Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred strategy for young adults with ITP complicated by recurrent autoimmune neutropenia?
This is a great question, and I'll say that AIN can be particularly difficult to treat! I'd first ask how low the ANC is and if the patient is presenting with frequent infections/hospitalizations. If not, there may not be a need to treat the AIN (we may just be treating ourselves); oftentimes, there...
In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?
We typically try to wait as long as possible before we start WBRT. It depends on the burden and symptomatology of intracranial disease as well as the initial response to chemo-immunotherapy. If the brain metastases are asymptomatic and deemed OK to monitor closely (i.e., not likely to cause neurolog...
Which patients with muscle invasive bladder cancer will you treat with adjuvant nivolumab?
I treat patients who fulfill the eligibility criteria of CheckMate 274. Thus, patients must have had radical surgery (R0, with negative surgical margins) within 120 days before randomization, with or without neoadjuvant cisplatin-based chemotherapy. Patients must have had pathological evidence of ur...
How would you approach hormone replacement therapy for perimenopause in a patient with increased risk factors for VTE?
Like many medical choices, this decision involves weighing trade-offs—specifically, the risk of venous thromboembolism (VTE) versus the burden of severe menopausal symptoms. If we focus only on VTE risk (and set aside the trade-offs related to menopausal symptoms and the controversial issue of breas...
How do you counsel cancer patients when they ask if they should avoid sugar?
“We don’t have evidence to support any specific diet that can either worsen or improve outcomes. I encourage a healthy, well-balanced diet with my top priority being you maintaining your weight during treatment.” Particularly for my head and neck patients, getting in sufficient calories is of the ut...
What are the most common pain regimens that you use in cancer care?
Malignant pain is common, and oncologists should be comfortable initiating management in their patients. Let's imagine, for this case, that local therapies for a focal pain have been explored and we've decided it's time for medication/systemic approach. After an initial screening question for a subs...
How do you approach laboratory assessment for anticoagulation adherence when working up anticoagulation failure?
When faced with an anticoagulation failure, my go-to test for adherence is looking at the medication-dispense report (if you have this available at your institution, it is very handy for understanding the patient's adherence to anticoagulation). Typically, this will either show intermittent dispensi...
What are your top takeaways in Medical Oncology from SABCS 2024?
I would give the following studies the top 3 in terms of impact: GS2-12:The PATINA study, that tested the use of palbociclib in patients who were on maintenance first-line therapy after induction therapy for metastatic HER2 and hormone receptor-positive breast cancer with taxane or vinorelbine plus ...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
Do you incorporate the ALASCCA trial into your clinical practice and perform NGS on all early stage colon cancer patients to determine if adjuvant aspirin would be beneficial?
Yes, I recommend obtaining PIK3CA testing on patients with resectable colon and rectal cancer based on the ALASCCA trial, as well as other data for patients who are able to receive low-dose aspirin if they have a PIK3CA mutation. NCCN guidelines currently recommend post-surgery/adjuvant therapy aspi...