Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For AML patients, when do you stop antiinfective agents?
Our practice is typically to continue an anti-viral throughout induction/consolidation without stopping the agent. We typically utilize anti-bacterial and anti-fungal when the absolute neutrophil count (ANC) is under 500 and then stop them once the ANC recovers to above 500. Our preferred anti-funga...
For AML patients, when do you stop antiinfective agents?
Our practice is typically to continue an anti-viral throughout induction/consolidation without stopping the agent. We typically utilize anti-bacterial and anti-fungal when the absolute neutrophil count (ANC) is under 500 and then stop them once the ANC recovers to above 500. Our preferred anti-funga...
Do you avoid ESAs in patients with anemia and chronic kidney disease who also have Factor V Leiden?
I personally do not. I think it is better to get the hemoglobin in the 10-11 g/dL range and avoid having to give blood transfusions potentially than the slightly increased risk of hypercoagulability.
How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?
Engage your Pulmonology colleagues to assist in these difficult cases. Important to rule out other causes of persistent symptoms including infectious processes. Rebronch can be helpful for infectious work up and/or determining the nature of the inflammatory process that is ongoing (for example, the ...
In 2024, do you consider isolated gain(1q) [not amp(1q)] to be a high-risk cytogenetic abnormality in multiple myeloma?
The brief answer from my standpoint is that some patients with 1q gain will have their disease behave high-risk and some will not. The longer answer...As the question alludes to, the presence of high-risk cytogenetic abnormalities and 1q gain should be considered high-risk (or even ultra high-risk)....
When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?
Routinely available anti-platelet antibody tests have a sensitivity too high and specificity too low to be of much clinical use. A patient's response to first line therapy (steroids or IVIg) is most telling and if there is no response, a bone marrow is warranted as it would be atypical for ITP. Ther...
What duration of ADT + abiraterone do you recommend prior to initiation of HDR brachytherapy followed by EBRT for very high risk localized cT3bN0 prostate cancer?
This is a short answer (for me) given the lack of data to support brachy boost in T3b disease in a randomized trial.The only randomized multicenter trial comparing dose-escalated EBRT to brachy boost is ASCENDE-RT. They specifically excluded T3b patients (see supplementary content for all exclusion ...
Would you offer adjuvant therapy for poorly differentiated adenocarcinoma of the galbladder s/p R0 resection with negative nodes?
We would offer adjuvant chemotherapy to this patient based on data from the BILCAP study. Final results are still to be published in a peer reviewed journal. This study enrolled patients with biliary malignancies who were randomized to adjuvant capecitabine vs. observation following resection. 18% o...
What factors do you consider when choosing adjuvant treatment for resected (R0) gallbladder carcinoma with positive nodes?
There is sparse data directing the best adjuvant treatment plan for R0 resected Gallbladder Cancer with positive lymph nodes. Long term outcomes are poor even for patients who undergo a complete resection. Interestingly, the patterns of recurrence favor distant sites of disease over locoregional rec...
How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?
If disease status allows weaning, we slowly wean per recommendations in HLH94. If they need steroids because of significant hyperinflammation that is damaging, then we add risperidone, which generally works very well.