Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to bone imaging in MGUS?
Excellent question. For low-risk MGUS (M-spike <1.5 g/dL, normal serum free light chain ratio, and an IgG type protein), it is reasonable to forego any bone imaging in the absence of any relevant bone-related symptoms. The rate of bone involvement in patients with an M-spike of 1.5 g/dL was noted to...
What is your approach to bone imaging in MGUS?
Excellent question. For low-risk MGUS (M-spike <1.5 g/dL, normal serum free light chain ratio, and an IgG type protein), it is reasonable to forego any bone imaging in the absence of any relevant bone-related symptoms. The rate of bone involvement in patients with an M-spike of 1.5 g/dL was noted to...
Would you supplement iron for low iron studies in absence of anemia?
The answer is absolutely and positively. Iron deficiency causes symptoms independent of anemia which include fatigue, brain fog, restless legs syndrome, and pagophagia and other forms of pica. You simply cannot dignify waiting for overt iron deficiency to develop in someone with symptomatic iron def...
How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?
Oral iron will not work. I would bet my last dollar there was no anaphylaxis but rather an imprudently treated minor infusion reaction which is the cause of ostensible “anaphylaxis” over 99% of the time. You can’t verify that it was real because I can assure you: It was not. They did not do a trypt...
Do you routinely refer young patients with iron deficiency anemia for GI evaluation?
The answer is no, I do not. However, if after iron repletion deficiency persists, then I do. But as for pregnancy, unless there has been a precipitous and proven drop, I would definitely not do a GI workup during pregnancy.
Do you routinely refer young patients with iron deficiency anemia for GI evaluation?
The answer is no, I do not. However, if after iron repletion deficiency persists, then I do. But as for pregnancy, unless there has been a precipitous and proven drop, I would definitely not do a GI workup during pregnancy.
How would you manage symptomatic iron deficiency in patients with PV on frequent phlebotomies?
While iron deficiency by itself is not harmful, if someone has symptomatic iron deficiency, you could consider them intolerant to phlebotomies, and start a cytoreductive agent. Then, over time they can replete their iron stores. In some patients who are very symptomatic from their iron deficiency, I...
How would you manage symptomatic iron deficiency in patients with PV on frequent phlebotomies?
While iron deficiency by itself is not harmful, if someone has symptomatic iron deficiency, you could consider them intolerant to phlebotomies, and start a cytoreductive agent. Then, over time they can replete their iron stores. In some patients who are very symptomatic from their iron deficiency, I...
How soon after initiating oral anticoagulation therapy for atrial fibrillation can it be interrupted for surgery or procedures?
As with most things medical, multiple answers. If a patient walks into my office for preOp "clearance" and behold, they are in atrial fib, but asymptomatic, then it would depend on the urgency of their surgery. If elective, then you have time to work up his atrial fib and look for a reversal cause (...
For a patient with NSCLC harboring an EGFR or ALK mutation that transforms into SCLC, would you add immunotherapy to chemotherapy or avoid immunotherapy given the tumor's EGFR/ALK origin?
I typically avoid immunotherapy and continue the targeted therapy, such as osimertinib, with the chemotherapy.