Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?
I do not believe that there is an "optimal" chemotherapy regimen for advanced nodular lymphocytic predominant Hodgkin lypmhoma. The most commonly used regimen is probably ABVD +/- rituximab. CHOP-R might be a good choice when the question of early transformation to diffuse large B-cell lymphoma is s...
What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?
I often consider treating with high dose methotrexate alternating with R-CHOP in such cases. At the end of treatment, I consider radiation to the contralateral testicle. Others have treated similar patients with Hyper-CVAD (Park et al. Am J Hematology 2007)
For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?
We found in an institutional retrospective experience that patients with MM can safely be treated with lenalidomide, bortezomib, and cytotoxic therapy with palliative xrt.https://www.ncbi.nlm.nih.gov/pubmed/25176474
How would you approach a chronic phase CML patient who is responding to second generation TKI but not yet in molecular remission and is now pregnant?
If the patient is now pregnant, I would stop the TKI immediately, and initiate therapy with interferon. If that is not tolerable, I'd recommend hydroxyurea, although it will likely not control relapse into overt chronic phase.
For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?
Hard to answer this one. My preference would be that the patient be in MMR confirmed by two readings three months apart before experiencing a dose interruption.
What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?
ALK positive ALCL is the most responsive of the aggressive PTCL’s to chemotherapy, and the majority of young patients can be cured with an anthracycline containing chemotherapy regimen. Either CHOP or CHOEP (ie CHOP plus etoposide) are frequently used. In a young healthy patient I favor CHOEP based ...
How do you manage rituximab-induced neutropenia?
Rituximab induced neutropenia is a relatively rare but well known phenomenon and can occur in the immediate post treatment period as well as a late sequela of rituximab treatment. In my experience, patients often improve with administration of G-CSF. In cases where a patient's ANC remains <500, I co...
If a patient with myeloma develops a symptomatic DVT or PE while on an immunomodulatory drug such as lenalidomide, would you stop the IMiD?
In general I prefer using enoxaparin (most convenient LMWH in US) or apixaban (least renally dependent Xa inhibitor) in myeloma patients for IMiD-induced VTEs. I don't generally wait 7-10 days as the anticoagulant effect is rapid for these agents. While compliance is always challenging with injecti...
Is venetoclax expected to be useful in patients with refractory CLL/SLL who do not have Del(17p)?
Venetoclax is active in all types of CLL including those patients who do not have del(17p). In fact, the data thus far suggests that the durability of response will be better in this group of patients.
Are there any indications on advanced stage Hodgkins disease that one might consider stopping the bleomycin after first two cycles?
The specific question was studied and the results published in NEJM June 2016 Barrington et al- Adapted treatment guided by PETCT in Advanced Hodkins LymphomaThe results suggested non-inferiority from the standpoint of PFS when bleomycin was omitted after an interim PET/CT suggested no disease. Pati...