Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the management of a patient with elevated iron saturation (60%) and ferritin (500s) with negative genetic testing for hemochromatosis?
I would approach this clinical scenario in the following manner: Always starting with good medical and family history first. Is there any history compatible with secondary hemochromatosis (i.e., history of blood or multiple iron transfusions)? Could the patient be tested for other non-282Y genetic ...
How do you plan to integrate exercise programs after adjuvant chemotherapy in patients with colon cancer, given the results of the CHALLENGE trial?
The CHALLENGE study demonstrated that structured exercise following adjuvant chemotherapy significantly benefits patients with resected high-risk stage II or stage III colon cancer. The study's success hinged on its mandatory behavioral-support sessions. Unlike the control arm, which received only h...
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Do you offer RT both to the prostate and synchronous oligometastases in de novo oligometastatic prostate cancer?
We do not yet have good evidence to tell us whether or when we should offer metastasis-directed therapy (MDT) for de novo oligometastatic prostate cancer. ORIOLE (like STOMP) was conducted in the recurrent setting. Those trials showed that MDT could delay progression and possibly allow a delay in th...
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
Dexamethasone is one of the most frequently prescribed medications in neuro-oncology clinics. Dexamethasone is often favored over other corticosteroids owing to its lower mineralocorticoid effects and high potency as well as essentially 1:1 oral to IV ratio meaning that we use similar IV and oral do...
What is your treatment approach for MAG antibody associated polyneuropathy?
When patients have a classic Distal acquired demyelinating sensory (DADS) Neuropathy phenotype (by clinical +/- EDX criteria), typically an SPEP/IFE is checked first, and if an IgM monoclonal gammopathy is observed, then I typically check MAG antibodies at that point (if clinical and EDX features ar...
When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?
The SWOG 8736 study included patients with stage I (bulky or non-bulky) and nonbulky stage II aggressive non-Hodgkin lymphomas (mostly DLBCL). Bulky was defined as a mediastinal mass >1/3 maximal chest diameter or any mass > 10 cm. Patients were randomized to 8 cycles of CHOP or 3 cycles of CHOP + R...
Would you consider adding adjuvant ribociclib for a patient who has already received 2 years of endocrine therapy and is eligible for ribociclib according to the NATALEE trial?
Since the NATALEE trial excluded patients who received more than 12 months of neoadjuvant or adjuvant endocrine therapy, I would probably not consider ribociclib for your patient, as she is too far out from initiation of endocrine therapy.
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...