Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
I typically follow the NCCN guidelines for monitoring/follow up: Visit every 3 months for 2 years, then every 3-6 months for 3 years, then yearly after year 5. CA125 (or other tumor markers) at each visit if initially elevated (with the understanding that CA125 monitoring does not affect survival, ...
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...