Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the role of "adjuvant" systemic chemotherapy in patients previously resected NSCLC, now with isolated solitary relapsed brain lesion, treated with resection and SBRT?
Most of the data/publications for treating isolated, solitary lesions (brain or otherwise) revolve around the local therapy (stereotactic radiosurgery or conventional surgery for example), and there is not much data regarding the use of systemic therapy in this setting. There is a recent article sug...
How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?
Dr. @Dr. First Last answered the question of severe thrombocytopenia in a patient with APS and an acute thrombotic stroke. I agree with his approach. However, this “between a rock and a hard place” clinical scenario does also appear not infrequently during the chronic management of patients with APS...
What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?
I have treated occassionally and have recommended 20 cGy to 25 cGy alternate day x 3 or 4 fractions It works well as spleen is a very radiosensitive organ and does not require doses above 150 cGy
What adjuvant therapy would you give to a patient with resected pT4bN2M0 MSI-H colon cancer and post-op markedly elevated CEA but no metastatic disease seen on imaging?
This patient has a high-risk stage III MSI-H colon cancer with persistently elevated CEA without radiographic evidence of disease (given the persistent elevated CEA after surgery, I would get a PET-CT to rule out occult metastatic lesion). The standard answer should be oxaliplatin-based systemic adj...
Are there specific ROS1 fusions/mutations that confer sensitivity or resistance to therapy to help guide treatment selection in first line or at progression?
So far, the fusion partner with ROS1 fusions does not seem to predict response to ROS1 TKIs.
For AML patients, when do you stop antiinfective agents?
Our practice is typically to continue an anti-viral throughout induction/consolidation without stopping the agent. We typically utilize anti-bacterial and anti-fungal when the absolute neutrophil count (ANC) is under 500 and then stop them once the ANC recovers to above 500. Our preferred anti-funga...
For AML patients, when do you stop antiinfective agents?
Our practice is typically to continue an anti-viral throughout induction/consolidation without stopping the agent. We typically utilize anti-bacterial and anti-fungal when the absolute neutrophil count (ANC) is under 500 and then stop them once the ANC recovers to above 500. Our preferred anti-funga...
Do you avoid ESAs in patients with anemia and chronic kidney disease who also have Factor V Leiden?
I personally do not. I think it is better to get the hemoglobin in the 10-11 g/dL range and avoid having to give blood transfusions potentially than the slightly increased risk of hypercoagulability.
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
Engage your Pulmonology colleagues to assist in these difficult cases. Important to rule out other causes of persistent symptoms including infectious processes. Rebronch can be helpful for infectious work up and/or determining the nature of the inflammatory process that is ongoing (for example, the ...
In 2024, do you consider isolated gain(1q) [not amp(1q)] to be a high-risk cytogenetic abnormality in multiple myeloma?
The brief answer from my standpoint is that some patients with 1q gain will have their disease behave high-risk and some will not. The longer answer...As the question alludes to, the presence of high-risk cytogenetic abnormalities and 1q gain should be considered high-risk (or even ultra high-risk)....