Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you approach a patient with metastatic breast cancer with extensive skin involvement?
The issue of extensive skin involvement in metastatic breast cancer can be very challenging. Many factors come into play including whether the patient has had a mastectomy or has an intact breast as well as whether previous radiation has been delivered. For a previously untreated intact breast: Sur...
In a patient with type I von Willebrand disease who is pregnant and at increased risk for preeclampsia, would you recommend treatment with aspirin?
Yes, and is tolerated well.
When would you initiate exchange transfusion in babesiosis and significant hemolysis?
There are no studies that answer this question. Some people have extrapolated from the use of exchange transfusions for severe malaria to consider using this treatment with babesiosis, another intraerythrocytic protozoan infection. Unfortunately, though there are some studies on malaria, the results...
Due to the high incidence of hyperlipidemia secondary to lorlatinib, do you recommend empiric statin therapy to all patients without known contraindications upon initiation of lorlatinib?
I do not empirically start statin therapy. However, I will check lipid and triglyceride levels prior to initiation of lorlatinib and periodically (every 3-6 months) thereafter. I will initiate or change statins in patients where we see a rise in lipids and triglycerides. I will aim for a level that ...
What is your approach to treating inoperable mucosal melanoma of the head and neck region?
It is often nasal cavity/paranasal sinuses, so 1.2 Gy BID to 74.4 Gy and electively treat the neck. Otherwise 70 Gy/35 fx/30 treatment days SIB.
Do you have a maximum size cutoff for lung SBRT in central NSCLC?
The bigger the tumor size, the lower the efficacy of SBRT. Typically, I wouldn’t treat lesion of size >7 cm for the following reasons: The local control is lower even with BED>100 Gy; There is high chance that the PTV overlaps with critical structures so toxicities could be high. There is high poss...
How do you choose which BTK inhibitor to use in NHL?
At this point, I use very little ibrutinib. If I need CNS penetration, ibrutinib has a track record there. Otherwise, I have pivoted to acalabrutinib and zanubrutinib. I typically will pick by indication - acala for CLL and zanu for WM/MZL. In MCL or likely soon in CLL, I am not entirely sure how to...
How do you choose which BTK inhibitor to use in NHL?
At this point, I use very little ibrutinib. If I need CNS penetration, ibrutinib has a track record there. Otherwise, I have pivoted to acalabrutinib and zanubrutinib. I typically will pick by indication - acala for CLL and zanu for WM/MZL. In MCL or likely soon in CLL, I am not entirely sure how to...