Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?
The reported evidence on using a TPO-RA in chemotherapy-induced thrombocytopenia (CIT) is complicated but this seems like a situation where it is worth trying a TPO-RA. Repeated dose reduction and/or delay is not good for treatment of a cancer in general. It is very important to individualize the ca...
Would you give transdermal hormone replacement therapy to a woman with remote history of provoked pulmonary embolism?
There is good evidence that transdermal HRT does not pose the same risks as oral HRT (Morris and Talaulikar, PMID 36573625). ASA or DOAC prophylaxis is likely not indicated.
Can a patient with MDS have ring sideroblasts in the absence of mutation such as SF3B1?
Yes, < 50% of MDS RS have SF3B1 mutation by NGS. Malcovati et al., PMID 32347921
How would you approach radiation therapy for indolent T-cell lymphoproliferative disorder of the gastrointestinal tract?
Indolent T-cell lymphoproliferative disorder of the GI tract was a provisional entity in the 4th edition of the WHO classification system. In the 5th edition, the disease has been renamed, "Indolent T-cell lymphoma of the GI tract" (Alaggio et al., PMID 35732829). The disease is rare, often mimickin...
Do you utilize post-vaccination IgG titers to detect common variable immunodeficiency in patients who are about to start or are actively on B cell depleting therapy?
I have checked M-M-R, Td, and pneumococcal titers in patients with hx of infection and low Ig levels to see if they are making an immunological response. If any of these immune titers are low or the immunization is “due” by routine schedules, I recommend immunization and repeat testing in 6 weeks. T...
How do you approach a patient with chronic low ADAMTS13 activity and low level of inhibitor without signs of thrombocytopenia or hemolysis?
I'm assuming there is a history of overt TTP that led to the ADAMTS13 level being measured.In patients with a history of TTP, I monitor the ADAMTS13 level every 1-6 months (more often if the level is lower or dropping) and administer a single dose of rituximab if it drops below 20%. In my experience...
How do you manage anticoagulation bridging for outpatient ESKD patients given concerns for bleeding risk with enoxaparin in this population?
I don't think we know what is the best route to take. Personally I still usually give lower doses of enoxaparin but it all depends on the circumstances. Why the patient needs anticoagulation? Does the risk of hospitalization out way the risk of increased bleeding from enoxaparin? Can the patient get...
How would you approach grade 2 neurologic toxicity in a patient on daratumumab, dexamethasone, and lenalidomide for relapsed multiple myeloma?
Clarification of the question was made, and it was focused on peripheral neuropathy. The polyneuropathy in Dara/Rev/dex is mostly due to the Revlimid. Most neuropathy from rev, if any, is grade 1- 2. The first step will be to start with gabapentin without reducing the dose of Revlimid. It is a very ...
How do you approach a patient with CP-CML who has a history of inadequate response and severe myelotoxicity to multiple TKIs such as imatinib, nilotinib and dasatinib?
This depends in part, on the status of the disease (transcript levels), the doses of TKIs that have been used, the nadir blood counts, what lineages are involved in myelosuppression, and the comorbidities of the patient. In principle, ponatinib or asciminib could be used. If ponatinib, I would start...
What is the most convenient and reproducible setup for simulation and treatment of the contralateral testis in a primary testicular lymphoma?
Frog leg position with the penis taped to the pubic/abdominal wall. Usually, electron beam with energy based on thickness and dose of 24 Gy.