Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Agree with Dr. @Dr. First Last. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?
Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.
How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?
I advise patients that there remain many unanswered questions regarding these side effects that will be resolved with longer term use with these agents. Shared decision-making is critical for these discussions. Data available from current extensions of clinical trials for JAKi, additional risk facto...
What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?
Selinexor makes sense in combination with a partner, usually, either Carfilzomib or Pomalidomide, after patients are refractory to RVd --> Dara-Pd --> KPd --> Belantamab. An alternate route might be Dara-Rd --> KPd or PVd --> Bela. In essence, Selinexor is what I use when there's nothing left standa...
In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?
A complex situation and a lot will depend on the clinical circumstances e.g., compliance, type of failure, etc. I would still consider apixaban. However, if the failure was a more serious event, consider alternative anticoagulants.
What workup do you perform to evaluate for underlying triggers/associated conditions in a pediatric patient with autoimmune hemolytic anemia?
The diagnostic workup that I would recommend in order to rule out a possible underlying condition includes the following: Extensive red blood cell typing in anticipation of possible transfusion. Further immune-haematological investigations: C3, C4, CH50 Auto-antibodies (ANA, anti DNA), antiphosp...
How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?
If the patient is asymptomatic and the catheter is functioning well, I recommend starting anticoagulation.If the patient develops symptoms, he or she should still be anticoagulated but the catheter removed. Anticoagulation options in ESRD patients include Coumadin, Eliquis (my preference is a dose o...
Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?
I would definitely consider BV/Nivo in frontline settings for elderly patients if no trial is available.Prognosis is worse in elderly HL for several reasons - SOC chemotherapy is not well tolerated and biology of the disease is different (mixed cellularity being prevalent and more frequent EBV posit...
How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?
The management of DLBCL in the elderly, particularly those unfit for standard anthracycline-based chemoimmunotherapy, is an area of unmet need and clinical challenges. While there is no single standard of care, and participation in clinical trials designed for this patient population is encouraged, ...
Do you check pertussis serologies when sending labs for antiphospholipid syndrome?
The short answer is no. I do not check pertussis antibodies when evaluating patients for anti-phospholipid syndrome. A slightly longer answer is still no and, for example, a review published in the Annals of Rheumatic Diseases by Ron Asherson in 2003 discussing the relationship between various infec...