Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach monitoring for lymphoproliferative disease in Sjogren's patients?
I have an increased index of suspicion for lymphoma, myeloma, and amyloid in Sjogren's. Increased age, longer disease duration, and greater disease activity increase the lymphoproliferative risk.Persistent unilateral parotid or other salivary gland enlargements, lymphadenopathy, vasculitis (purpura,...
What is your preferred initial systemic therapy approach to metastatic clear cell adenocarcinoma of the urethra (CCAU)?
Clear cell adenocarcinomas of the urethra are very rare tumors, and the cell of origin remains unclear. These may arise from the urothelial lining, or alternatively the peri urethral glads or other stromal tissues. Given its rarity, it is not surprising that no standard treatment for metastatic dise...
What is your preferred induction regimen prior to allo-HCT for mantle cell lymphoma?
I commonly use a reduced-intensity conditioning regimen before alloSCT for patients with MCL especially since most of these patients have received prior autoSCT, are older, and are heavily treated. I try to incorporate low dose TBI in the regimen such as TBI 200 cGy x 2 sessions in one day. Frequent...
What is your preferred induction regimen prior to allo-HCT for mantle cell lymphoma?
I commonly use a reduced-intensity conditioning regimen before alloSCT for patients with MCL especially since most of these patients have received prior autoSCT, are older, and are heavily treated. I try to incorporate low dose TBI in the regimen such as TBI 200 cGy x 2 sessions in one day. Frequent...
Would you consider holding treatment with hypomethylating agents and venetoclax in elderly patients diagnosed with AML who achieve CR and are MRD negative?
At this point there is no data demonstrating that azacitidine venetoclax is curative even in those who achieve MRD negative CR. As such, we continue cycles of therapy with timing and duration of therapy adjusted based on count recovery as long as there is continued evidence of response.
Would you consider holding treatment with hypomethylating agents and venetoclax in elderly patients diagnosed with AML who achieve CR and are MRD negative?
At this point there is no data demonstrating that azacitidine venetoclax is curative even in those who achieve MRD negative CR. As such, we continue cycles of therapy with timing and duration of therapy adjusted based on count recovery as long as there is continued evidence of response.
What is your preferred induction regimen for primary CNS lymphoma in a young patient?
There is no preferred induction as long as you choose a HD-MTX-based regimen. I recommend using the one you are most familiar with. For younger patients without comborbidities, I prefer MATRix based on data from IELSG324 (Ferreri et al., Lancet Haematol. 2016), which reported a CR rate of 50%, and 2...
What is your preferred induction regimen for primary CNS lymphoma in a young patient?
There is no preferred induction as long as you choose a HD-MTX-based regimen. I recommend using the one you are most familiar with. For younger patients without comborbidities, I prefer MATRix based on data from IELSG324 (Ferreri et al., Lancet Haematol. 2016), which reported a CR rate of 50%, and 2...
Aside from radiation, what is your approach to patients with EGFR-mutated or ALK-translocated metastatic NSCLC who have systemic disease control but fail in the CNS?
While there are systemic agents that have brain penetration, my most standard treatment remains radiotherapy. That said, the questions specifically asked about non-XRT options. I do think about parenchymal brain metastases and LMD a bit differently. For LMD in EGFR-mutated NSCLC, I do sometimes use ...
Would you offer neoadjuvant radiation therapy with concurrent chemotherapy for a T4 rectal carcinoma with an associated rectovesical fistula?
In the past, some considered fistulas to be a contraindication for radiation therapy due to concerns about potential worsening. However, our understanding has evolved, particularly in cases where the tumor itself is often the primary cause or a significant contributor to the fistula. Consequently, i...