Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
What is your preferred treatment agent for type 1 von Willebrand patients needing minor procedures if they have a history of severe hyponatremia with DDAVP?
I would avoid DDAVP. I typically individualize hemostatic management based on the procedure- related risk of bleeding and severity of the VWD. For example, for dental extraction, tranexamic acid alone may suffice; however, communication with the proceduralist to use topical agents such as topical th...
How exactly would you utilize ADT via leuprolide or bicalutamide with salvage RT post prostatectomy with PSA >0.5?
The dilemma on the need for hormonal therapy in the salvage radiation setting after radical prostatectomy is a major one in current clinical practice, driven by the modest survival benefits seen in the RTOG 9601 trial with 2 years of bicalutamide (Shipley et al., PMID 28146658), but also follow up s...
Do you have a certain tumor size threshold in which you change chemotherapy recommendations for a small, triple negative breast cancer?
Breast cancer death from small tumors is often underestimated. In 2000, 0.92%, 4.0%, and 10.7% breast cancer-specific deaths were due to T1a, T1b, and T1c node-negative cancers, respectively, which increased significantly to 1.9%, 5.8%, and 14.7% by 2017. This is an interesting read on death from sm...
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...
What is your preferred treatment for arthralgias from AIs?
I usually reassure patients that this is common, and can improve on its own. Because everyone is different i give them options. Duloxetine has the advantage of improving arthralgias, hot flashes and mood. However, a lot of patients are opposed to taking more medication. Acupuncture is effective, and...
Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?
I do not offer consolidation chemotherapy to patients prior to durvalumab in patients with locally advanced, unresectable NSCLC. The PACIFIC trial was a randomized phase III trial that established the role of consolidation durvalumab after definitive chemoradiation for patients with stage III NSCLC....
In an early stage breast cancer post neoadjuvant chemotherapy, do you repeat ER/PR and HER2 status on the surgical specimen if there is residual disease?
It can be more nuanced than always repeating all the receptors. If there is residual disease after NAC, and the cancer is grade 3, I do feel it is worthwhile to at least repeat HER2. After all, we have good options for reducing the risk of recurrent HER2+ disease in the residual disease after NAC se...
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...