Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?
I frequently recommend low-intensity DOAC therapy in this setting, but only after careful consideration of the patient's risk factors for recurrent VTE and bleeding, and after determining the patient's preference about treatment options following a discussion of the pros and cons of each option.
Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?
I frequently recommend low-intensity DOAC therapy in this setting, but only after careful consideration of the patient's risk factors for recurrent VTE and bleeding, and after determining the patient's preference about treatment options following a discussion of the pros and cons of each option.
Can durvalumab incorporation to gem+cis for advanced BTCs allow for earlier discontinuation of cytotoxic chemotherapy in patients exhibiting response?
The TOPAZ-1 study was double blinded, and there were no meaningful differences in gemcitabine/cisplatin treatment duration between the groups. I do not intend to give fewer cycles of gemcitabine/cisplatin now that durvalumab has been added to the armamentarium. In the past, I would usually discuss m...
How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?
This specific question has not been addressed in a clinical trial to my knowledge. If the patient is symptomatic, I would anticoagulate for 3 months in the absence of a contraindication, just as I would for most other provoked VTE events. One might consider a watch and wait approach without anticoag...
How do you determine duration of anticoagulation for an ovarian vein thrombosis following a provoking event?
This specific question has not been addressed in a clinical trial to my knowledge. If the patient is symptomatic, I would anticoagulate for 3 months in the absence of a contraindication, just as I would for most other provoked VTE events. One might consider a watch and wait approach without anticoag...
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
Do you offer adjuvant chemotherapy to patients with rectal cancer who were on Watch-and-Wait, had local recurrence and underwent resection?
I would not. Watch and wait indicates the patient already received some form of chemotherapy and I do not know that additional chemo after removing a regrowth of the tumor will make much or any difference.
What is the appropriate treatment approach for a primary squamous cell carcinoma of the trachea?
Treating tracheal malignancies is obviously challenging. I typically determine treatment based on the location of the primary. Upper tracheal (above the sternal notch) I treat more like a HN cancer while below that I treat more like a lung cancer. Upper tracheal cancer are more difficult to resect d...
Is there a role of adjuvant or systemic therapy for patients with resected stage I colon cancer with subsequent local recurrence S/P a second resection and now has NED?
Tough question. Depending on the numbers, there is literature to suggest 5% recurrence and also in some ctDNA series of similar numbers have recurrence.In general, it would not be unreasonable to offer some systemic. However, the decision to consider that would be in the context of: Clinical details...