Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways from ASH 2023?
Gene therapy for sickle cell disease and beta thalassemia. This was the first approval of CRISPR/Cas-based therapy in humans. Ex-vivo engineering of isologous hematopoietic stem cells followed by their reinfusion after myeloablative conditioning led to induction of 40-50% fetal hemoglobin in patient...
Would you extrapolate results from ELEVATE-RR study to favor use of acalabrutinib as first-line therapy in treatment-naive CLL?
The ELEVATE-RR study enrolled patients with a median of 2 prior regimens, with either deletion 11q or deletion 17p. I think one could debate whether selecting this patient population as compared to a less selected treatment naïve population would be more likely to find a difference between the two d...
Would you extrapolate results from ELEVATE-RR study to favor use of acalabrutinib as first-line therapy in treatment-naive CLL?
The ELEVATE-RR study enrolled patients with a median of 2 prior regimens, with either deletion 11q or deletion 17p. I think one could debate whether selecting this patient population as compared to a less selected treatment naïve population would be more likely to find a difference between the two d...
How do you manage bruising in patients on ibrutinib?
Bruising is quite common in patients treated with ibrutinib, and it seems to be a class effect that also is seen with the 2nd generation BTK inhibitors, such as acalabrutinib. It should be mentioned when consenting patients, and reassurance generally is all that is needed because the bruising is usu...
Can acalabrutinib be used after ibrutinib failure in relapsed/refractory mantle cell lymphoma?
Acalabrutinib binds to the same pocket as ibrutinib on BTK. Theoretically, if a patient is ibrutinib resistant, acalabrutinib would not be effective. Ideally, there should have been a small trial testing this hypothesis. However, because of the theoretic concerns, nobody wants to do this trial. As w...
What is your preferred salvage therapy for patients with follicular lymphoma who relapsed within 24 months of completing front-line chemoimmunotherapy (POD24) and will proceed to high-dose therapy with Auto-SCT?
There is no standard therapy for patients progressing within 24 months of 1L chemoimmunotherapy. If you have a well-designed clinical trial, I would do this 1st. Outside of a clinical trial, I would 1st try to biopsy a hot spot to r/o large B-cell transformation. If so, if the patient is a candidate...
How do you manage bruising in patients on ibrutinib?
Bruising is quite common in patients treated with ibrutinib, and it seems to be a class effect that also is seen with the 2nd generation BTK inhibitors, such as acalabrutinib. It should be mentioned when consenting patients, and reassurance generally is all that is needed because the bruising is usu...
Can acalabrutinib be used after ibrutinib failure in relapsed/refractory mantle cell lymphoma?
Acalabrutinib binds to the same pocket as ibrutinib on BTK. Theoretically, if a patient is ibrutinib resistant, acalabrutinib would not be effective. Ideally, there should have been a small trial testing this hypothesis. However, because of the theoretic concerns, nobody wants to do this trial. As w...
What is your preferred salvage therapy for patients with follicular lymphoma who relapsed within 24 months of completing front-line chemoimmunotherapy (POD24) and will proceed to high-dose therapy with Auto-SCT?
There is no standard therapy for patients progressing within 24 months of 1L chemoimmunotherapy. If you have a well-designed clinical trial, I would do this 1st. Outside of a clinical trial, I would 1st try to biopsy a hot spot to r/o large B-cell transformation. If so, if the patient is a candidate...
What are the factors that convince you to not immediately treat mantle cell lymphoma and to follow a course of "active surveillance"?
A subset of patients with MCL have a significantly longer survival (often more than 7-10 years) and a more indolent disease course. Two separate groups have reported patients who did not receive up-front chemotherapy at the time of diagnosis but were instead actively monitored, the watch-a...