Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How should elevated PT of unclear etiology and significance be evaluated?
Mild prolongation of the prothrombin time (PT) may represent a normal ‘outlier’. If there is no obvious explanation for a moderate to marked prolongation of the PT (for example, anticoagulation therapy effect, liver disease, nutritional deficiency like vitamin K deficiency. then the next step is to ...
How would you treat lymphoplasmacytic lymphoma (LPL) with a non-IgM paraprotein?
My treatment approach would be similar to those with IgM LPL (WM).
What's the role of ibrutinib and venetoclax in CLL in light of data emerging from ASH 2022?
Authored by @Dr. First Last and @Dr. First Last The current FDA-approved, standard-of-care for frontline chronic lymphocytic leukemia (CLL) therapy includes continuous therapy with a Bruton tyrosine kinase inhibitor (BTKi) such as ibrutinib or acalabrutinib, with or without an anti-CD20 antibody, or...
When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?
The Khorana scoring system is a great tool when this question comes up. I use it for all my ovarian cancer patients who have measurable disease in the neoadjuvant and adjuvant settings. I re-evaluate their score every 3 months to ensure they are still candidates for VTE ppx. Mulder et al., PMID 3060...
How would you manage a patient with erythrocytosis of unknown cause in pregnancy?
Pregnancy invokes changes in the blood volume and erythropoiesis: the plasma volume expands, erythropoietin production falls, and the hematocrit (don't use the hemoglobin level) declines (the hydremia of pregnancy) until the last trimester. So that by the third trimester, the hematocrit varies betwe...
How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?
I do not do anything as there are no data to support intervention in this case.
How would you counsel a patient with active SLE on treatment, low to moderate level of one of the APLS antibodies, and remote history of provoked blood clot regarding perioperative anticoagulation?
Without knowing more specific details, my approach would be to repeat the full panel of antiphospholipid antibodies, institute treatment with HCQ if not there already, discontinue all estrogen products and counsel the patient against smoking. I would coordinate perioperative anticoagulation with a h...
What would you use for a maintenance regimen after high dose chemotherapy and autologous stem cell transplant for a patient with 17p-deleted multiple myeloma?
PI/IMiD maintenance — if RVd +/- Dara is used as induction, then Len with Bortezomib q 2 weeks. If KRd is used as induction, then Len with Carfilzomib q 2 weeks. Adjust dose/schedule based on tolerance/side effects.
What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?
This is a great question. I think the most important thing when it comes to the consideration of amyloidosis is thinking of it in the first place! For patients with MGUS (or myeloma) but with red flag symptoms of amyloidosis, it is important to work these up. The studies recommended may differ base...
How do you manage a patient with a nonspecific platelet function disorder and heterozygous protein C deficiency during pregnancy?
Assuming platelet function testing was done as part of a more comprehensive assessment of hemostasis and that there are no other detectable hemostatic defects (e.g., low von Willebrand factor level prior to 3rd trimester), I would not recommend giving DDAVP unless the patient has a significant bleed...