Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...
In a patient diagnosed with Multiple Myeloma, is there a role for 24-hour UPEP prior to treatment?
I’d do a random UPEP first. If no light chains or renal dysfunction, I would not do 24-hour test. If light chains present with renal dysfunction, or significant protein on UA (albumin), I may do 24-hour UPEP and protein quantitation to distinguish myeloma kidney from light chains vs nephrotic syndro...
In a patient diagnosed with Multiple Myeloma, is there a role for 24-hour UPEP prior to treatment?
I’d do a random UPEP first. If no light chains or renal dysfunction, I would not do 24-hour test. If light chains present with renal dysfunction, or significant protein on UA (albumin), I may do 24-hour UPEP and protein quantitation to distinguish myeloma kidney from light chains vs nephrotic syndro...
When would you consider larynx preservation in patients with T4N+ SCC of the larynx?
Most T4 patients should not undergo CRT alone. Surgery, followed by postoperative radiation, remains the standard of care for most patients with T4 disease. For patients who decline surgery, concurrent CRT is the best alternative and is superior to radiation alone. However, it is likely still inferi...
For an older patient with hormone-sensitive high-volume, high-risk prostate cancer with metastases to bone who developed toxicity with enzalutamide, what other oral AR blocker would you offer?
There are two other options that this patient might tolerate. One option is darolutamide, which has similar AR-blocking activity but does not cross the blood brain barrier. In large trials, the symptom profile was less severe than those of enzalutamide or apalutamide though some patients will have s...
When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?
Daratumumab is generally well tolerated so would at least consider DaraRd triplet regimen as per the MAIA trial, since there is already FDA approval of this combination for transplant-ineligible newly diagnosed MM patients. Now with SQ Dara also approved and more widely available, this regimen is mo...
When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?
Daratumumab is generally well tolerated so would at least consider DaraRd triplet regimen as per the MAIA trial, since there is already FDA approval of this combination for transplant-ineligible newly diagnosed MM patients. Now with SQ Dara also approved and more widely available, this regimen is mo...