Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How often should you screen for lymphoma in patients with primary Sjogren's syndrome?
Depends on index of suspicion, I don't have a set schedule. In addition to assessing the initial "phenotype" and disease activity of SjD, I want to know baseline status of quantitative Ig's and if a monoclonal is present. I reassess based on clinical scenario over time. Some colleagues will recommen...
Would you offer consolidative durvalumab after chemoRT for an isolated mediastinal recurrence of NSCLC that occurred during adjuvant pembrolizumab given for the initial lung cancer?
No, I would not
In what scenarios (if ever) would you check peripheral blood flow cytometry in a patient with known multiple myeloma to evaluate for circulating plasma cells (CPCs) in the absence of an abnormal smear?
The question alludes to the fact that there is substantial data now on the prognostic implications of circulating plasma cells at diagnosis. Jelinek et al., PMID 36315921 showed that 2%+ CPCs are associated with a plasma cell leukemia-like phenotype. Much lower levels of CPCs were also associated wi...
Would you use belzutifan in metastatic renal cell carcinoma with somatic mutation in VHL (VHL p.q73) without having germline VHL and/or other manifestations of VHL syndrome?
Currently, there is no proven role for belzutifan use in somatic VHL mutation RCC. However, phase III clinical trial in advanced pretreated RCC randomizing to everolimus or belzutifan is currently ongoing. Phase II trials conducted in advanced RCC have reported promising results with belzutifan ther...
What are your top takeaways in Hematologic Malignancies from ASCO 2024?
The top three would be IMROZ DREAMM-8 BENEFIT
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
Do you recommend sentinel node biopsy or ALND in cT4 or cT3 cN0 breast cancer patients?
The major trials comparing SLNB versus ALND (i.e., Table 1 from Lyman et al. 2014) either required tumors to be small (<= 2-3 cm), or had few patients with larger tumors (e.g., NSABP B-32: less than 2% with tumor > 4 cm; ALMANAC: 2% with tumor > 5 cm). Similarly, the major surgical trials comparing ...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...