Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What chemotherapy regimen would you offer to a patient with DLBCL who was originally diagnosed and treated (R-CHOP) 15 years ago, now with a 2nd primary/late recurrence of DLBCL?
Interesting question - the optimal approach to late-relapsing DLBCL in the modern era is not well defined. Often we will work to clarify if the late relapse is indeed a late relapse as opposed to a second primary - clonality studies on the new and prior lymphoma can be informative in some cases. If ...
Would you consider long term avatrombopag use in patients with cirrhosis requiring higher platelet counts for medical therapy?
In general, no, I would not use long-term avatrombopag in patients with cirrhosis requiring higher platelet counts for medical therapy due to the perceived thrombotic risk and hemostatic abnormalities of patients with liver disease.One thing to note in assessing the risk of long-term TPO mimetic the...
What is your recommended long term management of extensive dural venous sinus thrombosis in an otherwise healthy young patient?
From a Vascular Neurology perspective, there are two considerations when faced with patients with venous sinus thrombosis. First is the status of the intracranial venous circulation and whether or not there has been adequate reconstitution of venous outflow, either through recanalization or collater...
How would you structure your monitoring for a low-risk leukemic TP53-negative mantle cell lymphoma with 5% MCL cells detected in both peripheral blood and bone marrow, mild splenomegaly, and no lymphadenopathy or B symptoms?
This appears to be the prototypical indolent patient for whom observation would be ideal. For these patients, there isn’t a truly validated period of monitoring. I have typically extrapolated from follow-up from other chronic diseases, with a plan to extend follow-up intervals over several years. In...
How would you structure your monitoring for a low-risk leukemic TP53-negative mantle cell lymphoma with 5% MCL cells detected in both peripheral blood and bone marrow, mild splenomegaly, and no lymphadenopathy or B symptoms?
This appears to be the prototypical indolent patient for whom observation would be ideal. For these patients, there isn’t a truly validated period of monitoring. I have typically extrapolated from follow-up from other chronic diseases, with a plan to extend follow-up intervals over several years. In...
What is your preferred adjuvant chemotherapy regimen after a completely resected stage IIIB Granulosa Cell tumor of the ovary?
Recommendation: Patients undergoing surgery with complete resection of tumor for an ovarian granulosa cell tumor (GCT) may be offered systemic chemotherapy or observation. If chemotherapy is offered, I prefer a combination of carboplatin and paclitaxel. Background: GCT of the ovary is the most commo...
How do you manage stage III resectable NSCLC patients treated with neoadjuvant chemoimmunotherapy per CheckMate 816 with residual disease who subsequently refuse surgery?
(1) Carefully analyze what happened with the patient, their medical oncologist, and thoracic surgeon, (2) restage the patient with an FDG-PET/CT and brain MRI to rule out distant metastatic progression, (3) confirm with their medical oncologist that CRT-> Durva is still an option, (4) confirm that a...
How would you approach radiation for an elderly patient with pT2N1 TNBC s/p MRM and ALND who refused chemo-immunotherapy?
RT will offer improved local control in this patient, as she has an elevated risk of LRR (positive LN, triple negative, large-ish T2, grade 3, LVSI). It will be unlikely to change her survival, as the data for PMRT did not show survival benefit until the chemotherapy was good enough to decrease dis...
Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?
The initial trials that established DOACs as effective and safe in most patients with cancer-associated thrombosis (Agnelli et al., PMID 32223112, Planquette et al., PMID 34627853) only included patients with lower-extremity DVT or PE but clearly showed equivalence to low-molecular weight heparin (w...
Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?
The initial trials that established DOACs as effective and safe in most patients with cancer-associated thrombosis (Agnelli et al., PMID 32223112, Planquette et al., PMID 34627853) only included patients with lower-extremity DVT or PE but clearly showed equivalence to low-molecular weight heparin (w...