Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
How do you approach balancing the potential risk of worsening actinic damage and maintaining CTCL clearance in patients treated with nb-UVB?
NB-UVB continues to be the most effective skin directed therapy for patch MF. I try to use it as much as possible as monotherapy, or commonly in combination with retinoids for treatment and maintenance of early-stage disease. In patients with severe solar damage, I may continue phototherapy adding l...
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How do you choose between peginterferon and anagrelide for ET patients if hydroxyurea-intolerant?
This is largely dependent on the patient. I generally prefer to use peginterferon, however, have a discussion with the patient outlining the options. Anegrelide isn't well tolerated in general, but peginterferon can also have negative side effects and may be too costly.
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...
How would one approach concomitant diffuse large B cell lymphoma and fibrotic phase myelofibrosis?
This is a tough case without perfect answers. I will make some assumptions to answer and say that the DLBCL likely takes priority here as it's more likely to impact patient survival in the short term. Depending on the stage/risk of both diseases that will inform how these are managed and if the DLBC...