Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
How do you treat diffuse large B cell lymphoma (DLBCL) in a patient with cirrhosis complicated by thrombocytopenia?
Thank you for the question. This is a very challenging case. There are different factors to consider, such as age, PS, stage, and actual liver function. Liver function may have been affected by lymphoma.Most likely, the patient will require dose reductions of standard R-CHOP (such as mini R-CHOP). A...
What vitamins and minerals do you check yearly for patients post gastric bypass surgery?
Following Roux-en-Y gastric bypass it is essential to monitor micronutrients, vitamins, and minerals because malabsorption and long-term complications may occur with improper care. Based on ASMBS 2016 Nutrition Guidelines, AACE/TOS/ASMBS 2019 updates, and Endocrine Society recommendations, here are ...
For a BRCA1+ patient with a history of stage IVB endometrioid ovarian carcinoma s/p upfront surgery and adjuvant chemotherapy who has now completed 3 years of maintenance niraparib and is NED, how would you counsel about discontinuing vs continuing PARPi therapy?
Recommendation: I recommend that this patient with Stage IVB ovarian cancer, with a complete response to surgery, chemotherapy, and 3 years of maintenance PARPi, be counseled to discontinue niraparib.Background:The duration of therapy for primary maintenance PARPi should be tailored based on the ass...
In patients with iron deficiency due to history of gastric bypass or IBD, would you consider oral iron therapy if the iron deficiency anemia is mild?
Oral iron can often be effective in iron deficiency, as long as absorption is intact. If you are concerned about absorption, performing an oral iron challenge can be useful in allowing you to avoid long trials of oral iron that will be ineffective. Simply check an iron panel at baseline, then admini...
What features would push you towards re-operation for completion staging vs observation for a premenopausal woman with stage II borderline tumor of the ovary with capsule rupture and no other evidence of gross residual disease?
I would only reoperate if there were a survival benefit, symptomatic benefit, or change in treatment regimen. From the description, it doesn't seem like this meets any of those criteria.
What is your approach to the management of chronic GI bleeding from AVMs in an elderly patient on DOAC for atrial fibrillation?
I would definitely strongly consider the left atrial appendage occlusion device in these patients. While usually these devices (such as Watchman) do require anticoagulation for about 45 days until the device has an endothelial layer form on it (we usually confirm with a CT scan or TEE), there are so...
When, if ever, would you select a three-drug regimen instead of four-drug regimen in patients with newly diagnosed Multiple Myeloma?
Thank you for this question. For older, transplant-ineligible patients, there is no data that patients live longer or better (the true goals of treatment) with four drugs instead of three drugs. Yes, the responses are better, and we hope this may translate to longevity over time, but we do not know ...
When, if ever, would you select a three-drug regimen instead of four-drug regimen in patients with newly diagnosed Multiple Myeloma?
Thank you for this question. For older, transplant-ineligible patients, there is no data that patients live longer or better (the true goals of treatment) with four drugs instead of three drugs. Yes, the responses are better, and we hope this may translate to longevity over time, but we do not know ...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...