Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred next line of therapy for a fit patient with unresectable, refractory osteosarcoma who has progressed after MAP, local radiation, and IE?
Cabozantinib also showed activity per CABONE trial. Compares favorably to other TKIs.
Are there data to support full-dose anticoagulation added to an antiplatelet in recurrent peripheral arterial thrombosis requiring revascularization and stenting?
This question comes up frequently at our institution. I previously consulted with our vascular surgery team who referred me to this trial of Edoxaban with SAPT, trying to avert what may be limb loss if the bypass graft/stent fails. We've often promoted rivaroxaban 2.5 mg po BID per VOYAGER PAD if we...
In patients with unresectable, liver-limited neuroendocrine tumors (NETs), what clinical or radiographic criteria guide your decision to prioritize systemic therapy over locoregional approaches?
The first question is always if it is truly unresectable... What is considered unresectable by some might be considered resectable by others, so I always recommend getting an opinion from an HPB surgeon with substantial experience in treating patients with NETs (whether that is done in person or at ...
How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?
I agree with @Dr. First Last's detailed response. Practically speaking, I would also add that it is important to listen and validate your patient's concerns and respond to their frustration and sense of loss. A diagnostic evaluation will not only help you and your patient discover or 'rule out' othe...
Would you consider using IO alone for lung cancer patients with PD-L1 <1% but who have high TMB?
The brief answer here is a resounding no. A more extended version might include a statement that this would be a case of not seeing the forest for the trees.And the tree here is the FDA approval of pembrolizumab in a tissue-agnostic fashion for patients with advanced TMB >10 mutations/Mbase- likely ...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?
The short answer is "no". I do reimage many people near the end of the 3-6 months of treatment, but it doesn't really change my mind about duration of treatment in most instances. I use repeat imaging to help me understand how much of the clot resolved and thus, determine what their new baseline is....
How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?
I recommend indefinite anticoagulation for most patients with portal vein thrombosis, and at least 3-6 months if there are risk factors for bleeding. Once they complete anticoagulation for the first 6 months, I re-evaluate their risk of recurrent thrombosis vs bleeding, and if there is an underlying...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...