Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does phosphatidylserine antibody play a role in the diagnosis of antiphospholipid antibody syndrome?
While additional APLAs such as aPS/PT are being investigated for clinical relevance, to date, they are not established markers for disease. I would interpret the aforementioned paper with caution, as these antibodies were tested in individuals with known and diagnosed APS. Their role in establishing...
When should I consider anticoagulation in an unprovoked upper extremity deep venous thrombosis?
Would do careful history like hunting Would do anticoagulation Age and fam hx may be helpful if one does thrombophilia workup
When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?
I would consider anticoagulation when there are significant risk factors for extension to the deep vein system such as proximity to the deep veins, underlying thrombophilia (cancer in particular), symptoms, and large clot burden.
Do you consider resuming Venetoclax for patients with CLL upon progression/recurrence, in whom Venetoclax/Rituximab achieved CR and Venetoclax was previously well tolerated but stopped after completing 2 years of therapy?
Yes, in such situations in clinical practice, retrying venetoclax is entirely appropriate. How long has the patient been off prior exposure to venetoclax is a factor to consider, more than 2 years would make me more apt to retry venetoclax. Whether the patient has been given BTKi in the past and ha...
How would you manage a provoked blood clot for a patient who had been placed on low dose DOAC for history of unprovoked blood clot?
To clarify the scenario: the patient had an unprovoked VTE for which they are currently on low dose DOAC and now have experienced recurrence in association with a well-defined (as outlined in ASH guidelines Ortel et al., PMID 33007077) provoking event. A number of additional variables would weigh in...
What are your recommendations for adult sickle cell patients who end up being admitted several times a year for pain crises despite hydroxyurea, crizanlizumab, voxelotor, etc?
This is the problem that vexes all people treating sickle cell disease. First, is to be sure that drug dosing is optimized. Both voxelotor and crizanlizumab can be added to hydroxyurea. All three drugs could be used together. Perhaps equally important as drug therapy is to cope as best as possible w...
Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?
I do not use KCentra in this clinical situation. Firstly, the INR is validated for vitamin K antagonists (VKA) therapy only. The VKAs inhibit the synthesis of factors II, VII, IX, and X while the liver produces more clotting factors such as fibrinogen, II, V, VII, IX, X, XI, XII, etc. The INR has no...
How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?
Needs more information. Is the issue unresponsiveness or intolerance? Frequently, patients report GI intolerance and don't really take it. It's crucial to inquire about this and consider trying different preparations to find a suitable option. What was the nature of the iron sucrose allergy? Sometim...
In a patient hospitalized for several days with a refractory pain crisis would you ever consider transfusion, either simple or possibly exchange in an attempt to get the patient over the crisis?
While chronic transfusion therapy has been shown to prevent acute vaso-occlusive pain episodes (see studies that used chronic transfusion to prevent primary and secondary stroke), there are limited data to determine if they are effective for treatment of acute pain caused by vaso-occlusion. There ha...
Would you use a matched sibling donor with a germline heterozygous BRCA1 mutation for stem cell transplant?
This is a challenging question due to the lack of clarity around the risk of hematologic cancers in patients who have BRCA1 mutations if patients with Fanconi Anemia are excluded. The role of BRCA haploinsufficiency in marrow hematologic function in otherwise healthy donors is unclear. Multiple stud...