Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your standard workup and treatment for an incidentally-noted splanchnic vein thrombosis?
Splanchnic vein thromboses are clots found in the portal, splenic, mesenteric or supra-hepatic veins. These can be very challenging because they are often incidentally found and asymptomatic and for these folks, it is very unclear whether we even need to treat them or do any other evaluation. As wit...
How do you manage HIT in a patient with high bleeding risk?
If bleeding risk associated with the administration of an alternative anticoagulant is unacceptably risky, I usually recommend the administration of IVIG. Theodore E. Warkentin, PMID 31274032
Would you re-challenge a patient with refractory multiple myeloma with carfilzomib who responded well but developed grade 3 heart failure and subsequently recovered the EF upon holding carfilzomib?
I avoid rechallenging and try to find a different regimen if applicable. If Carfilzomib was the only option left for RRMM, then you might consider a dose reduction with close follow up with cardio-oncology to optimize HF medications.
Are you comfortable using DOACs in obese patients with VTE?
Although there are no direct randomized trials in this population of patients, emerging data from systematic reviews suggest that DOACs are non-inferior to warfarin in patients >120 kg. (Elshafei et al., PMID 32556939).
What's the optimal management of stage IA nodal ATLL in a young fit patient?
It is a difficult question to answer. More data is needed to give recommendations: LDH, Ca, circulating ATL, lymphocytosis, etc. as it will be useful to sub-categorize her disease as lymphoma-type vs. chronic-type (favorable or unfavorable). It looks like you are treating her as a lymphoma-type whic...
Does discovery of clonal hematopoiesis on liquid biopsy for solid tumors change your treatment approach in terms of which chemotherapy to offer for the solid tumor?
CHIP findings are relatively common. A small percentage of patients with CHIP abnormalities will evolve into a Hematological malignancy depending on the mutation in the 1-2% range. I am unaware of any data that indicates that this percentage increases due to treatment for solid tumors. Therefore, I ...
Does cytoreductive therapy in high risk PV reduce thrombotic events because of better normalization of blood counts as compared to phlebotomy, or through some other mechanism?
I suspect that several factors contribute to the decrease in thrombotic events. First, more consistent normalization of blood counts. However, probably more importantly is the reduction in inflammation. This would be supported by the lower thrombotic events in patients on ruxolitinib vs standard the...
What is the typical time course of cytopenias after CAR-T therapy, and how do you treat them?
There are no specific guidelines but most patients will have some degree of count recovery week 4-6 but albeit not always the strongest recovery.Management of neutropenia varies widely from institution to institution with regards to utilization of GCSF. Some places will start it in a prophylactic ma...
How would you manage a patient with history of follicular lymphoma treated with Bendamustine-Rituximab who now has a new FDG avid lesion that is biopsy proven CD30 positive CD20 negative DLBCL?
Certainly an unusual and challenging situation, and one that raises multiple questions. How long ago was the rituximab - is the CD20- status "true" or might it be a false-negative in the presence of blocking antibodies? Is it really totally negative or rare/dim?But taking at face value that the dise...
Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?
I would not hesitate to use voxelotor in most patients with sickle cell anemia, including Jehovah's Witnesses, if they have not responded to hydroxyurea with near cessation of acute vasoocclusive events and have continued hemolytic anemia. Voxelotor usually reduces hemolysis that results in an incre...