Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage docetaxel or other taxane-induced nail toxicity?
A variety of nail conditions have been reported with chemotherapy, particularly with docetaxel. There are no proven prevention strategies for taxane-induced nail toxicity. However, there are limited data that the cooling of extremities may help prevent nail complications (Scotte, F, Cancer 2008) but...
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
Ideally, would be at diagnosis to limit sickle related injury and generally, younger patients have less complications but since curative treatment is not perfect, it depends mainly on the donor. For matched sibling donor transplant, under age 5yrs has best outcomes with over 15yrs having more GVHD a...
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
Ideally, would be at diagnosis to limit sickle related injury and generally, younger patients have less complications but since curative treatment is not perfect, it depends mainly on the donor. For matched sibling donor transplant, under age 5yrs has best outcomes with over 15yrs having more GVHD a...
What is the role of adjuvant chemotherapy in a desmoid tumor after R2 resection?
None. In the unfortunate event of an R2 resection, the recommended approach would be to watch/follow the residual disease serially. If indeed progressive and/or symptomatic, then consider options including (?) completion surgery, XRT, or systemic therapy, ideally decided after a multidisciplinary di...
How would you treat a young patient with a resected stage III chromophobe RCC?
Good question, while it is tempting to give adjuvant pembro given stage III we don’t know that chromophobes will respond. Wondering if there’s a specific trial for this. Adjuvant non-clear cell.
How would you approach treating a patient who refuses surgery, but has significant residual disease after chemoradiotherapy for squamous cell carcinoma of the esophagus?
IO and herceptin/perjeta/enhertu
In a patient with low risk T3N1 stage III colon cancer unable to tolerate CAPOX due to profound GI toxicity, would you switch to FOLFOX and extend to 6 months of adjuvant therapy?
While I certainly agree the problem lies with the capecitabine far more than the oxaliplatin, I would approach this patient a little differently. Consider that we are told that the patient had “profound” diarrhea, and no other toxicity (at least, none is mentioned). That would be a bit unusual for c...
For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?
Your approach to incidental thromboembolism found on the workup of malignancy should be similar to any evaluation of a thrombosis. It should be a structured approach with the following questions evaluated before deciding on long-term or short-term anticoagulation. First, one should determine the loc...
For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?
Your approach to incidental thromboembolism found on the workup of malignancy should be similar to any evaluation of a thrombosis. It should be a structured approach with the following questions evaluated before deciding on long-term or short-term anticoagulation. First, one should determine the loc...
For patients with essential thrombocythemia who develop venous thrombosis in the setting of elevated platelet counts, would you continue lifelong anticoagulation even after cytoreduction is achieved?
This is a fantastic question, a true real-life scenario, with unfortunately little data to drive clinical decision making. What we do have to work with is that the combination of ASA plus anticoagulation increases the risk of bleeding, but does not decrease the risk of recurrent thrombosis in MPNs. ...