Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What precautions do you take prior to CABG in a patient with sickle cell trait?
Surgery and anesthesia are safe in sickle cell trait (HbAS) when normal precautions are followed. In patients with HbAS and control subjects, the frequency of anesthetic, surgical, and postoperative complications was similar; however, most patients were young, and few thoracic procedures were includ...
For T cell ALL treated in CR (without transplant), how often do you do BM biopsies as part of surveillance, and for how long?
The role of surveillance bone marrow exams in ALL (either B or T-lineage) is a matter of some debate. Thoughtful clinicians can disagree, but in my practice, I do NOT routinely perform these procedures, instead reserving them for signs or symptoms suspicious for relapse. This is analogous to how the...
How do you approach a cervical node biopsy-proven follicular lymphoma in situ in a symptomatic patient with night sweats and PET findings of low SUV uptake throughout the body?
Follicular lymphoma in situ, aka in situ follicular neoplasm (ISFN) is an uncommon entity, representing an early precursor lesion and better conceived of as premalignant as opposed to a true malignancy, and a pathologic diagnosis of ISFN is not an indication for therapy. Most patients with ISFN will...
How do you perform fertility counseling for a patient with a duplication of one of the alpha genes and their partner who has a beta chain point mutation?
There is a 25% chance that a fetus would inherit the alpha-globin genotype ααα:αα and a 25% chance of inheriting the beta-globin genotype βT:β. One family study suggested that the compound heterozygous genotype ααα:αα/βT:β had no clinical manifestations and resembled beta-thalassemia trait. (1) Howe...
Would you recommend adding a TKI to a pediatric regimen for a AYA B-ALL patient with IKZF1 mutation?
I would not add a TKI to standard chemotherapy in this situation. Background/Rationale: IKZF1 mutations (specifically deletions) are associated with inferior prognosis. Specifically, the prognosis appears to be worst with mutations that lead to loss-of-function (e.g., focal deletions [Beldjord et al...
How do you mitigate 6-MP-induced GI toxicity in pediatric and AYA patients with leukemia?
This is a great question as GI toxicities are commonly encountered in children, adolescents, and young adults being treated with 6MP including elevated transaminases, pancreatitis, and hypoglycemia. These GI toxicities are likely due to a skewing of 6MP metabolites with an accumulation of the GI tox...
How would you manage a transplant-eligible patient with DLBCL who relapsed 6-12 months following a CR1 to R-CHOP and then attained a CR2 to platinum-based salvage chemoimmunotherapy?
In this case, given that the patient obtained a CR2 to salvage therapy, I would, if they are otherwise eligible, take this patient to transplant given the data presented by Shadman et al., PMID 34570879 which indicates that those with at least a PR from salvage chemotherapy appeared to benefit as mu...
Would you continue warfarin anticoagulation in patients with unprovoked DVT if switching to low-dose DOAC is cost-prohibitive?
Would continue warfarin if this is cost-effective and doing well.
How can oncologists be more collaborative with palliative care physicians?
First and foremost, for oncologists to be collaborative with palliative care physicians, a trusting relationship is a must (good communication amongst teams is key to optimal patient care). This is akin to PCP-Oncologist (or even PCP-any other specialist relationship). Before advances in science and...
Would you consider complement inhibitor therapy or immunosuppressive therapy (e.g. cyclosporine, corticosteroids) for a patient with a PNH clone and early MDS who presents with pancytopenia?
It would depend on the size of the PNH clone and whether or not it was the dominant process as suggested by the depth of the cytopenias and whether there is evidence of hemolysis. I've seen a number of patients with MDS who are concurrently diagnosed with a small PNH clone and I have directed my tre...