Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you ever start with lower than standard doses of TKIs when initiating treatment for chronic phase CML?
Not usually with the exception of bosutinib. I specifically start bosutinib at 200 mg and go up by 100 mg every week until the patient is at full dose. I find this helps manage the initial diarrhea associated with the drug. Otherwise, I start at the standard dose for all drugs. I may decrease the do...
Can a rituxumab biosimilar be used for a high grade lymphoma?
Rituximab (Rituximab) was the landmark addition to treatment of B cell-Non Hodgkin Lymphoma in the late 1990s. It changed the treatment for B cell NHL. Rituximab is also used in many other off label indications (as for example ITP, TTP etc.). Recently two bio-similars were approved by US FDA: Truxim...
How do you incorporate prognostic mutations into your management of primary myelofibrosis?
Mutational testing is critical to help diagnose, prognosticate, and make treatment decisions in primary myelofibrosis. I obtain JAK2/CALR/MPL on all patients and also obtain an extended NGS panel to determine if there are any high molecular risk markers, such as SRSF2, EZH2, IDH1/2, and ASXL1. Mutat...
How do you approach a patient with metastatic inflammatory TNBC at diagnosis with a good PS?
I would approach this patient with weekly nab-paclitaxel and atezolizumab if she was PDL-1 positive (just like the Impassion Trial, NEJM 2018:379;2018-21). If the tumor (actually the stroma) was PD-L1 negative, then I would treat with paclitaxel and carboplatin (80 mg/m2 and AUC 2 days 1, 8, and 15 ...
When would you consider active surveillance for a patient with metastatic RCC?
What is your recommendations for vaccines to prevent shingles in CLL patients?
In October 2017, the U.S. FDA licensed the adjuvanted, recombinant zoster vaccine (Shingrix). Phase 1/2a studies in immunocompromised subjects, including autologous hematopoietic cell transplant recipients and HIV- infected adults, have confirmed that Shingrix is immunogenic and safe with no documen...
Do you alter your management of Stage I-II DLBCL if it's double or triple hit?
When do you recommend patients get vaccinations with respect to their chemotherapy course?
It depends on the nature of the treatment program and on the patient’s immune system. For treatments that are not B-cell lymphodepleting, routine vaccinations can be administered routinely, presuming no underlying immunodeficiency. For patients receiving anti-CD20 monoclonal antibodies, we typically...
Why do we immediately perform CNS staging with a LP at diagnosis of ALL when the risk of seeding is highest with a high lymphoblast count?
We wait until circulating blasts are cleared from PB before doing LP.
How do you approach further treatment of patients who develop grade 2-3 immune colitis from nivolumab/ipilimumab prior to completion of the 4 ipilimumab doses?
If the colitis completely resolves, I would consider a colonoscopy to be sure that subclinical microscopic lymphocytic colitis has completely resolved. If not, I would consider 3 dose of infliximab to reduce recurrence of colitis. Then once off steroids, I would restart single agent anti-PD1.