Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How many years of oral antibiotics prophylaxis do you recommend for a teenager with hereditary spherocytosis post-splenectomy?
If older than 5 and vaccinated, no proph.
How do you workup erythrocytosis with a normal or elevated serum erythropoietin?
First, I would consider using the term erythrocytosis rather than polycythemia. Too often, use of the term polycythemia may suggest polycythemia vera (PV) (a malignancy) rather than something more benign.The recommended up front testing in the evaluation of erythrocytosis consists of up front JAK2V6...
Is there any benefit in continuing VRd instead of VR as maintenance therapy in transplant ineligible multiple myeloma?
I love this question - mostly because it makes me think of just one study, but really, I'm excited to hear what others have to say. I always think of RV-MM-PI-0752 (ASH 2018) studying the efficacy and feasibility of dose/schedule adjusted Rd-R vs continuous Rd in elderly and intermediate-fit newly d...
How do you counsel patients who are candidates for a clinical trial regarding their options?
I typically discuss the option with patients as early as possible in their diagnosis, and explain that at some point during their treatment they may become a candidate for a clinical trial. I discuss resources to look into clinical trials and what they mean for patients. We discuss patient website r...
In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?
No... benefit outweighs risk. Evidence of benefit (and its magnitude) is clear without proven evidence of risk in this population (save for potential for increased bruising in setting of severe thrombocytopenia).
Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?
There may be a role for G-CSF for treatment of SLE-related neutropenia, though would recommend using with caution only for severe neutropenia (ANC less than 500) and at lowest dose. The use of G-CSF has been looked at in small case series over the years for both SLE patients with neutropenia and Fel...
How do you approach unresectable or borderline resectable symptomatic nasal/paranasal Rosai-Dorfman disease?
Sinus/nasal/paranasal RDD can be difficult to treat in many cases, with numerous recurrences. There is no one size fits all strategy for these cases, and most recommendations are based on case reports/series or anecdotal experience. If surgical resection is not feasible easily and refractory/recurre...
When would you recommend using a DOAC in a pediatric patient with VTE?
None of the DOACs are approved as of yet below the age of 18 in the United States. However, results of the phase 3 Einstein Junior study (Rivaroxaban) have been published and the FDA application for approval is pending - the hold up is awaiting results of the Rivaroxaban Fontan surgery study to be a...
Do you consider low-dose aspirin for primary thromboprophylaxis in patients with high-risk antiphospholipid antibody profiles?
Yes, I offer low dose aspirin for patients with high titer anti phospholipid antibodies. The patients often agree unless they are concerned of increased risk of bleeding due to their profession or hobbies, such as horseback riding. I do not recall such adverse events. Nevertheless, controlled trials...
What is your preferred oral iron formulation and dosing for treatment of iron deficiency anemia?
I recommend using ferrous sulfate given either every other day or twice weekly. (Powers and Auerbach, PMID 32844200)