Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For a relapsed AML patient who has previously received 7+3 followed by HIDAC consolidation, how do you choose between FLAG-IDA or MEC re-induction?
In general, there is no "optimal" intensive salvage regimen for relapsed/refractory AML failing prior 7+3 and HIDAC consolidation. Prior comparisons of cytotoxic regimens have demonstrated no clear "winner" so it is based partly on clinical experience. At our center, I tend to prefer adding cladribi...
For a relapsed AML patient who has previously received 7+3 followed by HIDAC consolidation, how do you choose between FLAG-IDA or MEC re-induction?
In general, there is no "optimal" intensive salvage regimen for relapsed/refractory AML failing prior 7+3 and HIDAC consolidation. Prior comparisons of cytotoxic regimens have demonstrated no clear "winner" so it is based partly on clinical experience. At our center, I tend to prefer adding cladribi...
Do you recommend treatment for CLL patients with biopsy proven infiltrative lesions in the liver without hepatic dysfunction or hepatomegaly?
This is a very difficult question without context of why the biopsy of the liver was done. In general, for virtually all body sites, when CLL is found as an asymptomatic surprise finding, I continue observation. This is particularly true when it is an area of high disease presence at the time of aut...
Do you recommend treatment for CLL patients with biopsy proven infiltrative lesions in the liver without hepatic dysfunction or hepatomegaly?
This is a very difficult question without context of why the biopsy of the liver was done. In general, for virtually all body sites, when CLL is found as an asymptomatic surprise finding, I continue observation. This is particularly true when it is an area of high disease presence at the time of aut...
Can tacrolimus in a transplant patient be used during radiation and concurrent chemoradiation?
Patients with solid organ transplants present unique challenges in management and risk of infectious complications, among others. The short answer is that tacrolimus can be used in the lowest dose possible, along with concurrent chemoradiation and close coordination with the transplant team. If the ...
Are there special considerations when treating a patient with sarcomatoid SCC of the head and neck?
Sarcomatoid HNSCC is generally considered a less uncommon but more aggressive version of conventional HNSCC, thought to be at least in part arise as de-differentiated high-grade SCC. While they have been reported in some small studies to arise within a previously irradiated region, these epithelial ...
Do you routinely evaluate for PE if a DVT is found?
I would not routinely evaluate for PE in a patient with new DVT, unless they had symptoms or signs suggestive of PE diagnosis. But I would usually evaluate for DVT in a new PE patient. This is in case the patient develops leg swelling or pain in the future and DVT is found then. It's difficult, oc...
Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?
Leukostasis is a feared complication of acute myeloid leukemia (AML) in patients developing peripheral WBC counts >100,000. The cells in AML are large, sticky, and invasive. By contrast, the lymphocytes in chronic lymphocytic leukemia are small (10 microns or so; not much larger than red blood cells...
Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?
Leukostasis is a feared complication of acute myeloid leukemia (AML) in patients developing peripheral WBC counts >100,000. The cells in AML are large, sticky, and invasive. By contrast, the lymphocytes in chronic lymphocytic leukemia are small (10 microns or so; not much larger than red blood cells...
What hypofractionated radiotherapy dose regimen is acceptable for plasmacytoma?
At the end of the day, it all comes down to delivering a reasonable BED in the range of +/- 50 Gy in fractions of 2 Gy. The type of fractionation chosen is a question of the treatment volume, location, and adjacent OARs. I have treated a few plasmacytomas with SBRT (for instance in the ribs) with 3-...