Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Can a rituxumab biosimilar be used for a high grade lymphoma?
Rituximab (Rituximab) was the landmark addition to treatment of B cell-Non Hodgkin Lymphoma in the late 1990s. It changed the treatment for B cell NHL. Rituximab is also used in many other off label indications (as for example ITP, TTP etc.). Recently two bio-similars were approved by US FDA: Truxim...
Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?
Irradiation to the contralateral testis is an important component of any successful curative regimen for patients with all stages of disease.In a survey by IELSG (JCO 2003), patients who did not receive contralateral testicular RT had a 43% incidence of testicular failure after CR to anthracycline b...
What is your recommendations for vaccines to prevent shingles in CLL patients?
In October 2017, the U.S. FDA licensed the adjuvanted, recombinant zoster vaccine (Shingrix). Phase 1/2a studies in immunocompromised subjects, including autologous hematopoietic cell transplant recipients and HIV- infected adults, have confirmed that Shingrix is immunogenic and safe with no documen...
Do you alter your management of Stage I-II DLBCL if it's double or triple hit?
Why do we immediately perform CNS staging with a LP at diagnosis of ALL when the risk of seeding is highest with a high lymphoblast count?
We wait until circulating blasts are cleared from PB before doing LP.
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...
What dose and volume would you treat in a patient with diffuse large B-cell lymphoma confined to the stomach after complete response to R-CHOP?
In a patient with stage IE gastric DLBCL in a complete response (Deauville 1-3) after R-CHOP, I would consolidate with 30 Gy of RT. The volume would depend upon the size of the original tumor and how defined the original disease was on PET-CT and upper endoscopy. In a patient with a smaller lesion i...
Would you offer consolidative RT to a patient with early stage, non-bulky, high-grade non-Hodgkin's lymphoma of the orbit after 6 cycles of RCHOP + IT chemotherapy?
Yes I would. The high grade nature of disease and the location would be enough to convince me. There are now several large, single institution series that show that the pattern of failure is the same in patients with unfavorable DLBCL (non GCB type, DH/DL, Ki-67> 90, CD5+, Burkitt’s type DLBCL etc.)...
How would you treat a stage IE diffuse large B-cell lymphoma of the adrenal gland in an elderly patient who is not a candidate for systemic therapy?
This is an extremely tough situation if the patient cannot get systemic therapy. These tend to be non-GCB subtype with a generally poor prognosis even with R-CHOP based chemotherapy regimen with high rates of systemic and CNS relapses. Typically, I would recommend R-da-EPOCH, CNS directed chemothera...
What would you recommend for a patient with bilateral conjunctival MALT (without systemic disease)?
While technically this patient is stage IVAE (>1 extranodal site is categorized as stage IV), these patients do as well as those with unilateral conjunctival MALT NHL. Bilaterality is not unusual in this disease. This is a situation where definitive treatment (24 Gy in 12) is appropriate for stage I...