Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you manage anxiety in patients prior to bone marrow biopsy procedure in the clinic?
With the use of the drill procedure for bone marrow biopsies, my experience is that the pain element of this procedure has essentially been eliminated. Prior to this, we offered conscious sedation, when possible, to our patients because of the painful nature of the biopsy procedure, which is not aba...
How do you interpret nodes with minimal increased uptake on PSMA PET in prostate cancer?
This question is relatively similar to another recent question on indeterminate PSMA PET (#26360), where I provided a longer answer in a bit more detail. The summary is that this essentially relies upon your clinical judgement, and there is no definitive algorithmic way to determine the true nature ...
For atrial fibrillation patients with high risk of CVA who cannot tolerate full dose AC due to bleeding, do you consider low dose/extended dosing anticoagulation even if they do not meet age/GFR criteria for a dose reduction, if Watchman is not readily available as an option?
Most drugs, including anticoagulants, have a dose-response. Therefore, one could argue that even though DOACs were not studied at low doses, except in defined sub-groups such as the very elderly, using such a dose in other situations may have some benefit. The problem is that without data, we simply...
For atrial fibrillation patients with high risk of CVA who cannot tolerate full dose AC due to bleeding, do you consider low dose/extended dosing anticoagulation even if they do not meet age/GFR criteria for a dose reduction, if Watchman is not readily available as an option?
Most drugs, including anticoagulants, have a dose-response. Therefore, one could argue that even though DOACs were not studied at low doses, except in defined sub-groups such as the very elderly, using such a dose in other situations may have some benefit. The problem is that without data, we simply...
What are your top takeaways in Medical Oncology from SABCS 2025?
lidERA trial. This is the first phase III trial showing an advantage for an oral SERD giredestrant over standard endocrine adjuvant therapy in early breast cancer. Treatment with giredestrant led to a 30% reduction in the risk of invasive disease recurrence over standard endocrine therapy at the fir...
Under what circumstances would you start steroids for a patient with a new brain tumor prior to biopsy or resection?
Agree. As a corollary, if lymphoma is suspected, do NOT use steroids before diagnostic confirmation unless there are severe symptoms or significant mass effect. If steroids are unavoidable, diagnostic confirmation should be pursued within days due to the lymphotoxic effects of steroids decreasing di...
When would you continue atezolizumab/bevacizumab beyond progression in advanced HCC?
The key parameters I use when considering treatment beyond progression for a patient on atezolizumab bevacizumab are clinical symptoms as compared to baseline, performance status as compared to baseline, and underlying hepatic function as compared to baseline. If there is worsening in any of these a...
For patients with early stage resected giant cell lung cancer and other less common histologies, are there any specific considerations for adjuvant therapy?
Giant cell carcinomas/pleomorphic carcinomas/sarcomatoid carcinomas are difficult, and typically aggressive entities. In reviewing the literature, there is precious little data to guide the selection of cytotoxic chemotherapy (most reports are pathology studies, some case reports, and unfortunately,...
What is your approach to systemic anticoagulation for patients with hypoalbuminemia and nephrotic syndrome secondary to a non-membranous nephropathy condition?
Patients with nephrotic syndrome (NS) and hypoalbuminemia have a several-fold higher risk of venous thromboembolism (VTE) than the general population and also a somewhat higher risk of arterial thromboembolism (ATE), such as MI and stroke. This risk seems to be higher in membranous nephropathy (MN) ...
Is there a role for resection of the cutaneous primary in a patient on dual-agent immunotherapy for metastatic melanoma?
Yes. The location and size (width, length) should be noted. The patient should first be treated with dual ICI. If the patient with metastatic melanoma, who has the primary intact, undergoes successful dual ICI therapy and has a documented CR, near CR, or excellent PR, which is typically noted within...