Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you anticipate a paradigm shift in first line treatment of multiple myeloma from RVD to immune therapy with CAR-T/bispecifics?
A great question that is no doubt being discussed not just by doctors & patients but also by investors, insurance companies, and more. It is certainly possible to shift paradigms in myeloma - I'd even argue, for example, that the induction strategy at most US centers now is Dara-VRd and not VRd as p...
How would you approach a patient with low grade follicular lymphoma (stage IE) of the breast who presents with local recurrence 1 year s/p lumpectomy?
I would re-stage the patient with imaging. If the disease remains localized, then I would treat with definitive RT (24-30 Gy in 2 Gy fractions using ISRT principles). It would be interesting to look back at the pathology from the original lumpectomy. Unless margins were widely negative, I would prob...
Are there any possible scenarios where you would do phlebotomies for heterozygous hemochromatosis?
The answer is yes but unusual. Occasionally, a heterozygote or double heterozygote will be weakly phenotypically positive. If the ferritin and TSAT (on overnight fasting sample) are high, I will. I prefer that blood donation be used but if not an option, I will take it. The iron parameters must be...
How do you approach the workup for a patient with persistently elevated inflammatory markers (CRP and ESR) whose history and exam do not point to a clear cause?
Our hematologist/oncologist referred just such a patient. No evidence of malignancy, but elevated CRP &ESR. I did an “internist’s” workup as I would for dermatomyositis, starting with the most important and therefore most thorough aspect: taking a full and very “invasive” history, followed by a comp...
What is the treatment approach if an AML patient receiving azacitidine/venetoclax is later found to have FLT3 and IDH2 mutations?
This is solely an opinion as there is little data. Since FLT3 inhibitors are not approved for use with azacitidine and venetoclax and data is just emerging about triplet therapy with the addition of these inhibitors, I would just keep going with azacitidine and venetoclax and reserve FLT3 and IDH2 i...
Do you offer IVIG to myeloma patients with recurrent infections?
I do offer IVIG to patients with myeloma who are having recurrent respiratory infections and have hypogammaglobulinemia (<400 mg/dL). I do counsel patients that we do not have strong clinical trial data to support the use of IVIG in this setting. While I dislike quoting anecdotal experience, I will ...
How should elevated PT of unclear etiology and significance be evaluated?
Mild prolongation of the prothrombin time (PT) may represent a normal ‘outlier’. If there is no obvious explanation for a moderate to marked prolongation of the PT (for example, anticoagulation therapy effect, liver disease, nutritional deficiency like vitamin K deficiency. then the next step is to ...
How would you treat lymphoplasmacytic lymphoma (LPL) with a non-IgM paraprotein?
My treatment approach would be similar to those with IgM LPL (WM).