Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with high risk acute promyelocytic leukemia, when do you consider ATRA+ATO with GO vs ATRA+ATO with idarubicin?
Given the recent publications with ATRA/ATO and GO in high risk patients or low risk patients who develop leukocytosis (Blood 2017) and the long term follow up of the comparative study form the NCRI AML Working Group (Blood 2018), GO is my preference in all cases unless there is hepatic toxicity or ...
In a patient with high risk acute promyelocytic leukemia, when do you consider ATRA+ATO with GO vs ATRA+ATO with idarubicin?
Given the recent publications with ATRA/ATO and GO in high risk patients or low risk patients who develop leukocytosis (Blood 2017) and the long term follow up of the comparative study form the NCRI AML Working Group (Blood 2018), GO is my preference in all cases unless there is hepatic toxicity or ...
In NSCLC, would you manage other MET alterations, such as a MET T618T mutation, in the same way as a MET exon 14 skipping mutation?
It depends on the specific MET alteration. For example, nonsynonymous SNV mutations in the juxtamembrane region that affect the Cbl binding site, such as Y1003F, may exhibit oncogenic potential similar to exon 14 skipping mutations. However, synonymous mutations such as the one in question, T618T, m...
What criteria are you using for retreatment with Pluvicto (Lu-177) in those who maintain a good performance status and appropriate lab work?
Mainly, whether or not they've exhausted standard options. At the time I'm answering this, Pluvicto is approved for castration-resistant metastatic disease, either pre- or post-taxane chemotherapy. If they have not had chemo, I usually recommend it. If they have, I get their medical oncologist to we...
How would you treat a patient with two concurrent plasmacytomas whose bone marrow showed no evidence of multiple myeloma and has no other MM defining features?
This is by definition Multiple Myeloma and I would treat it as such with systemic induction chemotherapy followed by transplant. These patients do better than the standard MM oftentimes. IMWG Criteria for the Diagnosis of MM | Inl Myeloma Fn
How would you treat a patient with two concurrent plasmacytomas whose bone marrow showed no evidence of multiple myeloma and has no other MM defining features?
This is by definition Multiple Myeloma and I would treat it as such with systemic induction chemotherapy followed by transplant. These patients do better than the standard MM oftentimes. IMWG Criteria for the Diagnosis of MM | Inl Myeloma Fn
How does the presence of indeterminate lymphadenopathy on PSMA PET scan alter your management of unfavorable intermediate-risk prostate cancer?
Summary: In practice, I usually review the imaging myself and attempt to evaluate for common pitfalls of interpretation or evidence that may convince me of a true positive. Often, I find a second review by a blinded radiologist helpful. Unless I am highly suspicious of a false positive, I often err ...
What is your escalation strategy for chronic GvHD?
There are now several available options for steroid resistant cGVHD. The old standbys - ECP and rituxan are useful in about 30% of patients. Ibrutinib was the first new drug to get FDA approval. Unfortunately, I don't think the real-world experience is anywhere near as good as the trial (Chin et al....
How do you manage hot flashes in men with prostate cancer on androgen deprivation therapy?
I prescribe Effexor extended release (XR) 37.5 mg increasing to 75 mg if needed. Serves double duty since many men would benefit from an antidepressant anyway. Works for women as well.
Will you use vadadustat in place of an ESA in treating anemia of chronic kidney disease?
Vadadustat is approved by the FDA only for patients who have been on dialysis for at least 3 months. It is not approved for patients with CKD not on dialysis. Its efficacy and safety are comparable to that of ESAs. I would consider using vadadustat in two patient populations: those on home dialysis ...