Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?
I advise patients that there remain many unanswered questions regarding these side effects that will be resolved with longer term use with these agents. Shared decision-making is critical for these discussions. Data available from current extensions of clinical trials for JAKi, additional risk facto...
What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?
Selinexor makes sense in combination with a partner, usually, either Carfilzomib or Pomalidomide, after patients are refractory to RVd --> Dara-Pd --> KPd --> Belantamab. An alternate route might be Dara-Rd --> KPd or PVd --> Bela. In essence, Selinexor is what I use when there's nothing left standa...
In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?
A complex situation and a lot will depend on the clinical circumstances e.g., compliance, type of failure, etc. I would still consider apixaban. However, if the failure was a more serious event, consider alternative anticoagulants.
What workup do you perform to evaluate for underlying triggers/associated conditions in a pediatric patient with autoimmune hemolytic anemia?
The diagnostic workup that I would recommend in order to rule out a possible underlying condition includes the following: Extensive red blood cell typing in anticipation of possible transfusion. Further immune-haematological investigations: C3, C4, CH50 Auto-antibodies (ANA, anti DNA), antiphosp...
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
If the patient is asymptomatic and the catheter is functioning well, I recommend starting anticoagulation.If the patient develops symptoms, he or she should still be anticoagulated but the catheter removed. Anticoagulation options in ESRD patients include Coumadin, Eliquis (my preference is a dose o...
Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?
I would definitely consider BV/Nivo in frontline settings for elderly patients if no trial is available.Prognosis is worse in elderly HL for several reasons - SOC chemotherapy is not well tolerated and biology of the disease is different (mixed cellularity being prevalent and more frequent EBV posit...
How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?
The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, ...
Do you check pertussis serologies when sending labs for antiphospholipid syndrome?
The short answer is no. I do not check pertussis antibodies when evaluating patients for anti-phospholipid syndrome. A slightly longer answer is still no and, for example, a review published in the Annals of Rheumatic Diseases by Ron Asherson in 2003 discussing the relationship between various infec...
In patients with a history of HIT, how do you counsel them on the use of the AstraZeneca vaccine given reports of unusual thrombosis and association with PF4/heparin antibodies?
Until we know more, it seems prudent to avoid the AstraZeneca and J&J vaccines, particularly if there is a history of HIT. The Pfizer and Moderna vaccines use a different technology and have not been associated with the thrombosis/thrombocytopenia syndrome.
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
There is no data to support the 21-day use in everyone. Also, some patients might even need a longer course than the prescribed 21 days if manifestations are ongoing. A good general rule of thumb would be to continue (provided no bleeding or other toxicities) for 3-5-7 days post resolution of ong...