Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Is a CLL FISH panel sufficient to aid in treatment decisions in CLL or is p53 sequence analysis also needed?
At a minimum, patients should undergo IGHV mutation analysis as well as testing for deletion of 11q and 17p prior to treatment initiation. However, testing for a TP53 mutation is ideal. While many patients with TP53 mutations will have a concomitant deletion 17p, this is not always the case. Given t...
How would you qualify and treat a patient with neutropenia, anemia, and abnormal NK cell population with normal trilineage marrow maturation?
I would run a molecular test to confirm that the clonality does not show a CD8-positive clone, as that is more common in LGL. The findings of a clonal NK population by flow cytometry would be enough, in the setting of neutropenia and anemia, to consider a diagnosis of NK cell LGL.
For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?
can you clarify the question? Is the question whether to treat superior and inferior conjunctiva (eyelids) or whether to treat deeper and more laterally on either the sup or inf Eyelid?
How do you choose between azacitidine and decitabine when deciding to treat a patient with MDS with a hypomethylating agent?
The only agent to prolong overall survival in patients with MDS is azacitidine so this is always my first choice particularly in older individuals at higher risk for complications of myelosuppression occurring at a higher rate with decitabine. Other issues to consider include ease of administration ...
Do you use bevacizumab in patients with history of VTE (DVT/PE) who are stable on anticoagulation?
I have used bevacizumab in many patients who are stable on therapeutic anticoagulation for prior VTE. If the first VTE occurs during treatment with bevacizumab, I hold the drug and then consider restarting it (if warranted by the clinical situation) after a period of stability on therapeutic anticoa...
How do you choose among regimens for relapsed refractory myeloma?
To be brief - no one chooses elotuzumab with no single agent activity if Daratumumab is available, with its approximate 30% response rate in its pivotal study. I was just sitting down at a meeting with a number of myeloma physicians asking how do we currently choose treatment for relapsed myeloma.Fo...
For Hodgkin lymphoma patients with initial splenic involvement, do you ever include the pre-chemotherapy involved spleen as part of your consolidative ISRT treatment after a CR?
Our long standing policy, first at Yale, for the last 3 decades at Duke, has been to use consolidation RT to all sites of disease known to be present prior to chemotherapy, irrespective of "bulk". On a log scale little difference between bulk and clinically detectable disease of any size. The origin...
When do you consider re-starting treatment for a patient with relapsed myeloma?
Do you start anti-myeloma therapy when patients have progressive disease (25% increase in paraprotein or new or worsening myeloma bone disease) or clinical relapse (CRAB criteria, hyperviscosity, new plasmacytoma)? The goal is to pull the trigger right before clinical relapse. How is this done in th...
Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?
If SMILE regimen is used here (the preferred regimen for NK/Tcell lymphoma), radiotherapy should be delivered sequentially (not concurrent) due to normal tissue toxicity and poor tolerance.
When do you choose to give CyBorD over RVd in a newly diagnosed myeloma patient?
I only use VCd when patients are going to be inpatient for a while or the patient is unable to afford an IMiD. For patients with renal insufficiency, where time is of the essence, I recommend Velcade 1.3 mg/m2 SQ days 1,4,8,11 + dex 20 mg days 1,4,8,11 with Revlimid 5-15 mg in newly diagnosed MM. L...