Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are patients with bleeding disorders receiving plasma-derived products at increased risk of acquiring COVID-19?
No. The current process of manipulation of plasma derived products eliminates SARS-Cov-2. SARS-CoV-2 is a large virus (120 nm diameter) with a lipid envelope. Therefore, it is highly susceptible to processing steps used in processing such as solvent-detergent, low pH incubation, caprylate-pasteuriza...
Do you routinely prescribe anticoagulation for patients on active chemotherapy?
This is dependent on the risk factors of the patient for the development of VTE. Recently published ASCO guidelines (JCO 2019) incorporated the additional recommendation of VTE prophylaxis for high risk outpatients receiving chemotherapy with either eliquis, xarelto, or LMWH. The Khorana scoring sys...
What is the best approach for patients with DLBCL with early relapse (< 6 months) after initially attaining a CR with 6 cycles RCHOP?
Early relapse, regardless of interim imaging, suggests chemorefractory disease. It may be that we selected a more chemo/rituxan resistant clone that comprised a smaller % initially that has now become dominant. Regardless of pathophysiology, I think for today we are stuck with the same paradigm: sal...
When during ALL induction therapy are you checking for MRD?
It is generally advisable to measure MRD from a bone marrow aspirate at the end of the first course of therapy for ALL. If a pediatric-inspired regimen such as CALGB 10403 is being used, undetectable MRD after Remission Induction (i.e., approximately Day 28) is associated with an excellent rate of d...
Would you stop hydroxyurea for thrombocytosis in a prostate patient receiving radiation?
In cervical cancer literature, when hydroxyurea was used with RT as a radiosensitizer, acute side effects were significantly increased, including myelosuppression. I would consider holding it during RT.
What is your approach to advanced Hodgkin Lymphoma when bleomycin is contraindicated and infectious complications arise with A-AVD?
This is a very good question and a bit complicated. In patients with advanced HL, for whom 6-8 cycles of treatment would be the typical course, I try to maximize the dose intensity and density even in the face of infectious complications. That said, if a patient is already receiving growth factor su...
Would you choose a different anti-CD20 antibody in early relapsed (< 6 months) DLBCL treated with rituximab?
Unfortunately, the largest clinical trial asking the same question you pose here—does substitution of the anti-CD20 antibody in combination with platinum-based chemotherapy in relapsed/refractory DLBCL following RCHOP improve outcomes—has failed to demonstrate benefit to such an approach. The ORCHAR...
Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?
No—modern systemic and CNS directed therapy is sufficient to mitigate the historic higher risk of CNS relapse (Vora et al., JCO 2016). While there is still a small risk of cranial relapse with modern systemic therapy, the improved success of response and risk adapted strategies utilizing varying deg...
Would you anticoagulate a patient with an isolated arterial thrombosis in the setting of an inherited thrombophilia?
The situations in which anticoagulation is clearly required in cases of arterial thrombosis are: stroke or systemic embolism in association with atrial fibrillation or mechanical heart valves or presence of a mural thrombus (where anticoagulation with an appropriate agent should be administered prop...
How long after discontinuation of TKI (for complete remission) would you feel it is safe for a patient with CML to consider pregnancy?
Tyrosine kinase inhibitors have been demonstrated, in animal models, to be teratogenic when utilized early in pregnancy. In retrospective studies in humans, congenital anomalies similar to what was identified in animal studies have been reported. Since spermatogenesis takes several weeks, some have ...