Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer local therapy to a patient with GEJ adenocarcinoma with FDG-avid para-aortic node oligometastasis?
I have favored induction systemic therapy and interval re-assessment. If responsive or at least stable disease, I have offered extended field CRT as long as the treatment volume seems reasonable and my perception is that it would be tolerable when assessed in the context of a patient’s performance s...
Do you offer anticoagulation to patients with prior antiphospholipid antibodies detected in pregnancy without a history of pregnancy loss or thrombosis?
I do not know what the risk of pregnancy loss is in a woman without a prior history of VTE or pregnancy loss. I am sure the risk is affected by whether the woman has an underlying rheumatological disease (SLE) and whether she has single positive vs. triple positive LAC. I recommend a baby aspirin on...
What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?
I am so glad someone asked this question. I have heard some peers state that they are reluctant to use immunosuppressants in this situation. However, I do not agree with this. The whole reason our systemic lupus (SLE) patients have leukopenias is due to their autoimmunity (but make sure drugs, infe...
How do you approach anticoagulation in the setting of HIT and thrombocytopenia?
This is a very relevant but rather broad question. On a day-to-day basis, the decision on whether one is dealing with HIT vs other causes of thrombocytopenia can be complex. Applying the 4Ts score is easier in retrospect, but in real life patient management, the score has the potential to change alm...
If a patient had a grade 2 infusion reaction to initial dose of IV Rituximab, can you give subcutaneous Rituximab for cycle 2 or continue with IV Rituximab?
I would likely continue IV rituximab until no more infusion reactions are observed before switching to SQ.
How do you prepare patients with DLBCL on the potential need for cellular therapies after progression on first line regimens?
Once a patient is identified by the lymphoma team, they are referred to our cellular therapy service for full evaluation and discussion of CAR T cell risks, benefits, and logistics. The discussion of protocol versus commercial product, chemotherapy side effects versus CRS/ICANS, and severity includi...
Would you add Daratumumab to upfront treatment of multiple myeloma in a patient with tetraploidy on FISH?
I think the shortest answer is, "Do what you do for your patients with high-risk cytogenetics." If you ask 4 different myeloma specialists, you'll get 4 different answers: VRd for everyone, Dara-VRd for everyone, KRd just for high-risk, Dara-KRd just for high-risk... and then some (not me) will reco...
Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?
If you Google "CRP levels in sickle cell disease", you will find a number of articles reporting that CRP levels are chronically elevated in many patients with SCD. This undoubtedly reflects the chronic inflammatory state that is part of the clinical milieu of SCD. Patients with Sickle - alpha thalas...
Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?
I do not recommend routinely initiating prophylactic antiplatelet therapy for post splenectomy thrombocytosis. First, in patients without a myeloproliferative neoplasm (MPN), the increase in platelet number post splenectomy is both delayed and mild, and there is no correlation between reactive throm...
Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?
Unfortunately, there are no strong guidelines around this topic. In general, I do not count long car rides as a risk factor unless there is something extremely unusual about the trip. Most people are going to get out and stretch their legs every couple of hours. Long flights are different. There are...