Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For a patient with PSMA+ mCRPC but relatively low SUV values, does that influence your decision to use 177Lu-PSMA or discussion with patient regarding potential benefit?
In general, the use of PSMA-lutetium is primarily utilized in patients with advanced metastatic castration resistant prostate cancer which has been heavily pre-treated with at least one novel anti-androgen (and often several) and one or two taxane based therapies. No prospective trial has addressed ...
Do you recommend IVIg and/or cytoreduction for patients with IgM MGUS with reciprocal depression in IgG and recurrent infections?
Treating MGUS due to immune suppression is not a common practice. If IgG level is severely depressed below 200 mg/dl with recurrent bacterial infection, I would administer IVIG.
Is there a role for repeat CAR-T with a potentially different product in relapsed and refractory multiple myeloma?
Unfortunately, no great data yet, largely case series and retrospective observations. Our group presented data at the 2022 IMS meeting (Reyes et al., "Salvage Therapies and Clinical Outcomes After Relapse Following BCMA CAR-T in Patients with RRMM") showing a 75% ORR and median duration of response ...
If you treat a patient with high-risk smoldering myeloma on trial and they develop biochemical progression by M-spike, but still no CRAB-SLiM criteria, what would you do next?
My personal preference is to not treat smoldering myeloma.One of the reasons for this is you fall into this very conundrum.The decision to treat was made while the patient was asymptomatic and without end-organ damage. The patient is now in the exact same scenario, so why should the decision-making ...
What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?
This is a difficult question which I will break into 2 parts: 1) Rx of primary refractory (i.e. chemotherapy resistant) localized DLBCL and 2) special considerations for a hand site. I presume the recurrent/persistent disease is still localized.Treatment of primary refractory DLBCL is a very difficu...
Would you continue ruxolitinib in combination with HMA plus venetoclax in myelofibrosis at the time of transformation to AML?
That is a good question. It would be difficult to give these three agents together as cytopenias would be very difficult to manage. In addition, it’s worth mentioning there are no data for this triplet and these drugs are not approved to be used together. That being said, there are some scenarios we...
Will you use or have you been using the IPSS-M as the primary way to risk-stratify patients with MDS to determine use of hypomethylating agents?
For the last 10 years, the IPSS-R has been the gold standard for risk stratification of patients with MDS. It is used by the NCCN guidelines to split patients into lower or higher risk groups, each with its own distinct treatment recommendations. The IPSS-R has been used to select patients for clini...
Would you consider trastuzumab deruxtecan for a patient with metastatic HER2+ colorectal cancer even if the cancer is RAS mutated?
The best available evidence for the role of trastuzumab deruxtecan (T-DXd) in HER2 positive (IHC 3+ or IHC2+/FISH+) colorectal cancer is the DESTINY-CRC01 study (cohort A) which showed a response rate of 45.3%, median progression-free survival of 4.1 months in patients who had >=2 lines of treatment...
How would you treat a bladder cancer with rectal invasion with radiation?
In general, it may be difficult to achieve durable control with chemoRT alone for such a locally advanced T4 cancer such as this, and the patient may be better served with neoadjuvant chemo, restaging, and cystectomy, if this is feasible. If he is not a candidate/refuses cystectomy, would treat the ...
How do you manage refractory hyponatremia in patients on active therapy in small cell lung cancer?
The classic teaching is that if this is a paraneoplastic SIADH then treat the underlying cancer. If hyponatremia is worsening despite treatment, it might herald progression. I have used tolvaptan in the past as bridge but without effective treatment, this is likely not going to be very effective. Of...