Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach adjuvant chemotherapy in patients with resected pancreatic adenocarcinoma?
For my good performance status patients, I offer gem/cap as per the ESPAC-4 trial. Though the incremental benefit is modest, it was statistically significant and the toxicities associated with the combination are quite manageable most of the time. I look forward to the results of three other adjuvan...
How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?
I agree with @Dr. First Last's detailed response. Practically speaking, I would also add that it is important to listen and validate your patient's concerns and respond to their frustration and sense of loss. A diagnostic evaluation will not only help you and your patient discover or 'rule out' othe...
Would you consider using IO alone for lung cancer patients with PD-L1 <1% but who have high TMB?
The brief answer here is a resounding no. A more extended version might include a statement that this would be a case of not seeing the forest for the trees.And the tree here is the FDA approval of pembrolizumab in a tissue-agnostic fashion for patients with advanced TMB >10 mutations/Mbase- likely ...
In a patient with borderline resectable pancreatic adenocarcinoma s/p 10 cycles FOLFOX and aborted Whipple due to locally advanced disease, do you recommend dose escalation beyond 54 Gy?
Yes, there is no contraindication to giving an ablative dose after exploration. 54 Gray is a palliative dose, which has not improved overall survival based on the LAP07 trial. While it's fair to say that we do not know the definition of definitive or ablative in LAPC, we have published OS results ve...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?
The short answer is "no". I do reimage many people near the end of the 3-6 months of treatment, but it doesn't really change my mind about duration of treatment in most instances. I use repeat imaging to help me understand how much of the clot resolved and thus, determine what their new baseline is....
How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?
I recommend indefinite anticoagulation for most patients with portal vein thrombosis, and at least 3-6 months if there are risk factors for bleeding. Once they complete anticoagulation for the first 6 months, I re-evaluate their risk of recurrent thrombosis vs bleeding, and if there is an underlying...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...