Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
Do you intensify treatment for patients with double-hit lymphoma or double expressor lymphoma?
My personal practice is that I DO intensify therapy for patients with DHL but not necessarily with DE lymphoma. Generally, the "intensification" of choice is based on age. Young fit patients (for which there are few) with DHL are candidates for CODOX-M/IVAC or DA-REPOCH. Older patients (which the ma...
Would you consider adjuvant osimertinib for NSCLC with an EGFR E746_S752delinsV exon 19 mutation?
Yes. While some uncommon EGFR exon 19 deletions appear to be resistant to first and third-generation EGFR TKIs (e.g., L747P variant with higher IC50 requirements preclinically and associated with worse response/survival in case analyses), EGFR E746_S752delinsV appears to respond well to EGFR TKIs (W...
How do you manage fatigue in women receiving chemotherapy/hormonal/radiation therapy for breast cancer?
Managing fatigue is challenging for patients undergoing cancer therapy. One of the best ways to increase energy is to exercise. It is a bit of a catch 22, but if you explain to patients they can start out with small goals and there symptoms will improve that can help. A very important contributor to...
How would you manage an enlarging brain metastasis that has progressed in size three months after radiosurgery?
Before making a decision, I would want to know the tumor histology, SRS dose delivered, and whether the current site of progression is truly within the prior radiation field (using new MRI fused to the SRS plan in treatment planning software). If the lesion is within the high-dose region and the pat...
Would you add whole-pelvis radiation as MDT (metastasis-directed therapy) in a patient with 1 pelvic node and 2 osseous metastatic sites for castrate-resistant prostate cancer?
This patient would not fit the PEACE V-STORM eligibility criteria, since the trial excluded patients with distant metastases and did not include patients who were castrate resistant, so I do not think you can extrapolate the results to this patient. One could argue that what you propose to do (SBRT ...
In patients with HER-2 positive breast cancer on pertuzumab/trastuzumab with newly developed asymptomatic brain metastases only, do you wait 3 weeks after administration of the targeted therapy to deliver SRS?
In a recently published study from Italy, Ippolito et al., PMID 35053467 a total of 10 patients with 32 HER2+ breast cancer brain metastases were treated with concurrent fSRT (27 Gy in 3 fractions) and Pertuzumab. Necrosis was reported in only 1 of the 32 treated lesions. The study is small but the ...
What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?
I prefer to give ferumoxytol 510 mg X 2 doses of available.
How do you counsel patients with minimally symptomatic factor VII deficiency about procedures and periprocedural management?
Partial Factor VII deficiency is relatively easy to discover (long PT/INR) but the bleeding risk tends to be over-estimated. The available evidence (Peyvandi et al., PMID 22321862) suggests that significant bleeding is uncommon unless the factor VII level is less than about 15% of normal. I would th...
Do you account for the effect of coffee on platelet aggregation studies?
Although recommendations from the International Society of Thrombosis and Haemostasis (ISTH) [1] suggest that individuals should avoid caffeine for at least 2 hours before blood is drawn for light transmission platelet aggregation studies, (and be fasting, be rested for 30 minutes, and avoid smoking...