Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In what scenarios (if ever) would you check peripheral blood flow cytometry in a patient with known multiple myeloma to evaluate for circulating plasma cells (CPCs) in the absence of an abnormal smear?
The question alludes to the fact that there is substantial data now on the prognostic implications of circulating plasma cells at diagnosis. Jelinek et al., PMID 36315921 showed that 2%+ CPCs are associated with a plasma cell leukemia-like phenotype. Much lower levels of CPCs were also associated wi...
Would you use belzutifan in metastatic renal cell carcinoma with somatic mutation in VHL (VHL p.q73) without having germline VHL and/or other manifestations of VHL syndrome?
Currently, there is no proven role for belzutifan use in somatic VHL mutation RCC. However, phase III clinical trial in advanced pretreated RCC randomizing to everolimus or belzutifan is currently ongoing. Phase II trials conducted in advanced RCC have reported promising results with belzutifan ther...
What are your top takeaways in Hematologic Malignancies from ASCO 2024?
The top three would be IMROZ DREAMM-8 BENEFIT
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
Do you recommend sentinel node biopsy or ALND in cT4 or cT3 cN0 breast cancer patients?
The major trials comparing SLNB versus ALND (i.e., Table 1 from Lyman et al. 2014) either required tumors to be small (<= 2-3 cm), or had few patients with larger tumors (e.g., NSABP B-32: less than 2% with tumor > 4 cm; ALMANAC: 2% with tumor > 5 cm). Similarly, the major surgical trials comparing ...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...
Would you consider offering adjuvant Olaparib to a patient with early stage triple negative breast cancer, cT3N0, ypT1aN0, with BRCA VUS who has residual disease after neoadjuvant KEYNOTE-522 regimen?
Patients with TNBC and residual disease have several options. As trials of different approaches ran roughly concurrently, we lack data on how/when to combine, sequence, or choose. The capecitabine and olaparib trials did not include patients on IO therapy that would continue to the adjuvant setting....
What is your preferred chemotherapy when dealing with hepatic visceral crisis in metastatic breast cancer?
This, of course, depends on the cancer's subtype. For patients with ER+/HER2- cancers, I would consider an initial trial of endocrine therapy and a CDK 4/6 inhibitor (and ovarian function suppression if the patient is premenopausal), based on results from the RIGHT CHOICE study presented at SABCS 20...