Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Which patients with smoldering myeloma do you treat?
Let me address the last comment regarding treatment of high risk smoldering myeloma. IF one thinks that the patient requires treatment for myeloma, why treat with a regimen that is NOT the preferred treatment for myeloma? For example, lenalidomide alone or lenalidomide/dexamethasone. If this were "a...
Which patients with smoldering myeloma do you treat?
Let me address the last comment regarding treatment of high risk smoldering myeloma. IF one thinks that the patient requires treatment for myeloma, why treat with a regimen that is NOT the preferred treatment for myeloma? For example, lenalidomide alone or lenalidomide/dexamethasone. If this were "a...
How do you evaluate a patient with MGUS and peripheral neuropathy?
When I see a patient with MGUS and peripheral neuropathy, I think about it in stages: Does the patient have an IgM-monoclonal gammopathy? If so, then I think about DADS-M. An EMG/NCS, anti-MAG antibody, PET scan, and bone marrow biopsy are generally all part of the workup. I try to do MYD88 testing...
How do you evaluate a patient with MGUS and peripheral neuropathy?
When I see a patient with MGUS and peripheral neuropathy, I think about it in stages: Does the patient have an IgM-monoclonal gammopathy? If so, then I think about DADS-M. An EMG/NCS, anti-MAG antibody, PET scan, and bone marrow biopsy are generally all part of the workup. I try to do MYD88 testing...
For patients with metastatic poorly differentiated large cell neuroendocrine carcinoma of the lung, do you typically use NSCLC or SCLC regimens?
Earlier Studies have shown controversial results. Some show that small cell lung cancer-based regimen concluded better outcome; however, more recently, gemcitabine-platinum therapy in specific and NSCLC-based regimens led to a better outcome.We reported a retrospective study showing no statistically...
How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?
There's obviously a lot of additional information that would help in making individual patient-level recommendations here. What was the first line of chemoimmunotherapy, and how was it tolerated? How long was his duration of response? How was the response to covalent BTKi in depth and duration? What...
How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?
There's obviously a lot of additional information that would help in making individual patient-level recommendations here. What was the first line of chemoimmunotherapy, and how was it tolerated? How long was his duration of response? How was the response to covalent BTKi in depth and duration? What...
Based on the VESPER trial data, do you recommend the full 6 cycles or 3-4 cycles of ddMVAC for neoadjuvant muscle invasive bladder cancer treatment?
For clinically node negative MIBC: I give 4 cycles of neoadjuvant chemotherapy either (preferably) dose dense MVAC with G-CSF or Gemzar/Cisplatin. For cN+ MIBC: I tend to restage after 3 cycles and consider up to 6 cycles for patients who can tolerate induction chemo and do not have interim progress...
Based on the ASC4MORE trial, would you add asciminib to imatinib if patients do not achieve deep molecular remission at 1-year?
This is hard to justify. If you are using asciminib, the patient likely has had resistance to several prior TKI's. In this setting, treatment discontinuation is not recommended outside of clinical trials. Achieving BCR::ABL1 <=1% is an adequate response likely to improve survival, and about 40% of p...
Based on the ASC4MORE trial, would you add asciminib to imatinib if patients do not achieve deep molecular remission at 1-year?
This is hard to justify. If you are using asciminib, the patient likely has had resistance to several prior TKI's. In this setting, treatment discontinuation is not recommended outside of clinical trials. Achieving BCR::ABL1 <=1% is an adequate response likely to improve survival, and about 40% of p...