Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the most convenient and reproducible setup for simulation and treatment of the contralateral testis in a primary testicular lymphoma?
Frog leg position with the penis taped to the pubic/abdominal wall. Usually, electron beam with energy based on thickness and dose of 24 Gy.
Would you recommend radiation to a painful rib fracture in a patient with multiple myeloma on systemic therapy with ongoing response to treatment?
It depends if it’s a newly diagnosed MM setting versus relapsed MM setting with a rib fracture. Some possible scenarios: For the ND setting, systemic therapy with adequate pain management early on is preferred. For relapsed setting, if the rib fracture heralded the relapse then systemic therapy/pai...
Does phosphatidylserine antibody play a role in the diagnosis of antiphospholipid antibody syndrome?
While additional APLAs such as aPS/PT are being investigated for clinical relevance, to date, they are not established markers for disease. I would interpret the aforementioned paper with caution, as these antibodies were tested in individuals with known and diagnosed APS. Their role in establishing...
When should I consider anticoagulation in an unprovoked upper extremity deep venous thrombosis?
Would do careful history like hunting Would do anticoagulation Age and fam hx may be helpful if one does thrombophilia workup
When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?
I would consider anticoagulation when there are significant risk factors for extension to the deep vein system such as proximity to the deep veins, underlying thrombophilia (cancer in particular), symptoms, and large clot burden.
Do you consider resuming Venetoclax for patients with CLL upon progression/recurrence, in whom Venetoclax/Rituximab achieved CR and Venetoclax was previously well tolerated but stopped after completing 2 years of therapy?
Yes, in such situations in clinical practice, retrying venetoclax is entirely appropriate. How long has the patient been off prior exposure to venetoclax is a factor to consider, more than 2 years would make me more apt to retry venetoclax. Whether the patient has been given BTKi in the past and ha...
How would you manage a provoked blood clot for a patient who had been placed on low dose DOAC for history of unprovoked blood clot?
To clarify the scenario: the patient had an unprovoked VTE for which they are currently on low dose DOAC and now have experienced recurrence in association with a well-defined (as outlined in ASH guidelines Ortel et al., PMID 33007077) provoking event. A number of additional variables would weigh in...
What are your recommendations for adult sickle cell patients who end up being admitted several times a year for pain crises despite hydroxyurea, crizanlizumab, voxelotor, etc?
This is the problem that vexes all people treating sickle cell disease. First, is to be sure that drug dosing is optimized. Both voxelotor and crizanlizumab can be added to hydroxyurea. All three drugs could be used together. Perhaps equally important as drug therapy is to cope as best as possible w...
Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?
I do not use KCentra in this clinical situation. Firstly, the INR is validated for vitamin K antagonists (VKA) therapy only. The VKAs inhibit the synthesis of factors II, VII, IX, and X while the liver produces more clotting factors such as fibrinogen, II, V, VII, IX, X, XI, XII, etc. The INR has no...
How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?
Needs more information. Is the issue unresponsiveness or intolerance? Frequently, patients report GI intolerance and don't really take it. It's crucial to inquire about this and consider trying different preparations to find a suitable option. What was the nature of the iron sucrose allergy? Sometim...