Medical Oncology

Pediatric Oncology   

Questions discussed in this category


For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?

There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?

If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your man...

Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again afte...

How is your approach different from or similar to those who undergo surgical menopause? 

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...

Would surgical margins, evidence of angiolymphatic spread, number of lymph nodes removed during surgery inform your decision? 

iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.

Ewing sarcoma of the right lung, status post bi-lobectomy and adjuvant VDC/IE, with recurrence 6 years in the right lung only. He has reached a cumula...

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

Is this an artifact of what agent prior clinical trials used or something to do with mechanism of action (ie less mineralocorticoid effect of dex)?

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked. 

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP?  What ...

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

Do your recommendations differ between those who receive ABVD and escalated BEACOPP? Do you recommend consultation with fertility specialists for all...

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Results of AHOD1331 are not yet known, but adults have started using Brentuximab upfront for high risk patients  

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How often do you monitor ADAMTS-13 levels off therapy?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

NCCN guideline V4.2021 DLBCL page BCEL-3 states stage I-II, bulky >= 7.5cm should be treated with 6 cycles of RCHOP, but most bone lymphoma studies...

Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

Would you use ALK inhibitors such as crizotinib based on recent phase II data? Are there any research efforts to combine ALK inhibitors with current ...

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

If standard of care BEP chemo, tandem transplant, and radiation to primary site have been done previously.

What is the lowest level you have seen with uncomplicated or complicated crises?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy. 

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

What if the patient has a history of confirmed COVID-19 but has since recovered?

Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...


Papers discussed in this category


JAMA,

Gynecol Oncol, 2019 Aug 16

Cancer, 2004-08-15

Br. J. Haematol., 2003-11-01

Br. J. Haematol., 1998-08-01

Cancer, 1990-11-15

Radiother Oncol, 1990-01-01

Clin. Cancer Res.,

Fertil. Steril., 2013 Sep 05

J. Clin. Oncol., 2019 Sep 25

Lancet Oncol., 2020 Feb 14

Ann. Oncol., 2020 Mar 26

J. Clin. Oncol., 2019 Sep 10

Journal of the National Cancer Institute, 2005-09-21

Eur. J. Cancer,

Br. J. Cancer, 2007 Jan 30

American journal of hematology, 2018-08

Blood, 2019-04-04

Am. J. Hematol., 2019 Nov 19

J. Neurosurg., 2017 Mar 03

Acta Neurochir (Wien), 2019 Jan 29

J. Neurooncol., 2018 Apr 06

Proceedings of the National Academy of Sciences of the United States of America, 2015-11-03

Oncologist, 2020 Mar 10

Semin Diagn Pathol, 2016 Dec 23

The New England journal of medicine, 2007-01-25

Haematologica, 2020

Nature, 2019-03

Blood, 2018 May 02

Leuk Lymphoma, 2019 Dec 26

Journal of the National Cancer Institute, 2013-08-21

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2010-02

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-09-01

Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2016-04

Blood, 2018 Jul 12

Ann. Intern. Med., 2019 Oct 15

Blood Transfus, 2018 Oct 24

J Thromb Haemost, 2018 May 08

The New England journal of medicine, 2017-02-02

Blood, 2009 Nov 10

Clin Lymphoma Myeloma Leuk, 2017 Mar 07

American journal of hematology, 2011-10

The American journal of medicine, 2017-12

American journal of hematology, 2018-05

Am J Hematol, 2020 Jun 29

Am J Hematol, 2019 Sep

Am J Hematol, 2018 Jun

JAMA,

N Engl J Med,

The journal of allergy and clinical immunology. In practice, 2017

Archives of surgery (Chicago, Ill. : 1960), 2008-07

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2018-01

Ann Surg,

N. Engl. J. Med., 2015-04-23

Blood, 2018 Sep 6

J Clin Oncol, 2017 Mar 14

Blood, 2020 Sep 23

The Lancet. Oncology, 2017-11

The Lancet. Oncology, 2018-03

The Lancet. Oncology, 2019-06

J Hematol Oncol, 2016 Jun 03

Blood, 2013-12-05

Blood Adv,

Blood,

Blood, 2013 Sep 19

The Lancet. Haematology, 2015-09

Haematologica, 2017-07

American journal of hematology, 2019-04

Cancer medicine, 2019-01

Journal of the National Cancer Institute, 1988-07-06

Annals of oncology : official journal of the European Society for Medical Oncology, 2015-02

Anticancer Drugs,

J Adolesc Young Adult Oncol, 2019 Nov 08

N. Engl. J. Med., 2018-01-25

Bone Marrow Transplant, 2019 Oct 01

Front Immunol, 2020 Apr 03

Blood, 2021 Mar 08

Gynecologic oncology, 2016-01

Gynecol Oncol, 2020 Jul 9

Gynecol Oncol, 2020 Jul 25

J Clin Oncol, 2021 Apr 07

Ann Oncol, 2007 Nov 15

Leuk Lymphoma, 2019 Nov 04

Seminars in hematology, 2013-07

Pediatr Blood Cancer, 2019 Jul 24

J. Clin. Oncol., 2020 Feb 14

Cancer, 2020 May 19

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-01

Cancer, 2020 Mar 15

J Clin Oncol, 2021 Apr 06

Ann Oncol, 2021 Mar 18

Clin Transl Oncol, 2020 Sep 17

J Assist Reprod Genet, 2020 Jun 02

Lancet Oncol, 2018 Sep 13

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-02-20

Lancet (London, England), 2010-12-11

Blood, 2012 Apr 04

Clin Lymphoma Myeloma Leuk, 2019 Sep 30

Bone Marrow Transplant, 2018 Jun 08

J Clin Oncol, 2020 Apr 10

The Lancet. Oncology, 2017-09

Blood, 2016-07-14

Blood, 2016 Sep 26

Transfusion, 2020 Sep 24

Lancet Haematol,

British journal of haematology, 2014-06

International journal of radiation oncology, biology, physics, 2019-06-01

Annals of oncology : official journal of the European Society for Medical Oncology, 2007-04

Blood, 2018-07-05

Blood,

Blood,

J Clin Oncol, 2021 Jun 25

Blood, 2019-06-06

Eur J Haematol, 2021 Feb 17

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2011-10

Journal of oncology practice, 2019-01

Support Care Cancer, 2021 Aug 16

Arthritis Rheumatol, 2021 Apr 01

The New England journal of medicine, 1981-09-24

Ann Intern Med,

Cancer, 2011 Feb 01

Practical radiation oncology, 2019-03

Cancer Cell, 2020 Oct 08

J Gen Intern Med, 2021 Feb 02

JAMA Netw Open, 2020 Jun 01

Blood, 2008-02-15

Blood, 2016-07-28

Blood advances, 2016-12-27

The Lancet. Haematology, 2018-12

N Engl J Med,

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2015-04

Pediatr Blood Cancer, 2019 Jul 31

Journal of hospital medicine, 2018-08-01

Front Oncol, 2022 Mar 09

BMJ Support Palliat Care, 2022 Jul 08

Nutr Cancer, 2019 Oct 12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-03-01

Sci Rep, 2020 Jul 01

Neuro Oncol,

Annals of oncology : official journal of the European Society for Medical Oncology, 1993-11

Gastroenterology, 1993-06

Gastroenterology, 1991 Jul

Z Naturforsch C J Biosci, 2002 Mar-Apr

Immunopharmacol Immunotoxicol, 2003 Nov

Exp Toxicol Pathol, 2002 Feb

Biochem Biophys Res Commun, 1999 Sep 24

Ital J Gastroenterol Hepatol, 1998 Dec

Chem Biol Interact, 2001 Dec 21

Metal-based drugs, 2010

J Allergy Clin Immunol Pract, 2019 Feb 15

Pediatr Blood Cancer, 2021 Apr 12

The Lancet. Haematology, 2019-03

J Clin Oncol, 2021 Dec 02

Urology, 1982-09

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2009-03

Clin Infect Dis, 2005 Jan 21

Pediatr Transplant, 2014 Sep 08

J Clin Oncol, 2021 Apr 30

Pediatr Infect Dis J, 2014 Nov

Bone Marrow Transplant, 2006 Mar

Clinical cancer research : an official journal of the American Association for Cancer Research, 2008-01-15

Eur J Clin Pharmacol, 2001 Aug

JAMA Netw Open, 2021 Aug 02

Blood, 2006-05-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-02-01

Blood, 2017-03-09

The Lancet. Oncology, 2015-10

N Engl J Med, 2013 Jul 11

Blood, 2012 Jun 19

Genetic epidemiology, 2016-09

American journal of hematology, 2019-03

Blood, 2021 Jan 07

Blood, 2019-04-11

N Engl J Med, 2022 Dec 11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-02-01

Obstet Gynecol, 1998 Oct

Acta Oncol, 2019 Apr 08

Journal of neurosurgery, 2013-04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-01

Cochrane Database Syst Rev, 2020 Apr 28

J Clin Pharmacol, 2021 Jul 16