Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider a BRCA carrier patient for kidney transplantation?
I would certainly consider a potential recipient who is a BRCA carrier. Would involve genetic counseling as well as informed consent regarding the risk of malignancy post-transplant. The mortality risk, depending on co-morbidities, of remaining on dialysis is high and should certainly be considered ...
How would you evaluate a patient with an isolated high RBC count but with a normal hemoglobin and hematocrit?
My first question would be, how long has the elevated red cell count been present? I ask this because, in a study of 10,000 individuals, erythrocytosis was initially found in 88 but after a year only 11 still had this finding (Ruggeri et al., PMID 13679323). If therefore, the observation is recent, ...
Will you offer lurbinectedin with atezolizumab for patients with ES-SCLC during maintenance if they had brain metastases at baseline?
The IMforte trial specifically excluded these patients, a major drawback of this trial in my opinion. It may not be unreasonable to consider it, especially if the patient has a good performance status and is motivated to get it. However, I would discuss the pros and cons and make it clear that this ...
Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?
This is a really interesting discussion. I do tend to get Dopplers at the end of the anticoagulation treatment period, but only to assess the new baseline and to help decision-making in the future if they develop new symptoms and have another Doppler. I find this to be very helpful to understand if ...
Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?
This is a really interesting discussion. I do tend to get Dopplers at the end of the anticoagulation treatment period, but only to assess the new baseline and to help decision-making in the future if they develop new symptoms and have another Doppler. I find this to be very helpful to understand if ...
What would be your recommended regimen for an AYA patient with relapsed mediastinal pure seminoma, with relapse 20 months after completion of BEP?
Mediastinal seminoma is rare and has a high cure rate with chemotherapy alone (BEP x3). I would refer a patient like this to a high-volume center. Treatment options are high-dose chemotherapy followed by ASCT vs. resection. This should be a tumor board discussion. Despite limited data and the interv...
In patients with post-PV myelofibrosis who are ineligible for allogeneic stem cell transplant, how do you approach symptomatic splenomegaly refractory to splenic radiation and ruxolitinib?
This is always a tough situation. First, I would make sure the patient is truly not a candidate for transplant. With reduced intensity conditioning and the addition of ruxolitinib before and after transplant, transplant is better tolerated than it once was. Otherwise, would consider switching to ano...
In patients with post-PV myelofibrosis who are ineligible for allogeneic stem cell transplant, how do you approach symptomatic splenomegaly refractory to splenic radiation and ruxolitinib?
This is always a tough situation. First, I would make sure the patient is truly not a candidate for transplant. With reduced intensity conditioning and the addition of ruxolitinib before and after transplant, transplant is better tolerated than it once was. Otherwise, would consider switching to ano...
How would you approach management and monitoring of AL amyloidosis with isolated renal involvement?
This is tough for sure, and my first question would be to ask how the renal biopsy was determined to be AL amyloidosis. Sometimes typing isn't required if the pattern is overwhelmingly lambda-restricted or kappa-restricted by immunofluorescence... but in this case, mass spectrometry typing may be wo...
How would you approach management and monitoring of AL amyloidosis with isolated renal involvement?
This is tough for sure, and my first question would be to ask how the renal biopsy was determined to be AL amyloidosis. Sometimes typing isn't required if the pattern is overwhelmingly lambda-restricted or kappa-restricted by immunofluorescence... but in this case, mass spectrometry typing may be wo...