Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do patients with central adrenal insufficiency on maintenance hydrocortisone therapy require doubling of their corticosteroid during chemotherapy cycles?
I would follow the same sick day rules. If the patient is not feeling well with nausea, diarrhea, or worsening fatigue, the same rules of doubling the GC dose would apply. In cases of severe vomiting and not being able to keep the double dose of GC, parenteral GC injection and going to the ED for fl...
How do you approach very treatment-refractory ITP?
Severely refractory ITP doesn't account for a large fraction of ITP patients, but it can be quite a challenge for treaters and patients alike. Combination therapies, varied immunosuppressive agents, and careful checks on adherence are all helpful. Some alternative agents with entirely different mech...
How do you approach very treatment-refractory ITP?
Severely refractory ITP doesn't account for a large fraction of ITP patients, but it can be quite a challenge for treaters and patients alike. Combination therapies, varied immunosuppressive agents, and careful checks on adherence are all helpful. Some alternative agents with entirely different mech...
What is your approach to DVT prophylaxis in patients who require IVIG but are at increased risk for thrombotic events?
I am unaware of any published data to guide the decision-making for this topic. Empirically, I recommend low-dose aspirin in patients >50 who have to get long-term IVIG especially if there are a lot of underlying risk factors for thrombosis like diabetes, immobility, etc. Again, this is not an evide...
Does your approach to first line treatment of metastatic colon cancer change for a mucinous adenocarcinoma?
Thanks for the question! I think at this time, molecular features of cancer are more likely to impact treatment choices over histology! For example, we have several biomarker-driven options including MMR-D (KEYNOTE 177, CheckMate 8HW) BRAF (BREAKWATER) and we will likely see similar practice-changin...
Is there a role of definitive radiation or prostatectomy, in a patient who has M0 castrate resistant prostate cancer and whose PSA is undetectable on ADT and enzulatamide?
The question posed comes from a rather unusual clinical situation. In most cases, M0 crpc would have evolved from a diagnosis of prostate cancer and the application of curative intent local therapy surgery/radiotherapy, with psa progression in the absence of metastatic disease managed with ADT now w...
How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?
The lymphocyte variant hypereosinophilic syndrome (L-HES) is a rare form of reactive eosinophilic driven by clonal, phenotypically aberrant T-lymphocytes that secrete IL-5 and other eosinophilopoeitic cytokines. Diagnosis is based primarily on immunophenotyping (flow cytometry) of peripheral blood. ...
How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?
The lymphocyte variant hypereosinophilic syndrome (L-HES) is a rare form of reactive eosinophilic driven by clonal, phenotypically aberrant T-lymphocytes that secrete IL-5 and other eosinophilopoeitic cytokines. Diagnosis is based primarily on immunophenotyping (flow cytometry) of peripheral blood. ...
How do you utilize cytokine panels in your clinical practice?
It's become easier to order cytokine panels that get processed locally in my hospital. However, I think we're still far from knowing how to interpret these or make clinical changes as a result. While it's tempting to think, "If TNF is elevated, I will give the patient a TNF inhibitor, which will mak...
How do you approach patients with lymph node positive osteosarcoma of the extremities for neoadjuvant chemotherapy?
The treatment for such patients is still the same as for any osteosarcoma. However, I would approach such patients with a mindset of dealing with metastatic disease. The fact that the lymph nodes are positive for osteosarcoma fortels of a poor prognosis (as it makes this a metastatic disease). In ad...