Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you approach patients with SDH deficient advanced GIST tumor for systemic treatment?
For SDHB mutant GIST (the most common SDH mutation), I try to observe them for as long as possible and resect the enlarging lesions when possible (NF1 and SDH mutant GIST tend to grow slowly compared with their KIT/PDGFR mutant counterparts). If no surgical resection options are available, the les...
Is pembrolizumab-carboplatin-pemetrexed an acceptable initial therapy for metastatic non-squamous NSCLC regardless of PD-L1 status?
In my opinion, the approval of Pembro-chemo for 1st line therapy of non-squam NSCLC, based on the small randomized Phase II KEYNOTE 021 trial, with no link to PD-L1 expression, was premature. The implications are so great that waiting a few months for the Phase III results is warranted. Afterall, th...
Would you offer bridging radiation before or after leukapheresis?
We believe the ideal time for bridging radiotherapy is after leukapheresis but before CAR T-cell infusion to avoid a negative impact on T-cell collection. However, the clinical situation has to be considered, and if a symptomatic presentation necessitates urgent treatment before leukapheresis, treat...
Would you offer bridging radiation before or after leukapheresis?
We believe the ideal time for bridging radiotherapy is after leukapheresis but before CAR T-cell infusion to avoid a negative impact on T-cell collection. However, the clinical situation has to be considered, and if a symptomatic presentation necessitates urgent treatment before leukapheresis, treat...
How would you approach BCMA-directed therapy in a patient with myeloma and renal failure on dialysis?
The short answer: Very carefully. Lots of anecdotes and theoretical fears out there, but very little real data to guide us as of July 2023 as I write this. The largest experience with BCMA CAR-T with CKD is this TCT abstract by Sidana and colleagues that I don't think has been published yet:Sidana e...
What induction regimen do you choose for high risk newly diagnosed multiple myeloma in light of the recent high risk focused studies?
Two things are clear from the slew of high-risk enrichment studies and subgroup analyses that have been done. In the age of upfront quadruplet therapy with an anti-CD38 monoclonal antibody, outcomes for patients with one high-risk cytogenetic abnormality are very good, even in the absence of prolong...
What induction regimen do you choose for high risk newly diagnosed multiple myeloma in light of the recent high risk focused studies?
Two things are clear from the slew of high-risk enrichment studies and subgroup analyses that have been done. In the age of upfront quadruplet therapy with an anti-CD38 monoclonal antibody, outcomes for patients with one high-risk cytogenetic abnormality are very good, even in the absence of prolong...
Do you routinely prescribe PPI prophylaxis for myeloma patients who will be on low-dose aspirin and weekly dexamethasone?
Depends on the dose of weekly dexamethasone. If 40 mg weekly, would use PPI. If given along with cyclophosphamide as CyBorD, would use PPI regardless of dose of dex; if symptomatic gastritis on aspirin or dex, will use PPI even with lower doses of dex.
Do you routinely prescribe PPI prophylaxis for myeloma patients who will be on low-dose aspirin and weekly dexamethasone?
Depends on the dose of weekly dexamethasone. If 40 mg weekly, would use PPI. If given along with cyclophosphamide as CyBorD, would use PPI regardless of dose of dex; if symptomatic gastritis on aspirin or dex, will use PPI even with lower doses of dex.
For otherwise transplant-eligible patients with myeloma, given developments of bispecifics and CAR-T, what is your age cutoff for consolidative autologous transplant?
For any lawyers reading this, there is no upper age cutoff for consideration of transplantation. For the physicians and other healthcare providers reading this, it's much more nuanced. As the question poster alluded to, this isn't 2010 and we have many more treatment options available. I have many p...