Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
If you treat a patient with high-risk smoldering myeloma on trial and they develop biochemical progression by M-spike, but still no CRAB-SLiM criteria, what would you do next?
My personal preference is to not treat smoldering myeloma.One of the reasons for this is you fall into this very conundrum.The decision to treat was made while the patient was asymptomatic and without end-organ damage. The patient is now in the exact same scenario, so why should the decision-making ...
What is your simulation setup and dose fractionation for DLBCL of the hand with Deauville 4 residual disease following R-CHOP?
This is a difficult question which I will break into 2 parts: 1) Rx of primary refractory (i.e. chemotherapy resistant) localized DLBCL and 2) special considerations for a hand site. I presume the recurrent/persistent disease is still localized.Treatment of primary refractory DLBCL is a very difficu...
Would you continue ruxolitinib in combination with HMA plus venetoclax in myelofibrosis at the time of transformation to AML?
That is a good question. It would be difficult to give these three agents together as cytopenias would be very difficult to manage. In addition, it’s worth mentioning there are no data for this triplet and these drugs are not approved to be used together. That being said, there are some scenarios we...
Will you use or have you been using the IPSS-M as the primary way to risk-stratify patients with MDS to determine use of hypomethylating agents?
For the last 10 years, the IPSS-R has been the gold standard for risk stratification of patients with MDS. It is used by the NCCN guidelines to split patients into lower or higher risk groups, each with its own distinct treatment recommendations. The IPSS-R has been used to select patients for clini...
Would you consider trastuzumab deruxtecan for a patient with metastatic HER2+ colorectal cancer even if the cancer is RAS mutated?
The best available evidence for the role of trastuzumab deruxtecan (T-DXd) in HER2 positive (IHC 3+ or IHC2+/FISH+) colorectal cancer is the DESTINY-CRC01 study (cohort A) which showed a response rate of 45.3%, median progression-free survival of 4.1 months in patients who had >=2 lines of treatment...
How would you treat a bladder cancer with rectal invasion with radiation?
In general, it may be difficult to achieve durable control with chemoRT alone for such a locally advanced T4 cancer such as this, and the patient may be better served with neoadjuvant chemo, restaging, and cystectomy, if this is feasible. If he is not a candidate/refuses cystectomy, would treat the ...
When is a lumbar puncture indicated in a lymphoma staging work up for a pediatric or AYA patient?
LP is not necessary in any Hodgkin patient irrespective of stage. LP plus IT chemo is indicated in all advanced stage NHL. The one exception to that is primary mediastinal B-cell with sclerosis which is an intermediate grade lymphoma (similar to Hodgkin) and rarely spreads to CNS. It is true that ...
In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?
I am not aware of any direct clinical evidence that addresses this question. That said, I would be very reluctant to treat with G-CSF in the setting of HLH. G-CSF is an inflammatory cytokine that might aggravate HLH. Moreover, since the mechanism of neutropenia in HLH is thought to be increased neut...
What factors do you look at while deciding between a daratumumab-based quadruplet induction versus standard triplet induction such as VRd for newly diagnosed MM?
This is becoming an increasingly thorny issue. A few guidelines to keep in mind:1) Dara-VRd has only been studied (thus far) in transplant-eligible patients. So this discussion of Dara-VRd vs. VRd is hard to apply to patients without intent for transplant. 2) When you look at the CASSIOPEIA and GRIF...
How would you approach early stage unfavorable classical Hodgkin lymphoma with metabolic CR apart from a single residual positive node after 6 cycles of ABVD?
If a patient with early-stage, unfavorable HL had an excellent response to 6 cycles of ABVD, but had a single lymph node that only achieved a PR (Deauville 4), then there are two primary options.1. If you judge that the patient has achieved a reasonable response to chemotherapy, suggesting that syst...