Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
For patients with a JAK2 positive myeloproliferative neoplasm, do you always perform a bone marrow biopsy at diagnosis?
A bone marrow biopsy is very helpful at diagnosis for patients with MPN as it can clearly establish a diagnosis. Although many times we can guess a diagnosis by looking at peripheral blood counts, we can often miss pre-MF or overt MF without a bone marrow biopsy. For young patients especially, a bon...
Is it appropriate to dose de-escalate in low risk HPV+ SCC of the oropharynx outside of a clinical trial setting?
I am going to write specifically on de-escalating HPV-OPSCC in the adjuvant setting first, important caveats for adjuvant de-escalation, and then about the general philosophy on de-escalation in clinical trials.Concerning adjuvant treatment, after careful consent, we are de-escalating patients with ...