Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are your top takeaways in Hematologic Malignancies from ASCO 2022?
Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce ...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
I recommend continuing imatinib through the radiation. The time of imatinib is rather short and stopping poses a risk of CML coming back with the fact that molecular remission is iffy. Kanti Rai
How would you treat a patient with blastoid mantle cell lymphoma with hepatic involvement causing significantly elevated bilirubin?
Tough situation. Ideally, if the cause of the liver dysfunction is the disease then based on age. The goal would be to start therapy in order to alleviate some of the disease burden to reduce the bilirubin level; if this isn't amendable, stenting or percutaneous drainage. If bilirubin can be improve...
Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?
I do not think of treating cardiac amyloid without the results of mass spec. You really need to know what type of amyloid you are dealing with.
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Definition of bulk in lymphoma is not homogenous among countries, study groups, and diseases.Overall, 10 cm is considered the cutoff by some. Recently, the cutoffs of 7 or 7.5 cm have been introduced, especially in DLBCL. The definition tends to be disease-specific sometimes, since landmark studies ...
In a patient with a bleeding disorder, how would one approach anticoagulation during active COVID infection?
This is very dependent on what the bleeding disorder is, how severe it is, and what you think is the risk of clotting with this COVID infection in this individual. For example, if this is a mild-moderate type I VWD with very infrequent bleeding with a need for treatment, you could probably handle th...
In someone with an asymptomatic JAK2 V617 mutated and BCR/ABL negative MPN with a steadily rising WBC, when do you decide to start cytoreductive therapy and which agent(s) do you recommend?
First, let's abandon the phase "BCR/ABL-negative MPN". This is an oxymoron because BCR/ABL can be expressed in a JAK2 driver mutation-positive MPN. In fact, both BCR/ABL and JAK2 mutations can be expressed in normal individuals at very low levels without causing disease. Both mutations can also be p...
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
Given that we would delay rituximab treatment for many active infections, I would recommend that we apply the same restrictions. I would hold the rituximab for ten days after covid test confirmation.
Would you consider anifrolumab in the management of hematologic manifestations in SLE?
Hematologic manifestations in SLE vary widely from asymptomatic to life-threatening, from cytopenias to severe bleeding to thrombosis to multiorgan failure. Hematologic manifestations can also be compounded by medications, infections, and co-existing conditions. Each of these manifestations is drive...
What is your preferred first line regimen for myeloma with severe renal impairment, either on or off dialysis?
In general, for patients with renal insufficiency related to their myeloma, time is nephrons. So the earlier you can correct the hypercalcemia, lower circulating uric acid, stop ongoing bad behaviors (NSAID overuse, etc), and treat the myeloma, the better. If the patient is admitted, I will give pa...