Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
If PEAK (bezuclastinib + sunitinib) is approved, how would it influence your second-line treatment strategy for patients with advanced KIT-mutant GIST following imatinib failure?
This will be the preferred second-line therapy.
Do you consider FOLFIRINOX dose adjustments for elderly patients with a good performance status in the neoadjuvant setting for resectable pancreatic adenocarcinoma?
This is a question worth revisiting in light of recent data. The question assumes that we would prefer to use FOFLIRINOX as peri-operative treatment in resectable PDA and this is commonly the case based on extrapolation from cross-trial comparisons of randomized data evaluating combination therapy i...
In clearly resectable pancreatic adenocarcinoma with no arterial or venous involvement, is there a role for neoadjuvant chemotherapy?
There is currently equipoise regarding this question, and the Alliance A021806, a phase III trial evaluating perioperative versus adjuvant therapy for resectable pancreatic cancer, clinical trial will address it. There is a role in certain subsets of patients without clear vascular involvement regar...
What is your approach to optimizing pre-operative hemoglobin in patients with sickle cell disease?
This is always a question that has to be hyper-individualized. The research, and therefore the associated professional guidance, is thin. The American Society of Hematology (ASH) 2020 Guidelines for Sickle Cell Disease: Transfusion Support and the NHLBI Expert Panel Report (2014) are the only profes...
How would you treat an elderly patient with metastatic breast cancer with two new progressive right breast/chest wall lesions?
I addressed the question of how to manage patients with symptomatic breast masses in a posting on December 19, 2025. The first question for this patient with progressive lesions is whether they are symptomatic now or not. If not currently symptomatic, then I would likely defer RT until such time as ...
Do you consider co-prescribing hormone therapy and anticoagulation in a patient with prior DVT and uncontrollable VSM uncontrolled by non-hormonal therapies?
While I agree that you need to be thoughtful about adding additional VTE risk to patients with a history of VTE, I am much less concerned when patients are already on full-dose anticoagulation. Especially when the medication is transdermal estrogen, which has the lowest effect on thrombotic risk. I ...
Is it safe to use medroxyprogesterone for vasomotor flushing?
There are many options for management of hot flashes including venflaxine and gabapentin being most frequently used as well as some data on cognitive behavioral therapy, oxybutynin, and acupuncture. For the most refractory cases, I do discuss medoroxyprogesterone 400 mg IM as a one time option based...
Is there anything you use for patients with anticipatory nausea who has failed Ativan and Zyprexa?
I know of no data, but I would consider hypnosis, mediation and mindfulness, cognitive behavioral therapy, acupuncture, and medical marijuana as possible options for anticipatory nausea refractory to lorezapam and Zyprexa. Hypnosis, mindfulness, and cognitive behavioral therapy are in a sense are re...
For low/intermediate essential thrombocythemia not on cytoreduction, would you temporarily cytoreduce in anticipation of surgery?
First, I am going to answer this question with a question. What is low/intermediate essential thrombocytosis (ET)? I ask this question because we are living in the 21st century in the midst of the genomic era, and it is far past the time that we should be dwelling on phenotype instead of employing p...
For low/intermediate essential thrombocythemia not on cytoreduction, would you temporarily cytoreduce in anticipation of surgery?
First, I am going to answer this question with a question. What is low/intermediate essential thrombocytosis (ET)? I ask this question because we are living in the 21st century in the midst of the genomic era, and it is far past the time that we should be dwelling on phenotype instead of employing p...