Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you offer IVIG to myeloma patients with recurrent infections?
I do offer IVIG to patients with myeloma who are having recurrent respiratory infections and have hypogammaglobulinemia (<400 mg/dL). I do counsel patients that we do not have strong clinical trial data to support the use of IVIG in this setting. While I dislike quoting anecdotal experience, I will ...
How would you approach the adjuvant management of thoracic SMARCA4-deficient undifferentiated tumor of the lung following lobectomy?
We know these tumors behave aggressively, but don't have a good handle on chemo-sensitivity. Some morphologically look like a sarcoma, and some others, carcinomas. Given the lack of clarity, if completely resected with negative margins, reasonable to watch closely and treat with measurable/evaluable...
How would you treat lymphoplasmacytic lymphoma (LPL) with a non-IgM paraprotein?
My treatment approach would be similar to those with IgM LPL (WM).
What's the role of ibrutinib and venetoclax in CLL in light of data emerging from ASH 2022?
Authored by @Dr. First Last and @Dr. First Last The current FDA-approved, standard-of-care for frontline chronic lymphocytic leukemia (CLL) therapy includes continuous therapy with a Bruton tyrosine kinase inhibitor (BTKi) such as ibrutinib or acalabrutinib, with or without an anti-CD20 antibody, or...
When, if ever, would you consider deep venous thrombosis prophylaxis for patients with advanced epithelial ovarian cancer undergoing neoadjuvant chemotherapy?
The Khorana scoring system is a great tool when this question comes up. I use it for all my ovarian cancer patients who have measurable disease in the neoadjuvant and adjuvant settings. I re-evaluate their score every 3 months to ensure they are still candidates for VTE ppx. Mulder et al., PMID 3060...
What's your choice of next line therapy for a metastatic papillary RCC who has progressed on cabozantinib?
Combination immunotherapy works well.
What are the current timing recommendations for initiating radiation after lumpectomy?
For me, this is dependent on the RT technique and plans for chemotherapy. If planning partial breast (regardless of plan for chemotherapy), I will recommend the RT prior to chemotherapy. I will usually simulate 3-4 weeks post-op and then start RT a week later. If planning whole breast, if no plan f...
Assuming all options for BCMA-directed therapy are available, how would you approach treatment for a patient with 4 prior lines of myeloma-directed therapy who is eligible for a BCMA-directed therapy?
Great question with no right answer. I note, for example, that the original question stem asks about overall therapy approaches while the subsequent poll asks about effectiveness. With regard to effectiveness in isolation, I think it's fair to say that cilta-cel (a CAR-T therapy) has the best track ...
What would you use for a maintenance regimen after high dose chemotherapy and autologous stem cell transplant for a patient with 17p-deleted multiple myeloma?
PI/IMiD maintenance — if RVd +/- Dara is used as induction, then Len with Bortezomib q 2 weeks. If KRd is used as induction, then Len with Carfilzomib q 2 weeks. Adjust dose/schedule based on tolerance/side effects.
What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?
This is a great question. I think the most important thing when it comes to the consideration of amyloidosis is thinking of it in the first place! For patients with MGUS (or myeloma) but with red flag symptoms of amyloidosis, it is important to work these up. The studies recommended may differ base...