Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In a patient with sickle cell disease on hydroxyurea who is planning to have a family, for how long should they be off the drug before trying to conceive?
There is some consensus that pregnant women should not take hydroxyurea and should stop taking this when found to be pregnant. (Smith-Whitley, PMID 25472967) As far as I know, there is no data on how long hydroxyurea should be discontinued in either men or women before attempting pregnancy. In fact,...
How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?
For patients who are on VEGF inhibitors, I would be very careful with dosing of radiation to nearby bowel and I discuss holding VEGF inhibitors for a time before, during and after radiation. There have been multiple reports of in field toxicity, particularly with respect to bowel (liver SBRT frequen...
In sickle cell patients with continued pain crises despite hydroxyurea, how do we sequence the use of newer agents?
As the data supporting the approval of crizanlizumab in NEJM by Ataga et al demonstrated improvement in pain, that is our usual next agent based on the question of pain crises. The approval data around voxelotor related to an increase in hemoglobin of about 1gm/dl, so it may have a different role an...
Would you offer intensive CNS prophylaxis to Ph negative B-ALL patients who have possible mandibular nerve involvement on MRI face?
I would be inclined to treat this patient according to the CNS3 schedule of CNS-directed prophylaxis.Mental nerve neuropathy (or "numb chin syndrome," a rather pedestrian-sounding term for which I cannot take credit) can be a sign of leptomeningeal disease, presumably due to more focal involvement a...
Would you offer intensive CNS prophylaxis to Ph negative B-ALL patients who have possible mandibular nerve involvement on MRI face?
I would be inclined to treat this patient according to the CNS3 schedule of CNS-directed prophylaxis.Mental nerve neuropathy (or "numb chin syndrome," a rather pedestrian-sounding term for which I cannot take credit) can be a sign of leptomeningeal disease, presumably due to more focal involvement a...
What is your preferred treatment for locally advanced poorly differentiated carcinoma of the nasopharynx with bulky neck nodes that is EBER negative and p16 negative?
I prefer concurrent chemoradiation first if this can be started in a timely fashion and deemed reasonable by my radiation oncology colleagues. Discussion in multidisciplinary tumor board would be of immense value here. I would strongly consider adjuvant chemo based on Intergroup 0099 study in which ...
With the recent ODAC review of the commerically available CAR-T therapies in relapsed/refractory myeloma post 1-3 lines of therapy, what is your preferred regimen/therapy for first relapse, and which are the situations where you would absolutely consider CAR-T therapy at first relpase?
So, in a twist that almost never happens in myeloma, I largely still agree with my answer from a year ago: https://www.themednet.org/question/16578 In brief, at that time, I'd suggested that CAR-T primarily be used from the third line onwards - i.e., after at least two prior lines have failed. I st...
How long should patients treated with frontline therapy for Hodgkin lymphoma wait before attempting to conceive a child?
For males: All patients should have a fertility consultation to discuss fertility preservation prior to initiation of chemotherapy ABVD and BEACOPP regimens significantly reduce male fertility to varying effects depending on treatment duration. ABVD temporarily causes significant reductions in male ...
Is bone marrow biopsy indicated in patients with primary polycythemia but negative for JAK2 mutation including exon 12?
Thank you for your interest and your questions. I can't divine what the WHO experts were thinking (or not thinking), but they definitely had a problem when they a priori initially eschewed red cell mass (RCM) and plasma volume (PV) measurements for the diagnosis of PV because they didn't understand ...
For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?
I just want to point out that hemolytic microangiopathy (as seen on the peripheral smear by our Hematology colleague) is paramountly important in determining the presence of TMA. Laboratory parameters may be misleading. I have seen even ADAMT13 levels very low in sepsis and DIC process. Therefore lo...