Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?
Bilateral orchiectomy is considered an alternative for those who refuse ISRT to the testicles, so I agree with you that there does not appear to have strong indication for RT in this case. However, there may be a lot of other nuances to this case. I would talk to the surgeon to make sure there was n...
Do you perform biomarker-based screening for AL amyloidosis in patients with newly diagnosed MGUS?
No, unless the patient has signs and symptoms or imaging studies that suggest systemic Amyloidosis.
What is your alternative first line approach to follicular lymphoma that requires treatment if initial treatment with BR leads to significant neutropenia despite G-CSF?
My approach depends on the number of cycles the patient has received and the response to those cycles, along with reason for neutropenia (all treatment based vs disease related). If a patient has significant neutropenia from treatment/therapy, my initial approach would be to add GCSF for the next cy...
How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?
In front line therapy for MCL patients, induction followed by ASCT should be the standard of care followed by rituximab maintenance and follow up for MRD.In relapsed MCL, after anthracycline and cytrabine containing therapy, BTK inhibitors appear to be the most affective agents.Results of a pooled a...
What is your general approach to post-allogeneic HSCT maintenance therapy for AML?
I use midostaurin starting 60-90 days after allogeneic transplant continued till 1 yr post transplant for patients with Flt-3 mutations. Some of my colleagues prefer sorafenib for post transplant maintenance in this setting. I have not yet started using IDH inhibitors post allogeneic transplant. HMA...
What is your approach to CMV prophylaxis in the post-allogeneic stem cell transplant setting?
We do not routinely use letermovir but we are looking carefully at this data. We use prophylactic ganciclovir pre transplant and high dose acyclovir post transplant in high risk patients and are reviewing this data as well.
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Maintenance is a standard of care management for both transplant eligible and transplant ineligible, regardless of type of induction regimen. Studies have shown benefit for both groups. Time to progression (PFS) almost twice as long for both groups with maintenance compared to no maintenance. - For ...
For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?
This patient would be a good candidate for ovarian tissue cryopreservation (OTC), since time would be limited to stimulate and retrieve oocytes. One can complete OTC with line placement and other procedures and be able to start chemotherapy the day after OTC. I know not every center has access to OT...
What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?
How best to employ radiation therapy in patients with Hodgkin lymphoma (HL) who progress after autologous stem cell transplantation (ASCT) is not entirely clear. Often such patients are considered for an allogeneic stem cell transplant, typically utilizing a non-myelablative conditioning regimen. Th...
How do you approach the treatment of hairy cell leukemia with inadequate response to front line therapy?
It is unusual not to achieve an excellent response, usually CR, following initial therapy with a single cycle of Cladribine. I would always make sure that the diagnosis is correct. There are other lymphoproliferative disorders which can be mistaken for hairy cell leukemia (HCL). Whenever I hear of a...