Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are BTK inhibitors safe to use in patients with severe renal failure?
To my knowledge, there are no data related to BTKi in patients with GFR <30 nor those on dialysis. However, these drugs (ibrutinib, acalabrutinib, zanubrutinib) are not cleared by the kidney, and in the clinical trials where measured, PK did not change based upon kidney function. Therefore, my pract...
How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?
In my experience, tumor boards serve 2 purposes. Firstly, they are designed to bring multiple specialists and cancer providers together in real-time to facilitate patient care. Secondly, they help educate the various disciplines based on a robust interaction. Virtual conferences are complicated by d...
What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?
There are a number of appropriate options to consider depending on the specifics of the case. Could the patient be eligible for axi-cel? 2L CAR-T is appropriate for fit elderly patients so long as they fit eligibility for CAR-T and have access, and axi-cel is approved for early relapse/refractory pa...
How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?
There are no large scale controlled studies demonstrating outcomes of use of oral direct-acting anticoagulants (DOACs) in patients with hereditary thrombophilia. One can find published case reports demonstrating success, but the 'failures' likely do not get published. The general approach would be t...
How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?
Decline in donor chimerism is not very common in pediatric patients who underwent myeloablative conditioning regimen for hematologic malignancy, and if chimerism is initially 100% and subsequently falls, it usually represents a relapse of underlying leukemia, or a new malignancy. I always obtain lin...
How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?
I would refer to the following article that provides the most up-to-date definitions (including the definitions for low-level antibodies) and risk stratification tools including APL-S and GAPSS that are developed for people with autoimmune conditions. The article also discusses the levels of evidenc...
How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?
While admittedly the (non randomized) data comes from HL, would consider pembro-GDP vs BV/nivo with the plan to go to auto.
How does the presence of concurrent infections or wound issues affect your choice and timing of induction in patients with AML or MDS with excess blasts?
Many patients are diagnosed with AML or MDS with excess blasts after presenting with acute infections. In these circumstances, early recognition and initiation of broad spectrum antibiotics to prevent sepsis is essential. We typically delay induction chemotherapy until the infection is under control...
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
It depends so much on the patient, especially age. I think with CART being approved in FL, I’d probably hold allo until after CART in most cases.
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...