Does cytotoxic chemotherapy affect the yield of germline testing?
Chemotherapy does not typically affect the yield or accuracy of germline testing for genetic mutations. Germline testing analyzes a person's DNA from a blood sample or other tissue to identify inherited genetic variants. This type of testing focuses on the genetic information that is present in the ...
How do you manage thrombocytopenia when radiating the spleen?
Radiation oncologists are occasionally asked to see patients with symptomatic splenomegaly (early satiety, dyspnea, and pain) and evaluate for radiation therapy. Many such patients have non-functional bone marrow from diseases such as primary myelofibrosis. This leads to extramedullary hemoatopoiesi...
What criteria do you use to select which patients with thoracic mesothelioma to send for an extrapleural pneumonectomy or pleurectomy/decortication?
We approach each patient's case individually when considering multi-modality treatment of pleural mesothelioma; multi-disciplinary communication and planning is vital prior to the initiation of any therapy. Patients with stage IIIA disease or less with epithelioid or biphasic (with predominant epit...
How do you interpret PSMA/PET with focal prostate activity after XRT currently on ADT with stable PSA?
The most concerning element of the case presented is that the patient’s PSA continues to be ≈ 5 while on ADT with presumably castrate levels of testosterone, which should be verified. The current PSA is one order of magnitude greater than would be expected from the effect of ADT alone possibly indic...
How would you approach a patient with M0 castrate-resistant prostate cancer started on enzalutamide who continues to have increasing PSA levels without metastases seen on imaging?
This is an important question, given the new FDA approvals and NCCN guidelines in the M0 CRPC treatment space and likely increased use of apalutamide and enzalutamide in these men with PSA-only CRPC. In general, these studies continued treatment until metastatic progression (soft tissue or bone) was...