Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you use routine PET scans after two cycles of R-CHOP to guide first-line treatment de-escalation in low-risk (aaIPI = 0) DLBCL patients?
This phase III trial suggests that in very low-risk limited-stage DLBCL (aaIPI = 0), patients who achieve a negative PET after two cycles of R-CHOP can safely receive only four total cycles instead of six, with similar 3-year PFS (92% vs 89%) and less toxicity. However, the results apply to a highly...
When do you order genetic studies such as comparative genomic hybridization for melanocytic lesions?
In my practice, I confine copy number alteration studies (SNP array testing) for cases where the biological potential of a melanocytic proliferation is in question. I do not perform the testing if the case is diagnostic histopathologically and/or immunohistochemically of a nevus or melanoma.The seco...
How do you approach relapsed idiopathic HLH?
This question is quite non-specific - the answer depends very much on the specific context (child, adult, relapsed after what treatment?) and as such, can only be answered in broad strokes.First, ensure that it is truly idiopathic – check EBV, CMV viral loads, and other viral/infectious triggers as ...
How do you approach relapsed idiopathic HLH?
This question is quite non-specific - the answer depends very much on the specific context (child, adult, relapsed after what treatment?) and as such, can only be answered in broad strokes.First, ensure that it is truly idiopathic – check EBV, CMV viral loads, and other viral/infectious triggers as ...
Do you initiate anticoagulation prophylaxis for pediatric patients with vascular compression secondary to solid tumor/lymphoma?
It is an interesting question, but lacks critical details. Of course, most cancers are prothrombotic, and anticoagulation can have risks: Is it arterial or venous compression? Complete obstruction? Acute or chronic? Collaterals? Is it compromising an organ? Is thrombus seen, or is there blood flow?...
What is your preferred chemotherapy backbone (FOLFOX or FOLFIRI) when combining with encorafenib + cetuximab in the 1L setting for BRAF V600E-mutant mCRC?
In my practice, the treatment backbone regimen decision is driven by patient factors - thoughts about hair loss, current bowel function, performance status, existing neuropathy, and other comorbid conditions. All things equal, I prefer FOLFOX. Recent updates from ASCO GI show good activity for FOLFI...
Prior to gender affirming surgery, do you hold estrogen (or convert to transdermal) to minimize postoperative VTE risk?
I'd divide this into 2 sub-questions: what to do in a patient who has a history of thrombosis, and what to do in a patient without a history of thrombosis. In a patient with prior thrombosis, I would generally have them on indefinite anticoagulation alongside ongoing estrogen use. We know that trans...
How would you approach anticoagulation for a patient with acute bilateral pulmonary emboli related to malignancy, but with a concomitant cavitary lung mass experiencing episodic, small-volume hemoptysis?
This is an interesting question to which we need to apply the art of medicine, weighing the risks and benefits of treatment. The major fatal events in this exact scenario are: Recurrent PE from undertreatment. Sudden massive hemoptysis after aggressive anticoagulation. The physician's management s...
How would you approach anticoagulation for a patient with acute bilateral pulmonary emboli related to malignancy, but with a concomitant cavitary lung mass experiencing episodic, small-volume hemoptysis?
This is an interesting question to which we need to apply the art of medicine, weighing the risks and benefits of treatment. The major fatal events in this exact scenario are: Recurrent PE from undertreatment. Sudden massive hemoptysis after aggressive anticoagulation. The physician's management s...
Given the emerging benefit of neoadjuvant immune checkpoint inhibitors in selected patients with cutaneous melanoma, when should lymph node basin ultrasound or cross-sectional imaging (CT/PET) be considered prior to wide local excision (WLE) with or without sentinel lymph node biopsy (SLNB) in patients with clinically node-negative disease?
We usually would argue for cross-sectional imaging for T4 tumors and above. In the end, it will be clinical gestalt. If the pathologist confirms "no dermal attachment", then it is an argument for doing cross-sectional imaging. There is no guidance or evidence to support the idea that imaging for thi...