Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you approach the therapy in a patient with metastatic colon cancer (hepatic and limited non-hepatic metastases) that completely responded with systemic therapy in the non-hepatic sites but has limited hepatic disease?
Is there a substitution for etoposide you would recommend for testicular cancer patients who need multiple cycles of BEP?
If it is good risk disease can use our old regimen of cisplatin + vinblastine + bleomycin (PVB) as it was equivalent to BEP therapeutically in the good risk patient population. For intermediate or advanced disease, VeIP or TIP.
How do you approach CNS prophylaxis in double-hit lymphoma patients?
There is no consensus about the need for IT chemo for CNS prophylaxis in DLBCL. Factors such as IPI, the number and location of extranodal sites of disease, and LDH may be used to identify a group of patients with aggressive NHL who are at particularly high risk for CNS recurrence and might therefor...
Do you give radiation concurrently with adjuvant pertuzumab in locally advanced Her2 pos breast cancer?
I am in agreement here. Women with lumpectomy on APHINITY were encouraged to get simlutaneous radiation and traztuzumab/pertuzumab; there did not appear to be any increase in cardiac or other side effects over the traztuzumab arm of the trial in these subjects.
How do you counsel young and educated patients with non-metastatic breast cancer who choose non-proven "natural" treatments over standard therapy?
It is extremely difficult to persuade individuals skeptical of medicine to make evidence-based decisions. Most research related to changing scientific beliefs come from literature related to antivaccination attitudes. Previous research has suggested that provaccine messages about safety (messages co...
When do you combine hypomethylating agents with venetoclax or gemtuzumab ozogamicin in elderly patients with AML who are ineligible for intensive chemotherapy?
In September, 2017, the FDA granted approval for gemtuzumab ozogamicin (GO) in combination with daunorubicin and cytarabine (DA) and as a monotherapy for the treatment of adult patients with newly-diagnosed CD33-positive acute myeloid leukemia (AML). Approval of GO monotherapy was based on a randomi...
Would you consider using daratumumab in the first line setting for non-transplant eligible multiple myeloma?
Agree as above; you cannot fairly compare PFS when the treatment arms have different durations of therapy.One could argue that the current standard for previously untreated elderly myeloma patients is continuous lenalidomide and dexamethasone, as described in the FIRST study, (Benboubker et al, NEJM...
How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?
Looking at the trend of pro-lymphocyte increase will help in addition to clinical signs of progressive disease (splenomegaly). It is useful to check for TP53 and MYC translocations since these are common in PLL. As you mentioned, >55% pro-lymphocytes has been used to diagnosed PLL based on a report ...
Do you think there will be a role for duvelisib in the treatment of relapsed/refractory chronic lymphocytic leukemia?
I believe this agent could find a home for therapy in CLL as it is given by itself provided that further efficacy is demonstrated in a population where it would be most likely used, ibrutinib resistant CLL. Additionally, incorporation into non-BTK inhibitor combinations would also be possible. Given...
Would you consider stopping chemotherapy and continuing trastuzumab alone in a patient with metastatic HER2 positive GEJ cancer who had a complete response to chemotherapy and trastuzumab?
Since there are no data for a) stopping palliative chemotherapy in patients who achieve a clinical complete response (CR) or b) trastuzumab therapy alone, clinical practice is unburdened by any evidence. The rare patients I have had who have achieved a CR tend to have had small-volume metastatic dis...