Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider antiphospholipid syndrome to be a contraindication for checkpoint inhibitor immunotherapy?
Checkpoint inhibitor therapy is usually an important treatment for patients with advanced malignancy, and has greatly improved the prognosis of otherwise untreatable cancers, so I would not automatically proscribe these drugs because of a history of APS. I would ensure patients with APS are on full ...
How do you explain TTP to patients?
I tell them there is an enzyme in their blood called ADAMTS13 that helps keep their platelets from sticking together and plugging small blood vessels, and that for unknown reasons, their own immune system is destroying this enzyme. The symptoms of TTP are caused by clumps of stuck-together platelets...
What aspirin dose do you favor for thrombotic prophylaxis in myeloproliferative neoplasms?
I generally use 81 mg twice a day. If they have had a thrombotic event, or have microvascular symptoms, then I use 81 mg BiD.
How would you treat a patient with recurrent DLBCL 15 years after definitive treatment of initial de novo disease with R-CHOP?
As a new primary DLBCL, but with previous exposure to 6 cycles of doxorubicin, I would only give RCHOP x 2, then RCEOP x 4. If interim PET showed a poor response, I would switch to a CAR T-cell therapy as 2L therapy.
Do you hold histone deacetylase (HDAC) inhibitors for patients receiving palliative radiation therapy for cutaneous lymphomas?
Histone deacetylase (HDAC) inhibitors are often used in the management of mycosis fungoides, the most common cutaneous lymphoma. NCCN guidelines include two HDAC inhibitors in their list of recommended systemic therapies- romidepsin and vorinostat. Romidepsin was FDA approved for CTCL in 2009 and vo...
Do you offer anticoagulation to patients with prior antiphospholipid antibodies detected in pregnancy without a history of pregnancy loss or thrombosis?
I do not know what the risk of pregnancy loss is in a woman without a prior history of VTE or pregnancy loss. I am sure the risk is affected by whether the woman has an underlying rheumatological disease (SLE) and whether she has single positive vs. triple positive LAC. I recommend a baby aspirin on...
Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?
This is an extremely important and timely question. There simply isn’t enough data or firm guidelines on this leading to different practices. The reality is that there have been a number of meningococcal breakthrough infections in those vaccinated against meningococcal disease. Complement therapies ...
How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?
Bridging with HMA to transplant in MDS patients is a common practice although it did not show improved outcomes. You will definitely have to r/o other potential causes of pancytopenia (i.e., infections, etc). I would repeat a BM A/Bx to make sure that blasts are not increasing (< 20% and preferably ...
For a patient who has core binding factor AML but also a small FLT3-ITD mutation detected, do you proceed with allo transplant or only HiDAC consolidation after achieving CR from induction chemotherapy?
My CBF patients with FLT3-ITD who have achieved CR1 following induction have done quite well with high dose cytarabine consolidation and I cannot recall any of them who have required transplant. Historically, I have managed my CBF-AML patients with FLT3-ITD the same as those without FLT3-ITD since t...
How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?
I haven’t combined CHOEP with high dose methotrexate before! I have treated a patient with HIV-associated B-cell lymphoma with R-EPOCH and high dose methotrexate at D15 successfully with growth factor support. For patients with PTCL-NOS and leptomeningeal involvement at presentation, I would likely ...