Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?
If they have a very low JAK2 (i.e. <1%) and erythrocytosis or thrombocytosis, I always make sure to look for another possible cause. A bone marrow biopsy may be helpful (and I agree with Dr. @Dr. First Last that it is a good thing to do in all MPN patients). In patients with erythrocytosis and a low...
Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?
If they have a very low JAK2 (i.e. <1%) and erythrocytosis or thrombocytosis, I always make sure to look for another possible cause. A bone marrow biopsy may be helpful (and I agree with Dr. @Dr. First Last that it is a good thing to do in all MPN patients). In patients with erythrocytosis and a low...
What systemic therapy and dose adjustments would you implement for patients with pancreas cancer and cirrhosis with pancytopenia?
Of the five drugs available to us, two (abraxane and irirnotecan) are a challenge in liver dysfunction with the added thrombocytopenia. The question becomes, what is the real value of a single drug versus a combination in this setting when it comes down to clinically meaningful efficacy? Capecitabin...
Do you consider starting hydroxyurea in a patient with hemoglobin S-beta thalassemia with chronic kidney disease secondary to FSGS?
I consider initiating hydroxyurea in all individuals with sickle cell disease, even if they have rare or infrequent acute pain episodes. This is because pain is just one manifestation of the disease and ongoing hemolysis leads to a state of chronic inflammation characterized by cytokines, activation...
Would you consider giving neoadjuvant therapy using a KEYNOTE-522 regimen to someone with cT1c cN0 TNBC?
I would treat a larger cT1cN0 TNBC in a young, fit patient with neoadjuvant ddAC-T. As you point out, such a patient would not have been eligible for KEYNOTE-522 (which only enrolled stage II-III patients), and I do not think the added potential toxicity of the pembro and carbo are worth the unknown...
How do you treat stage I head of pancreas adenocarcinoma in an older patient who is not a candidate for chemotherapy or surgery?
The question of how to manage an elderly patient who is not a candidate for chemotherapy or surgery is a really important one. I would argue that this question is not unique to an elderly patient but should be asked for ANY patient who cannot receive systemic therapy. We are fortunately living in a ...
Can the presence of elevated ring sideroblasts (20%) on a bone marrow biopsy without dysplastic changes or suspicious molecular mutations still be indicative of an underlying MDS in a patient with unexplained anemia?
It is easy to forget that this clinical presentation was the rule not the exception in the pre-genomic era. We knew then that idiopathic sideroblastic anemia could be congenital or acquired due to drugs, toxins, or disorders of porphyrin or hemoglobin synthesis, or could rarely be clonal (using G6PD...
Can the presence of elevated ring sideroblasts (20%) on a bone marrow biopsy without dysplastic changes or suspicious molecular mutations still be indicative of an underlying MDS in a patient with unexplained anemia?
It is easy to forget that this clinical presentation was the rule not the exception in the pre-genomic era. We knew then that idiopathic sideroblastic anemia could be congenital or acquired due to drugs, toxins, or disorders of porphyrin or hemoglobin synthesis, or could rarely be clonal (using G6PD...
How would you approach treatment for a cT1N0M0 urothelial carcinoma of the ureter, high grade in a non-surgical candidate due to medical comorbidities?
Although there is limited data using radiation therapy or chemo-radiation in UTUC, in a non-surgical candidate, this may be a reasonable approach to consider in selected patients. This would be an extrapolation from the promising data from RTOG 0926, a single arm, phase II trial investigating trimod...
Is it unusual to have isolated LDH elevation and normal HCG and AFP in non-seminomatous germ cell tumor (embryonal carcinoma)?
It's hard to generalize: the details of the case matter. It is not very unusual to have an isolated LDH elevation. LDH is extremely non-specific. 101 different things can make LDH go up and this limits its usefulness as a tumor marker. Elevation of LDH on day 1 of cycle one of first-line chemotherap...