Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the staging and treatment of extranodal marginal zone lymphoma of left and right lacrimal gland?
This entity is described in literature as "ocular adnexal lymphoma". I usually screen those patients for Chlamydia infection and would empirically consider a 3-week course of doxycycline especially if the disease is indolent behaving clinically and there is prior serologic evidence of Chlamydia infe...
Would you consider doing Oncotype for a locoregional recurrence of ER positive breast cancer?
To re-phrase the question, would evidence that a local recurrence is biologically more aggressive than the primary affect our recommendations about administering adjuvant chemotherapy in a patient who recurred on adjuvant endocrine therapy, especially if she had never received adjuvant chemotherapy?...
In which patients with MGUS do you recommend a kidney biopsy to evaluate for MGRS?
If a patient has unexplained renal disease, and this could be interstitial or glomerular, and an MGUS, I strongly consider it. I typically try to get heme to do a bone marrow biopsy first because their findings may obviate a renal biopsy if they find something (although sometimes they may find low-g...
What treatment options do you consider if eosinophilia with end organ dysfunction persists with q8 week dosing of benralizumab and you can't obtain approval for q4 week dosing?
Depending on the degree of eosinophilia and end-organ dysfunction, if the patient is not already on oral steroids, they probably should be pending a new plan for a steroid-sparing agent. Is the diagnosis more consistent with HES or EGPA? Has the patient failed mepolizumab 300 mg? There is good data ...
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?
There is no single standard of care in the treatment of transplant-ineligible relapsed or refractory DLBCL in the second line. Many regimens would be considered relevant considerations here, including rituximab, gemcitabine, and oxaliplatin; bendamustine and rituximab; rituximab and dose-adjusted EP...
How would you approach a patient with metastatic breast cancer with extensive skin involvement?
The issue of extensive skin involvement in metastatic breast cancer can be very challenging. Many factors come into play including whether the patient has had a mastectomy or has an intact breast as well as whether previous radiation has been delivered. For a previously untreated intact breast: Sur...
In a patient with type I von Willebrand disease who is pregnant and at increased risk for preeclampsia, would you recommend treatment with aspirin?
Yes, and is tolerated well.
When would you initiate exchange transfusion in babesiosis and significant hemolysis?
There are no studies that answer this question. Some people have extrapolated from the use of exchange transfusions for severe malaria to consider using this treatment with babesiosis, another intraerythrocytic protozoan infection. Unfortunately, though there are some studies on malaria, the results...
Due to the high incidence of hyperlipidemia secondary to lorlatinib, do you recommend empiric statin therapy to all patients without known contraindications upon initiation of lorlatinib?
I do not empirically start statin therapy. However, I will check lipid and triglyceride levels prior to initiation of lorlatinib and periodically (every 3-6 months) thereafter. I will initiate or change statins in patients where we see a rise in lipids and triglycerides. I will aim for a level that ...