Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?
Leukostasis is a feared complication of acute myeloid leukemia (AML) in patients developing peripheral WBC counts >100,000. The cells in AML are large, sticky, and invasive. By contrast, the lymphocytes in chronic lymphocytic leukemia are small (10 microns or so; not much larger than red blood cells...
Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?
Leukostasis is a feared complication of acute myeloid leukemia (AML) in patients developing peripheral WBC counts >100,000. The cells in AML are large, sticky, and invasive. By contrast, the lymphocytes in chronic lymphocytic leukemia are small (10 microns or so; not much larger than red blood cells...
What hypofractionated radiotherapy dose regimen is acceptable for plasmacytoma?
At the end of the day, it all comes down to delivering a reasonable BED in the range of +/- 50 Gy in fractions of 2 Gy. The type of fractionation chosen is a question of the treatment volume, location, and adjacent OARs. I have treated a few plasmacytomas with SBRT (for instance in the ribs) with 3-...
How are you sequencing immunotherapy with zolbetuximab in locally advanced/metastatic GEJ cancer when CPS >5 and Claudin 18.2+ (>75%)?
In Claudin+: CPS 5 and above, would do checkpoint+ chemo CPS less than 5, would do chemo +zolbe. There is an ongoing study that will answer the question of the quadrable therapy. Till then, would do as the above given that CPI can give us OS benefit, and also ORR benefit, which was not very impressi...
How would you approach therapy for a localized adenoid cystic carcinoma of the breast?
ACC is a rare indolent subtype of breast cancer is usually but not always triple negative for ER, PR, HER2. Despite this available data on ACC indicates an excellent prognosis with local therapy (especially if it is node negative) only. So the absolute impact of chemotherapy is likley negligible in ...
How do you treat locally advanced, operable, Siewert 3 GE junction adenocarcinomas?
This remains an area of controversy, but perhaps not as controversial as Siewert type II tumors. Siewert type III tumors are staged as gastric cancers in the AJCC 8th edition. In addition, they are more histologically similar to gastric cancer and have patterns of nodal spread like gastric cancer as...
Do you routinely genotype adult beta thalassemia patients?
Yes, this is recommended by the American College of Medical Genetics and Genomics and is helpful for prognosis and complications. I also test for alpha gene duplication or triplication if there is a mismatch between the beta thalassemia genotype and the phenotype.
For patients with microcytosis MCV 75-79 and normal Hb, low TIBC, and normal ferritin do you always rule out thalassemia?
Microcytosis is typical in thalassemia. With a normal ferritin and hemoglobin concentration, I would start screening by measuring HPLC, HbA2 levels that are high in beta-thalassemia carriers. (HbA2 can be normal with “mild” thalassemia alleles and for several other reasons.) Microcytosis without iro...
How do you manage anemia in a patient with myelofibrosis and hemochromatosis?
It is a good question. There isn’t much more you can do. There are new targeted therapies for myelofibrosis which are best answered by an MPD specialist. As for the hemochromatosis, you should still check iron parameters, because if deficiency is present it SHOULD be treated, in this case with IV ir...
How do you manage anemia in a patient with myelofibrosis and hemochromatosis?
It is a good question. There isn’t much more you can do. There are new targeted therapies for myelofibrosis which are best answered by an MPD specialist. As for the hemochromatosis, you should still check iron parameters, because if deficiency is present it SHOULD be treated, in this case with IV ir...