Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is bone marrow biopsy indicated in patients with primary polycythemia but negative for JAK2 mutation including exon 12?
Thank you for your interest and your questions. I can't divine what the WHO experts were thinking (or not thinking), but they definitely had a problem when they a priori initially eschewed red cell mass (RCM) and plasma volume (PV) measurements for the diagnosis of PV because they didn't understand ...
For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?
I just want to point out that hemolytic microangiopathy (as seen on the peripheral smear by our Hematology colleague) is paramountly important in determining the presence of TMA. Laboratory parameters may be misleading. I have seen even ADAMT13 levels very low in sepsis and DIC process. Therefore lo...
How do you approach balancing the potential risk of worsening actinic damage and maintaining CTCL clearance in patients treated with nb-UVB?
NB-UVB continues to be the most effective skin directed therapy for patch MF. I try to use it as much as possible as monotherapy, or commonly in combination with retinoids for treatment and maintenance of early-stage disease. In patients with severe solar damage, I may continue phototherapy adding l...
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...
For a pathologic Stage I squamous cell carcinoma of the oral tongue with negative margins and adequate neck dissection, is perineural or lymphovascuar invasion alone an indication for adjuvant radiotherapy?
I think Dr Eisbruch is spot on- patients with PNI do worse in the surgical literature, but the benefit of XRT in this scenario to obviate recurrence is far from robust. My personal belief is that PNI is not a sign of neurotropism like in melanoma or adenoid cystic ca, but likely another surrogate fo...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...
Would you consider using luspatercept for a patient with MDS with anemia refractory to ESA/HMA, that has a SF3B1 mutation but without ringed sideroblasts?
A trial of luspatercept would be a reasonable option for this patient. While the phase III studies supporting the use of luspatercept do not represent this patient (MEDALIST Fenaux et al., PMID 31914241 and COMMANDS Platzbecker et al., PMID 37311468), the presence of an SF3B1 mutation does appear to...