Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When do you refer a patient with recurrent glioma for reoperation?
This question is a nuanced one that is dependent on many factors. When a patient has a recurrent glioma, the treatment options are generally re-resection, medical therapy (traditional chemotherapy or targeted agents, depending on the tumor), or radiation. Which treatment modality, or combination of ...
In addition to monitoring hemoglobin and supplementing folic acid, what is your approach to hereditary spherocytosis in pregnancy?
I use the same transfusion threshold for the general pregnant population but I do refer to maternofetal medicine/high risk pregnancy clinic for closer fetal monitoring. My personal preference is to obtain genetic testing to confirm the specific mutation responsible for hereditary spherocytosis as it...
How do you manage B12 deficiency refractory to subcutaneous replacement?
I tend to start with IM injections of B12 when patients are severely deficient. The most common mistake in replacing severely low B12 is to not load, or to check levels too early. I have not used SQ administration before. It should absorb, but if you are having issues I would go to IM and start week...
What is the role of liver transplant in NET?
Identifying the role of liver transplant (txp) in NET patients with all the other therapy options available is challenging. I will admit that there have been several years since I last was involved in the care of a patient that actually ended up having a liver txp. That said, I think certain patient...
Would you give GO and/or a FLT3 inhibitor for patients with AML with t(8;21) and FLT3-ITD low in addition to 7+3?
First, in terms of risk stratification, core binding factor (CBF) AML [whether inv16 or t(8;21)] is considered to be favorable risk by ELN22 even if a FLT3 mutation is present (Döhner et al., PMID 35797463). The incidence of FLT3-ITD in CBF-AML is 5-10% (Faber et al., PMID 27798625). There are some ...
Would you give GO and/or a FLT3 inhibitor for patients with AML with t(8;21) and FLT3-ITD low in addition to 7+3?
First, in terms of risk stratification, core binding factor (CBF) AML [whether inv16 or t(8;21)] is considered to be favorable risk by ELN22 even if a FLT3 mutation is present (Döhner et al., PMID 35797463). The incidence of FLT3-ITD in CBF-AML is 5-10% (Faber et al., PMID 27798625). There are some ...
With the addition of pembrolizumab following chemoradiation per KEYNOTE-A18, would you be less likely to treat the paraaortic chain prophylactically?
I would favor the same volume of RT with or without pembro. If there is an indication to treat PA nodal chain, would treat as per plan.
How would you treat a patient with isolated CNS relapse of seminoma?
As one would expect there are really no reliable data to use to make decisions. I am assuming that there is no significant elevation of HCG or AFP? Typically, I would first recommend engagement of a high-volume center to review details of the case and get guidance. This is a highly unusual setting f...
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
When deciding whether it is safe to re-challenge with rituximab after an infusion reaction, the most important consideration is the type of reaction that the patient experienced. This will help to risk stratify and determine whether same day or future infusions of RTX should be used. Importantly, th...
For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?
When deciding whether it is safe to re-challenge with rituximab after an infusion reaction, the most important consideration is the type of reaction that the patient experienced. This will help to risk stratify and determine whether same day or future infusions of RTX should be used. Importantly, th...