Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your preferred systemic treatment for patients progressing during or soon after completion of consolidation durvalumab for unresectable NSCLC?
This is an excellent question for which (to my knowledge) no randomized prospective data is available. As this is a frequent clinical scenario, one would hope that investigators in the thoracic oncology field would perform such a study in the future. That being said, I can see the rationale for givi...
How would you manage a young woman with vulvar langerhans cell histiocytosis and positive margins after wide local excision?
It is a complex situation/question, with no major existing studies to answer it directly. Further management depends on various factors- are there other sites of disease on full-body PET CT scan? Is further surgery possible without any disfigurement or major cosmetic issues? If localized disease onl...
How would you approach langerhans cell histiocytosis involving a single bone site after resection?
The outcomes for single-site LCH in adults are generally excellent. However, there is still a small risk of relapse. At this time, factors predicting relapse are unknown. It is recommended to ensure that it is truly a single-site disease by FDG PET scan and there is no diabetes insipidus. If yes, th...
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Patients I screen for hypogammaglobulinemia include those with: gammaglobulin gap (total protein-albumin) less than two; advanced multiple myeloma or mantle cell lymphoma; patients who have received CAR T cells or bispecific antibodies against BCMA or CD20.
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...
How is monoclonal gammopathy of renal significance (MGRS) different from myeloma kidney?
The terminology around renal failure and myeloma is confusing and sometimes unnecessarily complicated. Here is how I approach it: Light chain (cast) nephropathy - This is from toxic injury to the nephron tubules from excess light chains. This is usually picked up on biopsy or can be ascertained fro...
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...