Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you make diagnostic lumbar puncture part of routine work up for newly diagnosed AML if patient is asymptomatic?
Unlike acute lymphoblastic leukemia (ALL), central nervous system (CNS) involvement by acute myeloid leukemia (AML) occurs in less than 5% of patients at the time of diagnosis. Therefore, routine lumbar puncture is not recommended for asymptomatic patients. Certain clinical and biological features h...
How much later after starting a hypomethylating agent in an elderly patient with AML being treated in the upfront setting can venetoclax be started?
It can safely be started at that time, but the outcomes may not be quite as optimal as when used from cycle 1. There is not much data about this, but when used after patients have had progression with prior exposure to hypomethylating agents, responses are sometimes not as robust (see ASH abstracts ...
How would you approach therapy for a patient with newly diagnosed non-GC DLBCL with previous anthracycline exposure?
For fit patients with prior anthracycline exposure for non-lymphoma healthcare who are fit for chemotherapy and with preserved LV function, I would recommend considering daR-EPOCH. The history of the regimen was its original development as treatment of relapsed lymphoma after 1L bolus doxorubicin, a...
What is the role (if any) for Rituximab in a patient with CD20+, Philadelphia chromosome positive ALL?
There are no good randomized data in PH+ disease, but the incorporation of rituximab for CD20+ and PH+ ALL has been standard practice on MD Anderson trials of HyperCVAD+TKI. The challenge has been more on the insurance side - but our approach is to include it if approved.
What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?
PET-CT interpretation using Deauville Criteria (5 point scale) provides a more objective and descriptive methodology than previous scoring systems. However, there are still numerous limitations and challenges and I suspect refined methods to report PET-CT responses will evolve in the future. I utili...
How do you dose midostaurin in patients with AML who need azole antifungal prophylaxis?
Patients with acute myeloid leukemia are often neutropenic due to the disease or treatment. Anti fungal prophylaxis is often required. The azoles are attractive oral agents. However, they are Cyp3A4 inhibitors. Therefore, for patients taking Midostaurin we use micafungin for anti fungal prophylaxis....
When would you add daratumumab to a PI/IMiD/dex backbone for first-line treatment of transplant-eligible multiple myeloma?
Short answer - in patients with low risk disease.Long answer - CASSIOPEIA enrolled fit patients below 65 years of age with adequate kidney function (greater than or equal to 40 mL/min/1.73 m2) with predominantly stage 1 & 2 disease by the revised international staging system (91% in Dara-VTd, 90% VT...
Should consolidation autologous stem cell transplant be considered for de novo follicular lymphoma transformation to DLBCL after achieving a PR with R-CHOP x 6 cycles, if residual disease showed original indolent follicular lymphoma?
First, it is important to make sure that residual disease is FL rather than tFL, which it sounds like you have already done. However, the PET scan should be reviewed; if there is a different node that has very high FDG uptake, then that node should be sampled to rule out residual DLBCL. Historicall...
For an otherwise healthy individual, what would be your front line choice for de novo Richter’s transformation?
The management of de novo transformation of CLL to DLBCL is challenging. For young fit patients, the standard of care remains RCHOP chemoimmunotherapy. Limited data exist exploring other options, including retrospective data sets and small prospective studies, but nothing published convincingly esta...
Based on the SELECT-D trial, would you favor rivaroxaban over LMWH for treating cancer-associated VTE in patients with low risk of bleeding?
Both the SELECT-D trial and the HOKUSAI trial provide evidence that rivaroxaban and edoxaban respectively, have a role in the management of cancer-associated thrombosis (CAT). In addition, an oral presentation from ASH 2018, ADAM VTE trial, also supports a role for consideration of apixaban in the m...