Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use new DOAC loading dose or start with maintenance dosing for a stable patient on existing DOAC who needs to switch brand due to insurance/formulary reasons?
For some drugs, you need to do a loading dose to get the drugs to therapeutic levels. However, with DOACs, a loading dose is used at the time of VTE diagnosis and therapy initiation to jump start the anticoagulant effect when the clot burden is the highest. Thus, if you are switching from another fu...
Would you use new DOAC loading dose or start with maintenance dosing for a stable patient on existing DOAC who needs to switch brand due to insurance/formulary reasons?
For some drugs, you need to do a loading dose to get the drugs to therapeutic levels. However, with DOACs, a loading dose is used at the time of VTE diagnosis and therapy initiation to jump start the anticoagulant effect when the clot burden is the highest. Thus, if you are switching from another fu...
What is your preferred subsequent treatment in patients with metastatic bladder cancer with progression on pembrolizumab/enfortumab?
Given the fundamental change associated with bringing 2 agents, previously approved for salvage therapy after chemotherapy for metastatic urothelial cancer, forward to first line treatment has left practitioners wondering what the correct sequence of therapy should now be in salvage. This will likel...
Would you consider TPO agonists for thrombocytopenia from low risk MDS?
There are randomized data supporting the use of TPO agonists in low-risk MDS with thrombocytopenia. A phase II study of eltrombopag vs placebo demonstrated a platelet response in ~40% of patients treated with eltrombopag and no increased risk of disease progression/AML evolution between the eltrombo...
How was treatment response assessed on the PROSPECT trial?
Dr. Harvey reached out to his colleague, Dr. Marc Gollub, director of radiology at Memorial Sloan Kettering with expertise in gastrointestinal imaging (and who was the radiologist who collaborated on PROSPECT), for his thoughts on this question. Here is his answer: I had to “create” a non-volum...
In pure red cell aplasia, does peripheral blood-positive IgG for parvovirus have significance if persistently positive on retesting, but IgM and PCR are negative?
It is unlikely to be related; IgG will reflect past infection. The IgM is more reliable. I would treat this as autoimmune or idiopathic PRCA.
In pure red cell aplasia, does peripheral blood-positive IgG for parvovirus have significance if persistently positive on retesting, but IgM and PCR are negative?
It is unlikely to be related; IgG will reflect past infection. The IgM is more reliable. I would treat this as autoimmune or idiopathic PRCA.
What hydroxyurea dose do you target for HbSC disease?
Based on results reported recently, hydroxyurea at an average dose of 20.5 mg/kg/day appeared to reduce substantially the rate of acute painful episodes and other sickle cell disease-related events in both adults and children with HbSC disease (Dei-Adomakoh et al., PMID 39647172). Previous studies a...
What are your top takeaways in GU Cancers from ESMO 2024?
1. Tivozanib–nivolumab vs tivozanib monotherapy in patients with renal cell carcinoma (RCC) following 1 or 2 prior therapies including an immune checkpoint inhibitor (ICI): Results of the phase III TiNivo-2 study. This trial confirmed (along with CONTACT-03: cabozantinib +/- atezolizumab) that cont...
While we await the completion of RTOG 1008, what instances do you offer chemotherapy for salivary gland tumors?
There are no current prospective data about adding chemotherapy to definitive or adjuvant RT for high-grade salivary gland tumors. Data from the National Cancer data base suggested no improvement of post-op CRT compared with RT (Amini A et al, Jama Otolaryngol-HN Surg 2016), however there were more ...