Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?
In general, the schedule of IT chemotherapy is dictated by the systemic chemotherapy regimen chosen. For example, with a pediatric-inspired regimen like C10403, those with CNS involvement receive more LPs during the Remission Induction course. For hyperCVAD, the historical approach has been to give ...
How do you manage a DOAC if interested in testing for lupus anticoagulant?
Testing for anti-phospholipid antibodies encompasses two broad categories of testing. One is an ELISA based (aka solid phase) set of tests that include anti-cardiolipin and anti-beta 2 glycoprotein I antibodies. ELISA assay are not affected by DOACs. For the second lupus anticoagulant (aka fluid pha...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...
How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?
It's challenging to offer specific advice in this situation without knowing a lot more. First, it's important to recognize that CNS involvement by classical Hodgkin lymphoma is extremely rare and strictly requires a brain biopsy to make a diagnosis (even in a patient with active systemic CHL, a seco...
What is the recommended approach for systemic therapy in a patient with metastatic cutaneous squamous cell carcinoma with active autoimmune disease (dermatomyositis)?
Dermatomyositis can occur with myositis/myasthenia gravis (overlap syndrome). At the Ohio State University Comprehensive Cancer Center, we have established an Immunotoxicity Clinic headed by a rheumatologist, Dr. @Dr. First Last. I would recommend engaging with a rheumatologist who is familiar with ...
For inoperable cholangiocarcinoma, do you recommend up-front chemotherapy prior to offering SBRT or combination chemoradiation?
For inoperable cholangiocarcinoma, there are many factors to consider. First, does the patient have any metastatic disease? If no, then how large is the primary and are there any nodes? Finally, is the patient suffering from biliary obstruction - causing hyperbilirubinemia and persistent/recurrent c...
What are the indications for anticoagulation in splenic infarctions?
A great reminder that splenic infarct relates to ARTERIAL thromboembolism and not to VENOUS VTE. Too often, I see massive, blind thrombophilia work-up for (incidentally) detected splenic infarcts.
What are the indications for anticoagulation in splenic infarctions?
A great reminder that splenic infarct relates to ARTERIAL thromboembolism and not to VENOUS VTE. Too often, I see massive, blind thrombophilia work-up for (incidentally) detected splenic infarcts.
How do you approach evaluation for underlying rheumatologic disease in patients with chronic asymptomatic thrombocytopenia?
APL testing as well as evaluation for SLE and Sjogrens with complement, urine, antibody testing, not just an ANA.
How do you reconcile the lack of OS benefit in the CLEAR trial comparing Lenvatinib + Pembrolizumab to Sunitinib, to the very impressive ORR and mPFS benefit seen?
At the primary analysis point of the phase III open-label, CLEAR study (Study 307/KEYNOTE-581), with a median survival follow-up of 26.6 months, lenvatinib plus pembrolizumab showed superior efficacy versus sunitinib in the first-line treatment of patients with advanced renal cell carcinoma. (Motzer...