Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?
Do you recommend adjuvant treatment for nodal isolated tumor cells in endometrial cancer?No, I don’t recommend adjuvant treatment for endometrial cancer patients based on the presence of isolated tumor cells (ITCs) alone, in the absence of other poor prognostic factors. A recent survey on sentinel l...
How do you monitor blood glucose levels in patients without preexisting diabetes who are starting capivasertib?
Capivasertib inhibits phosphorylation of downstream AKT substrates. By blocking AKT, an obligatory node in insulin signaling that mediates GLUT4-dependent glucose uptake in muscle and adipose tissue and suppresses hepatic glucose production, capivasertib reduces peripheral glucose uptake and increas...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
What non-variceal EGD findings, if any, deter you from using atezo/bev in patients with advanced HCC?
I would discuss the severity and risk of bleeding with the endoscopy team and start beta blockers as indicated before starting anti-angiogenesis therapy.
For a patient with intracranial mets for ES-SCLC who undergoes resection, do you routinely offer post-op SRS to the cavity, or do you proceed with WBRT?
While Whole Brain Radiation Therapy (WBRT) has been the standard, stereotactic radiosurgery (SRS) to the surgical cavity is increasingly being used to minimize neurocognitive decline. However, the issue is especially more nuanced for an ES-SCLC (we don't know whether the primary has been controlled ...
Mindful of the coming approval of abemaciclib, how would you decide between a CDK 4/6 inhibitor in either the first or second-line setting in HR-positive, HER2-negative postmenopausal metastatic breast CA?
Side effect profile is generally a good starting point since there is no head to head comparison (not will there likely be). Abemaciclib does have a higher incidence of diarrhea but also a lower incidence of neutropenia. It also has the advantage of daily dosing which can be less confusing for pati...
What is the utility of a hypercoagulability workup in recurrent cryptogenic stroke, and what specific tests would you recommend?
Ambulatory monitoring for AFib is probably more helpful than such a thorough clotting workup.
Should we consider deferring adjuvant chemotherapy for resected early-stage NSCLC in light of COVID-19?
This is a great and timely question! The absolute benefit observed with adjuvant chemotherapy in surgically resected NSCLC is greatest in those patients with stage II and III disease. The question is how long can one wait to give adjuvant chemotherapy and maintain its benefits. Salazar and colleague...
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...
How do you approach patients who are inappropriately worried/fixated on a test result that is flagged as abnormal but not clinically significant?
This happens all the time now. I tell them that those results were flagged as outside the reference range (I don't use the term abnormal) but that they are not clinically significant. It does not always work if there is a patient who is super anxious or hyper-focused. Typically, if they need a lot m...