Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you have any concerns about enhanced radiation toxicity with any of the novel agents used to treat multiple myeloma?
We use radiotherapy in myeloma sparingly. Generally, ONLY for end stage patients for which there is few to any systemic treatment options.That being stated, I am not aware of overt radiosensitization by novel agents. On the rare occasion that we do incorporate radiotherapy, we also rarely add potent...
How do you approach CNS prophylaxis in double-hit lymphoma patients?
There is no consensus about the need for IT chemo for CNS prophylaxis in DLBCL. Factors such as IPI, the number and location of extranodal sites of disease, and LDH may be used to identify a group of patients with aggressive NHL who are at particularly high risk for CNS recurrence and might therefor...
What dose of radiotherapy do you use for low volume Castleman's disease?
Reports in the literature are varied in terms of radiation dose. For scenarios such as this with low volume disease, it is probably reasonable to consider the lower end of ranges reported by others to be successful, such as 30 Gy. Careful pathology review is important for these cases as well. One mu...
How do you manage patients with primary refractory Hodgkin lymphoma?
Without advising directly on this particular case, which is difficult to do without more information, a few principles in lymphoma management may be helpful: 1. Whenever there is discordance in the clinical picture, or whenever initial management would be drastically changed, it is always prudent to...
When do you combine hypomethylating agents with venetoclax or gemtuzumab ozogamicin in elderly patients with AML who are ineligible for intensive chemotherapy?
In September, 2017, the FDA granted approval for gemtuzumab ozogamicin (GO) in combination with daunorubicin and cytarabine (DA) and as a monotherapy for the treatment of adult patients with newly-diagnosed CD33-positive acute myeloid leukemia (AML). Approval of GO monotherapy was based on a randomi...
Would you consider using daratumumab in the first line setting for non-transplant eligible multiple myeloma?
Agree as above; you cannot fairly compare PFS when the treatment arms have different durations of therapy.One could argue that the current standard for previously untreated elderly myeloma patients is continuous lenalidomide and dexamethasone, as described in the FIRST study, (Benboubker et al, NEJM...
How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?
Looking at the trend of pro-lymphocyte increase will help in addition to clinical signs of progressive disease (splenomegaly). It is useful to check for TP53 and MYC translocations since these are common in PLL. As you mentioned, >55% pro-lymphocytes has been used to diagnosed PLL based on a report ...
Do you think there will be a role for duvelisib in the treatment of relapsed/refractory chronic lymphocytic leukemia?
I believe this agent could find a home for therapy in CLL as it is given by itself provided that further efficacy is demonstrated in a population where it would be most likely used, ibrutinib resistant CLL. Additionally, incorporation into non-BTK inhibitor combinations would also be possible. Given...
Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?
The transformed lymphoma that develops out of indolent small B cell lymphoma such as marginal zone lymphoma, follicular lymphoma or lymphoplasmacytic lymphoma, is typically diffuse large B cell lymphoma (DLBCL). When this type of transformed DLBCL develops in a patient who has not previously receive...
What is your experience with liposomal-encapsulated daunorubicin and cytarabine (CPX-351) for first line treatment of therapy-related AML or AML with myelodysplasia-related changes in elderly patients?
Our center has been administering CPX-351 to outpatients for the last few months. We monitor the patient closely in the first week for tumor lysis. Since the neutropenic fever rate is the same as 7&3 we have need to admit many of the patients at some point in the cycle but overall it has gone very w...