Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient diagnosed with Multiple Myeloma, is there a role for 24-hour UPEP prior to treatment?
I’d do a random UPEP first. If no light chains or renal dysfunction, I would not do 24-hour test. If light chains present with renal dysfunction, or significant protein on UA (albumin), I may do 24-hour UPEP and protein quantitation to distinguish myeloma kidney from light chains vs nephrotic syndro...
In a patient diagnosed with Multiple Myeloma, is there a role for 24-hour UPEP prior to treatment?
I’d do a random UPEP first. If no light chains or renal dysfunction, I would not do 24-hour test. If light chains present with renal dysfunction, or significant protein on UA (albumin), I may do 24-hour UPEP and protein quantitation to distinguish myeloma kidney from light chains vs nephrotic syndro...
When would you consider larynx preservation in patients with T4N+ SCC of the larynx?
Most T4 patients should not undergo CRT alone. Surgery, followed by postoperative radiation, remains the standard of care for most patients with T4 disease. For patients who decline surgery, concurrent CRT is the best alternative and is superior to radiation alone. However, it is likely still inferi...
For an older patient with hormone-sensitive high-volume, high-risk prostate cancer with metastases to bone who developed toxicity with enzalutamide, what other oral AR blocker would you offer?
There are two other options that this patient might tolerate. One option is darolutamide, which has similar AR-blocking activity but does not cross the blood brain barrier. In large trials, the symptom profile was less severe than those of enzalutamide or apalutamide though some patients will have s...
When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?
Daratumumab is generally well tolerated so would at least consider DaraRd triplet regimen as per the MAIA trial, since there is already FDA approval of this combination for transplant-ineligible newly diagnosed MM patients. Now with SQ Dara also approved and more widely available, this regimen is mo...
When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?
Daratumumab is generally well tolerated so would at least consider DaraRd triplet regimen as per the MAIA trial, since there is already FDA approval of this combination for transplant-ineligible newly diagnosed MM patients. Now with SQ Dara also approved and more widely available, this regimen is mo...
How is your experience with point-of-care INR systems for home monitoring of vitamin K antagonists?
Point of care (POC) INRs are reliable and can be used to monitor patients once their INRs have been stabilized on warfarin. In fact, there is data on better time in the therapeutic range for self-testing and also self-management of dosing. However, this needs to be done in conjunction with a warfari...
Are there specific indications where you would use thalidomide over lenalidomide for treatment of newly diagnosed multiple myeloma?
I would like to preface this response by noting that this is specific to a US practice setting. The short answer is that in the US, we rarely, if ever, use thalidomide in the frontline or relapsed setting in contemporary practice. This is due to the increased incidence of severe neuropathy with thal...
What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?
For cardioprotection, I would recommend: Baseline cardiovascular risk stratification, can use the HFA-ICOS risk calculator (https://www.cancercalc.com/hfa-icos_cardio_oncology_risk_assessment.php), consider alternative chemotherapies if very high risk and alternative therapy equal efficacy. Optimiz...
How does your management of ITP change when related to CLL?
The immune dysregulation associated with ITP is not necessarily a result of the CLL but occurs alongside and might be what underlies both disorders. The CLL clone is not making the antibody. ITP that persists despite a CR of the associated CLL should be treated as one would treat primary ITP. My fi...