Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach the treatment of hairy cell leukemia with inadequate response to front line therapy?
It is unusual not to achieve an excellent response, usually CR, following initial therapy with a single cycle of Cladribine. I would always make sure that the diagnosis is correct. There are other lymphoproliferative disorders which can be mistaken for hairy cell leukemia (HCL). Whenever I hear of a...
How does your approach differ when managing a "triple hit" versus a "double hit" or "double expressor" lymphoma?
Double-hit lymphoma and double-expressing lymphoma are biologically and clinically distinct entities. DHL is now classified within the WHO as high-grade lymphoma, and the majority are of germinal center immunophenotype, whereas DEL is most typically of non-germinal center immunophenotype and classif...
How do you chose between 4 or 6 cycles of chemotherapy in patients with small cell lung cancer?
Very good question made a bit more straightforward with the publication in NEJM of IMpower 133 for extensive stage disease and recently added to NCCN guidelines as a category 1, preferred first line therapy in ES-SCLC. I typically follow the four cycles as used in IMpower 133 for patients with exten...
How do you approach metastatic colon cancer that has been refractory to multiple lines of systemic therapy though maintaining an adequate PS for additional treatment?
Unfortunately, if the patient has seen all standard therapies, including third/fourth line TAS-102 and regorafenib, then the only option is clinical trials. Molecular profiling could also reveal less common (and less "standard" tested) molecular abnormalities that could offer more options, such as H...
How do you approach fit patients with quickly relapsed Hodgkin lymphoma (disease-free interval less than or equal to one year) after 6 cycles of ABVD and radiation therapy?
As of this point in 2018 such patients are curable only with high-dose chemotherapy with stem cell transplant and then only if they are in chemosensitive relapse. Accordingly, I would have the transplanters see the patient at once and follow their recommendation regarding the pre-transplant regimen ...
How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?
Stage IE MCL would be very rare; this is probably disseminated disease with extra nodal GI involvement which is seen in the majority of such patients. I would treat as disseminated disease, PS and comorbidity permitting per NCCN guidelines.
Are there data for treating patients with metastatic NSCLC with BRAF nonV600E mutations with BRAF and MEK inhibitors?
There is limited data on the efficacy of RAF and MEK inhibitors in the treatment of patients with lung adenocarcinoma that harbor a BRAF non-V600E mutation. Published series of small numbers of patients suggest that Dabrafenib, Vemurafenib, and Trametinib are less active in this patient population c...
How would you treat an elderly fit patient with stage IE DLBCL (single skin lesion)?
Is this a primary cutaneous large B-cell lymphoma, leg type? I suspect so. This is a rare and aggressive disease. I would carefully stage the patient ( to include bone marrow ) and treat as per any localised DLBCL with 3-4 cycles R-CHOP and XRT. Even with this regimen 50% of patients relapse so I'd ...
What systemic therapy option do you use for metastatic, anal squamous cancer with progression following FOLFOX and subsequent nivolumab?
If a clinical trial is not available and residual neuropathy from oxaliplatin is not an issue, I would favor carboplatin/paclitaxel.
Should olaparib maintenance therapy be recommended in patients with BRCA-positive, advanced ovarian cancer after first line platinum-based chemotherapy?
While the results of the SOLO-1 trial are initially impressive, we need to wait for the survival data and the results of the other 2 European trials (Paola-1 and ENGOT). Definitively a field of research to keep an eye on. Today, probably premature. On a case by case basis, might be acceptable, but n...