Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?
The biggest question in these situations is whether the patient truly has iron overload vs. just high ferritin. If iron sat is not elevated, true iron overload is very unlikely. If both ferritin and iron sat are elevated, but they don't have a homozygous C282Y genotype, I make sure that the patient ...
Do you continue ovarian suppression for metastatic hormone-positive breast cancer patients who are premenopausal, regardless of line of therapy?
I continue OFS while a patient is on an endocrine therapy, but discontinue OFS if the patient demonstrates resistance to endocrine therapies and transitions to chemotherapy, which typically suppresses ovarian function anyway.
Would you recommend indefinite or extended anticoagulation in any scenario of a provoked clot?
The answer, like most decisions with the duration of anticoagulation after a VTE, is it depends. The provoking factor is key to determining whether anticoagulation continuing beyond the treatment of the acute event is needed. If the provoking factor was a joint replacement surgery, even in the prese...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...
How do you think about using Ropeginterferon Alfa 2B for polycythemia vera in patients with active autoimmune disease?
Great question. In general, I avoid interferons in patients who have an autoimmune disease. In the PROUD-PV/CONTI-PV study, a medical history of autoimmune disease was an exclusion criterion. There have been reported cases of interferon-induced autoimmune disease, most commonly autoimmune thyroiditi...
How do you manage reactive thrombocytosis and potentially symptomatic fatigue from JAK2+ P Vera with iron deficiency?
This is a challenging scenario since if you start supplementing iron, you can increase erythropoiesis, raise the hematocrit, require more therapeutic phlebotomies, and end up chasing your own tail. For these reasons, I generally recommend against iron supplementation in PV. Regarding the fatigue and...
How do you manage reactive thrombocytosis and potentially symptomatic fatigue from JAK2+ P Vera with iron deficiency?
This is a challenging scenario since if you start supplementing iron, you can increase erythropoiesis, raise the hematocrit, require more therapeutic phlebotomies, and end up chasing your own tail. For these reasons, I generally recommend against iron supplementation in PV. Regarding the fatigue and...
In what situations would you place a prophylactic trach prior to radiation for head and neck cancers?
In my practice, the decision on a prophylactic trach is made in a multidisciplinary setting in close coordination with my ENT colleagues. Generally speaking, we will consider placing a trach prior to treatment if there is a high concern for potential airway deterioration during radiotherapy. Clinica...
Should we be giving adjuvant nivolumab to all eligible esophageal/GEJ cancer, irrespective of the PD-L1 status of the tumor?
The FDA approval is regardless of PD-L1 expression. We did not see tumor cell PD-L1 (TPS) enriching for DFS benefit. In a post-hoc exploratory analysis published in the supplementary appendix (S2) of NEJM publication, we evaluated DFS in patients with PD-L1 combined positive score (CPS) >5 compared ...
Is concurrent immuno-radiation therapy a viable treatment option for patients with unresectable, non-metastatic, locally advanced lung cancer, who have high PD-L1 expression and no oncogenic mutations?
Concurrent radiation and immunotherapy would not be recommended for patients with unresectable locally advanced NSCLC.The standard of care in this scenario is concurrent chemotherapy and radiation followed by consolidation durvalumab based on survival improvements seen with the addition of durvaluma...