Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
With the recent FDA approvals of Venetoclax and Glasdegib in AML, is one generally preferred over the other for elderly and/or unfit patients in combination with a hypomethylating agent/low-dose cytarabine?
Overall the combination of venetoclax with HMA or LDAC for newly diagnosed older AML patients is generally preferred for treatment of this subset of AML patients due to reports of high overall response rates (60-70%) and prolonged overall survival (median 18 months). Prior studies have shown that gl...
Which regimen do you prefer for patients with newly diagnosed DLBCL that are not candidates for doxorubicin secondary to low ejection fraction?
I like to use R-CEOP per Vancouver experience. Had very good results with it and is very well tolerated. I sometimes use it also in frail older patients who have normal EF. Etoposide substitutes doxorubicin in regimen: 50 mg/m2 on D1 and 100 mg/m2 PO on days 2-3 and can also give peg filgrastim on D...
Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?
AS a general rule, sophisticated RT planning techniques are very useful for some patients but hardly necessary for all. This is particularly true for lymphoma pts where doses are often low, such as favorable HL where 2 cycles of ABVD and 20 gy is the treatment of choice ( see Dr Kelsey's answer to a...
Is there a role for assessing measurable/minimal residual disease (MRD) in multiple myeloma at this time?
MRD assessment in myeloma is challenging. The EuroFlow standard and Adaptive ClonoSEQ technologies seem to be winning out for the moment, but the Mayo Clinic mass spectrometry peripheral blood assay may be the next generation. The advantage of the flow-cytometry based assay is that it involves live ...
With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?
I would say in the light of ECHLON-II data with a PFS and OS advantage specifically in ALCL and Advanced stage ALK positive disease Brentuximab-CHP would be the most beneficial option and standard of care.
Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?
The ECOG 1912 study presented at ASH this week showed better OS and PFS in younger patients with ibrutinib, which was great news. I used to use FCR in these patients as it was said to have a higher rate of MRD but potentially dangerous myelo- and immunotoxicity and of course there's concerning issue...
What is your preferred first-line therapy for a patient with standard risk multiple myeloma?
Tough question. Let's do the easy ones first. The low risk (R-ISS 1) fit patient could be treated any number of ways with Bortezomib+Lenalidomide+Dexamethasone (RVd), Carfilzomib+Lenalidomide+Dexamethasone (KRd), or Daratumumab+Lenalidomide+Dexamethasone (Dara-Rd). Bortezomib can lead to neuropathy...
How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?
Radiation therapy is utilized in two primary settings to palliate symptoms of splenomegaly in patients with hematologic malignancies.First, extramedullary hematopoiesis within the spleen can lead to symptomatic splenomegaly in a variety of hematologic malignancies (e.g., myelofibrosis). In this sett...
How would you treat DLBCL of the terminal ileum in an otherwise healthy patient?
Primary intestinal Diffuse large B cell lymphoma (PI-DLBCL), even if found incidentally on a screening colonoscopy in an asymptomatic patient, should be treated with systemic chemotherapy similar to what is done with nodal DLBCL. With this approach, the prognosis for PI-DLBCL is very good based on t...
In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?
In fit patients with less than a partial response to induction therapy, i.e. primary refractory, the optimal timing for stem cell collection is NEVER. If they don't respond to three drug induction (proteasome inhibitor + IMiD + steroid), they are unlikely to respond durably to a standard high dose m...