Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach frontline treatment for an elderly patient with adult T-cell leukemia-lymphoma (ATL)?
More information is needed. As you know, there are four clinical variants of ATL that differ in clinical presentation, prognosis and need for treatment. Are you dealing with acute, lymphoma-type, or unfavorable chronic-type ATL? If so, for elderly patients (≥70 years), a CHOP or CHOP-like regimen, b...
What is your approach to CMML-MDS in an older patient with low risk disease who is becoming transfusion dependent?
The short answer is that we treat lower risk CMML much like we treat lower risk MDS, even though we don't have dedicated studies in CMML to support this approach. After addressing any reversible causes of anemia (iron or vitamin deficiencies, hemolysis, etc...), NCCN guidelines for MDS would recomme...
What is your approach to CMML-MDS in an older patient with low risk disease who is becoming transfusion dependent?
The short answer is that we treat lower risk CMML much like we treat lower risk MDS, even though we don't have dedicated studies in CMML to support this approach. After addressing any reversible causes of anemia (iron or vitamin deficiencies, hemolysis, etc...), NCCN guidelines for MDS would recomme...
How would you approach transfusion-dependent anemia in an intermediate-risk MDS patient refractory to azacitidine?
An MDS patient with ESRD likely has multiple contributors to their anemia. It is surprising to see the EPO level >500, but this may reflect the use of ESAs. If so, I would make sure that the dose is appropriate for MDS (60,000 units at least weekly) and that it is not renally dosed. If the patient i...
How do you approach MDS patients with low/very low risk IPSS-R but high risk mutations on NGS?
This a great question and one that I think will become more frequent in clinical practice. As it stands in my practice currently, I have been managing my IPSS-R low/very low-risk patients as I always have, with either observation, ESAs, or lenalidomide (in the case of those with del 5q). Age and com...
How do you approach MDS patients with low/very low risk IPSS-R but high risk mutations on NGS?
This a great question and one that I think will become more frequent in clinical practice. As it stands in my practice currently, I have been managing my IPSS-R low/very low-risk patients as I always have, with either observation, ESAs, or lenalidomide (in the case of those with del 5q). Age and com...
How do you workup splenomegaly related to possible hematologic etiology in the absence of abnormal blood counts, adenopathy or severe constitutional symptoms?
The presence of splenomegaly is an important finding found either on physical exams or by imaging. As noted in the question, the initial work up includes physical exam looking for lymphadenopathy. In addition, laboratory evaluation, including absolute white count, and differential may help explain w...
How would you treat newly diagnosed stage IV GEJ adenocarcinoma with both Claudin 18.2 and HER2 (3+ via IHC) overexpression?
Would treat as any other HER+3. FOLFOX+Trastuzumab and add pembrolizumab only if PDL1+. Given the lack of data, would not add zolbe.
How would you approach patients with high risk mucoepidermoid carcinoma (high grade) of the parotid gland for optimal adjuvant treatment?
Would be nice to know all the risk factors - margins, PNI, etc.Due to high-risk features, adjuvant RT is appropriate and guideline-concordantHowever, there is no strong supporting evidence to add adjuvant chemo as salivary gland cancers are typically not chemo-sensitive.Published real-world data suc...
Is there any evidence for amyloid/amyloidosis causing a spurious/false PSA reading?
This is an excellent question.Our group has been involved with amyloid/radiation effects in patients with Alzheimer’s disease Turn our initial run-up and through our most recent reviews, I have not seen any significant publications nor have I seen clinical situations that this addresses, although am...