Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How should early-stage, well-differentiated neuroendocrine neoplasms of the breast with intermediate proliferative index (Ki-67 approximately 20–30%) be managed in the adjuvant setting?
Primary neuroendocrine cancer of the breast is a rare entity and in 2013, WHO classified the neuroendocrine cancers of the breast (NECB) into three subtypes - well-differentiated NE tumors, poorly differentiated small cell carcinoma of the breast, invasive breast cancer with NE differentiation. By d...
Is it acceptable to treat newly diagnosed small cell lung cancer with limited brain metastasis with upfront SRS?
First, to be clear, there's not good evidence regarding the role of radiosurgery in small cell patients who have not had WBRT or PCI. In patients without brain metastases, there's a clearly defined and clinically significant survival benefit, which seems to result from both control of existing metas...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
Has the data for the ENRICH study changed your practice for the initial treatment of mantle-cell lymphoma?
While the information presented was intriguing, it has not yet caused any change in my approach to initial therapy for MCL. I say this due to the fact that the IR arm did not seem better than BR, save for those with a P53 mutation. I have routinely avoided CIT in this patient population, so this inf...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
Has the data for the ENRICH study changed your practice for the initial treatment of mantle-cell lymphoma?
While the information presented was intriguing, it has not yet caused any change in my approach to initial therapy for MCL. I say this due to the fact that the IR arm did not seem better than BR, save for those with a P53 mutation. I have routinely avoided CIT in this patient population, so this inf...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Oftentimes, the symptoms related to MPNs are quite non-specific (fatigue, anorexia), so I typically look for other pieces of information from the CBC with differential and physical exam (e.g., splenomegaly). If the clinical suspicion for an MPN is high and I am pursuing confirmatory testing with a b...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Oftentimes, the symptoms related to MPNs are quite non-specific (fatigue, anorexia), so I typically look for other pieces of information from the CBC with differential and physical exam (e.g., splenomegaly). If the clinical suspicion for an MPN is high and I am pursuing confirmatory testing with a b...