Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?
It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages co...
When do you combine hypomethylating agents with venetoclax or gemtuzumab ozogamicin in elderly patients with AML who are ineligible for intensive chemotherapy?
In September, 2017, the FDA granted approval for gemtuzumab ozogamicin (GO) in combination with daunorubicin and cytarabine (DA) and as a monotherapy for the treatment of adult patients with newly-diagnosed CD33-positive acute myeloid leukemia (AML). Approval of GO monotherapy was based on a randomi...
Would you consider using daratumumab in the first line setting for non-transplant eligible multiple myeloma?
Agree as above; you cannot fairly compare PFS when the treatment arms have different durations of therapy.One could argue that the current standard for previously untreated elderly myeloma patients is continuous lenalidomide and dexamethasone, as described in the FIRST study, (Benboubker et al, NEJM...
How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?
Looking at the trend of pro-lymphocyte increase will help in addition to clinical signs of progressive disease (splenomegaly). It is useful to check for TP53 and MYC translocations since these are common in PLL. As you mentioned, >55% pro-lymphocytes has been used to diagnosed PLL based on a report ...
Do you think there will be a role for duvelisib in the treatment of relapsed/refractory chronic lymphocytic leukemia?
I believe this agent could find a home for therapy in CLL as it is given by itself provided that further efficacy is demonstrated in a population where it would be most likely used, ibrutinib resistant CLL. Additionally, incorporation into non-BTK inhibitor combinations would also be possible. Given...
Would you consider stopping chemotherapy and continuing trastuzumab alone in a patient with metastatic HER2 positive GEJ cancer who had a complete response to chemotherapy and trastuzumab?
Since there are no data for a) stopping palliative chemotherapy in patients who achieve a clinical complete response (CR) or b) trastuzumab therapy alone, clinical practice is unburdened by any evidence. The rare patients I have had who have achieved a CR tend to have had small-volume metastatic dis...
In a patient with metastatic HR+ breast cancer progressing on single agent AI, would you use a different AI with CDK4/6 inhibitor?
I doubt that changing the AI would make a difference - in the EFECT trial, patients progressing or recurring on a nonsteroidal AI had a 3.7 month median TTP on exemestane (JCO 2007) (meaning that many patients had progressed by their first reassessment. The more intriguing question is the potential ...
How do you counsel a patient with a history of breast cancer regarding use of breast MRI for screening?
In our Breast Survivorship Clinic at MD Anderson we do not regularly recommend a surveillance breast MRI to screen for local recurrence or for new breast cancer in all of our breast cancer survivors, since there is lack of data to support this practice. Not to mention the elevated cost and the possi...
Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?
The transformed lymphoma that develops out of indolent small B cell lymphoma such as marginal zone lymphoma, follicular lymphoma or lymphoplasmacytic lymphoma, is typically diffuse large B cell lymphoma (DLBCL). When this type of transformed DLBCL develops in a patient who has not previously receive...
What is your preferred chemotherapy regimen to give concurrently with radiation for unresectable stage 3 NSCLC?
I have generally preferred the cisplatin/etoposide regimen, in part due to the "consolidation" portion of the weekly paclitaxel/carboplatin regimen (ie in patients who could tolerate cisplatin based regimen, it seems preferable to be done after six weeks rather than 12 weeks). That being said, I do ...