Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you prefer to use 7+3 or CPX-351 as standard induction therapy in younger patients with AML-MRC or t-AML?
I prefer to use 7+3 based on the fact that Lancet et al., PMID 30024784, that showed the benefit of CPX-351 was in adults over 60.A paper by Othman et al., PMID 37171402 showed no overall survival benefit to CPX-351 when compared to FLAG-Ida in younger adults with high-risk AML/MDS.
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
This is a tough case, and the management would depend on the extent of disease. Assuming that this is advanced stage HL, given the use of BV+AVD, I would be in favor of completing 6 cycles of therapy with a non-anthracycline-based regimen. You can consider consolidative radiation, but this would nee...
What is your approach to the management of essential thrombocytosis in a woman planning to start a family?
This is an important question because it directly addresses what it means for a patient to have an MPN, and what it means for the physicians who treat them. The first is diagnosis: what is essential thrombocytosis (ET)? Some “experts” state that it is “related” to polycythemia vera (PV), or represen...
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
Plasma cells can be seen in mandible biopsy without myeloma in that region. Have had a similar patient. However, if the patient has confirmed myeloma relapse elsewhere or systemically then would treat relapse with chemo. Denosumab or zometa is contraindicated due to confirmed osteonecrosis. Not sure...
How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?
First, I would want to be assured that the diagnosis is truly panniculitis T cell lymphoma and not lupus profundus. The two can be hard to differentiate microscopically with T cell gene rearrangement positive in the lymphoma. If the diagnosis is lupus profundus, this would be managed as per rheumato...
How would you optimally manage a small solitary plasmacytoma of the alveolar ridge, including minimizing the risk of dental toxicity?
The alveolar ridge is an osseous structure (extension of the mandible and maxilla) that houses the sockets of the teeth. Assuming an appropriate work-up demonstrates no evidence of multiple myeloma (bone marrow biopsy, PET-CT/MRI, laboratory work, etc.), a plasmacytoma arising in this region would b...
Is a bone marrow necessary in patient with splenomegaly and polycythemia vera?
Yes. Bone marrow is necessary in a patient with polycythemia vera and splenomegaly. There is a possibility of missing ET or associated primary or secondary myelofibrosis. The only way to distinguish between the three bcr-abl negative MPN namely MF, ET, and PV is by performing a bone marrow biopsy an...
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...
What is the difference between involved node and involved site irradiation?
In both involved node and involved site (ISRT), prechemotherapy GTV determines the CTV. However, ISRT accommodates cases in which optimal prechemotherapy imaging is not available to the radiation oncologist. In ISRT, clinical judgment in conjunction with the best available imaging is used to contour...