Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How long do you give maintenance pemetrexed/pembrolizumab in metastatic NSCLC treated with upfront chemoimmunotherapy?
In the Keynote trials, therapy was continued for 2 years. With a median progression free survival of approximately 8 months, the number of patients who are able to continue therapy for 2 years is small. However, if a patient does stay on therapy I follow the protocol and recommend stopping therapy a...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?
Although there have been studies demonstrating that hypomagnesemia has been associated with an increased risk of AKI, there have been no clinical trials indicating preloading with mag prevents AKI. I would recommend to have the magnesium above 2mg/dl prior to cisplatin.
How do you manage catheter-associated, upper extremity superficial venous thrombosis?
I manage catheter-associated upper extremity superficial venous thrombosis (SVT) conservatively with arm elevation, warm compresses, NSAIDs, and topical creams containing NSAIDs. Upper extremity SVT is primarily caused by indwelling intravenous catheters, so I do strongly recommend catheter removal ...
What is the optimal management of hot flashes for women receiving hormonal therapy?
There are many treatments that have been shown to be effective in randomized trials. I usually suggest patients first try vitamin e or acupuncture and if that is not effective to consider Effexor. Gabapentin can be effective and help with sleep, without as many sexual side effects as the antidepress...
Do you routinely recommend loratadine for pegfilgrastim pain?
Despite its popularity, there is not good evidence that Loratadine improves bone pain from pegfilgrastim. There are small, uncontrolled studies that suggest a benefit, however a randomized trial of Loratadine vs. placebo did not show a difference between groups in bone pain or quality of life.
Would a low genomic MammaPrint score deter you from offering adjuvant chemotherapy to a premenopausal woman with HR+ pT3N0 breast cancer?
The MINDACT trial only included 11.6% T3 patients. And in MINDACT’s updated analysis, in women ≤50 years old with high clinical risk, there was about a 5% absolute difference in DMFS at 8 years, favoring chemotherapy even if they have low genomic risk. Of course, there is debate about whether chemot...
Do you check AMH levels to decide on adjuvant chemotherapy in premenopausal patients with node-positive ER+ breast cancer?
The short answer is no. The decision to recommend adjuvant chemotherapy for premenopausal, node-positive, ER+ breast cancer is based on the tumor's biology, not the patient's AMH levels. Here are my thoughts: Role of AMH: AMH levels are not used to decide on chemotherapy. They are used to counsel pa...
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...