Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients with essential thrombocythemia already on prophylactic dose DOACs, do you defer starting aspirin?
I usually defer aspirin in these situations. There is evidence from PV that aspirin plus anticoagulation increases bleeding risk (Zwicker et al., PMID 34162181). If an ET patient has a high-risk disease with prior arterial thrombosis, then I would favor adding aspirin.
Does evidence support extending the duration of intravenous iron dextran (INFeD) infusion in pregnant patients?
No, there has never been evidence with any of the four formulations supporting a longer rate of infusion (above the minimum recommended) as a harbinger of either benefit or safety. LMW ID (INFeD) should be given as 1000 mg in 250 ml of normal saline over one hour. My gut tells me 45 minutes is OK bu...
Does evidence support extending the duration of intravenous iron dextran (INFeD) infusion in pregnant patients?
No, there has never been evidence with any of the four formulations supporting a longer rate of infusion (above the minimum recommended) as a harbinger of either benefit or safety. LMW ID (INFeD) should be given as 1000 mg in 250 ml of normal saline over one hour. My gut tells me 45 minutes is OK bu...
Would you offer consolidative radiotherapy for oligometastatic NSCLC?
These are extremely challenging cases and the recent negative studies have somewhat dampened my enthusiasm. It has been challenging, in general, to obtain authorization for treatment in these cases and the release of this data will not make it any easier. And as experts note, there are multiple bin...
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
How do you counsel patients with acute intermittent porphyria when it comes to fasting for religious reasons?
This is a very difficult question and it depends on the individual patient, their disease severity, their particular triggers, and how they have done in the past with caloric restriction. The patient may want to speak with a clergy member for guidance in this situation as well. For inst...
How do you decide when to use andexanet (ANDEXXA) for intracranial hemorrhage associated with factor Xa inhibitors?
The ANNEXA-I trial presents a mixed perspective. The data demonstrated that Andexanet is superior to standard care in reducing hematoma expansion for intracerebral hemorrhage associated with factor Xa inhibitors. This conclusion is based on an imaging-based primary endpoint, supported by previous st...
Do you have a preferred systemic agent for patients with metastatic, unresectable, functional neuroendocrine tumors, such as an insulinoma, if the goal is to get a quick response?
The management of metastatic unresectable neuroendocrine tumors depends on many factors including functionality, tumor burden, primary tumor, and SS expression. Usually, part of the management will be SSA to control hormonal secretion, however, we should be careful in patients with insulinoma. While...
Do you ever offer adjuvant chemotherapy to patients with resected stage IB non-small cell lung cancer when the tumor is less than 4cm in size?
Would you offer zolbetuximab in a non-Asian population?
Great question. Both studies suggested a discrepancy in benefits between white and Asian patients. However, these were subgroup analyses and neither study was powered to specifically detect a significant effect in white patients. Issues like this are frequently encountered in randomized clinical tri...