Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Maintenance is a standard of care management for both transplant eligible and transplant ineligible, regardless of type of induction regimen. Studies have shown benefit for both groups. Time to progression (PFS) almost twice as long for both groups with maintenance compared to no maintenance. - For ...
For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?
This patient would be a good candidate for ovarian tissue cryopreservation (OTC), since time would be limited to stimulate and retrieve oocytes. One can complete OTC with line placement and other procedures and be able to start chemotherapy the day after OTC. I know not every center has access to OT...
What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?
How best to employ radiation therapy in patients with Hodgkin lymphoma (HL) who progress after autologous stem cell transplantation (ASCT) is not entirely clear. Often such patients are considered for an allogeneic stem cell transplant, typically utilizing a non-myelablative conditioning regimen. Th...
How do you approach the treatment of hairy cell leukemia with inadequate response to front line therapy?
It is unusual not to achieve an excellent response, usually CR, following initial therapy with a single cycle of Cladribine. I would always make sure that the diagnosis is correct. There are other lymphoproliferative disorders which can be mistaken for hairy cell leukemia (HCL). Whenever I hear of a...
How does your approach differ when managing a "triple hit" versus a "double hit" or "double expressor" lymphoma?
Double-hit lymphoma and double-expressing lymphoma are biologically and clinically distinct entities. DHL is now classified within the WHO as high-grade lymphoma, and the majority are of germinal center immunophenotype, whereas DEL is most typically of non-germinal center immunophenotype and classif...
How do you approach fit patients with quickly relapsed Hodgkin lymphoma (disease-free interval less than or equal to one year) after 6 cycles of ABVD and radiation therapy?
As of this point in 2018 such patients are curable only with high-dose chemotherapy with stem cell transplant and then only if they are in chemosensitive relapse. Accordingly, I would have the transplanters see the patient at once and follow their recommendation regarding the pre-transplant regimen ...
How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?
Stage IE MCL would be very rare; this is probably disseminated disease with extra nodal GI involvement which is seen in the majority of such patients. I would treat as disseminated disease, PS and comorbidity permitting per NCCN guidelines.
How would you treat an elderly fit patient with stage IE DLBCL (single skin lesion)?
Is this a primary cutaneous large B-cell lymphoma, leg type? I suspect so. This is a rare and aggressive disease. I would carefully stage the patient ( to include bone marrow ) and treat as per any localised DLBCL with 3-4 cycles R-CHOP and XRT. Even with this regimen 50% of patients relapse so I'd ...
How would you manage a primary dural low-grade lymphoma?
Primary dural low grade lymphoma is a rare presentation, usually marginal zone lymphoma, mostly scattered case reports in the literature but one recent series from Memorial Sloan Kettering (de la Fuente et al., PMID 27649904). I would rx similarly for other marginal zone sites. Local rx only, usuall...
What dosing regimen of carfilzomib do you use in the front line setting for high risk transplant-eligible multiple myeloma?
I almost never use carfilzomib in the front line setting, as there is almost no evidence to support its use over bortezomib in this setting. When I do give carfilzomib in combination with lenalidomide, I generally extrapolate from the twice weekly 36 mg/m2 dosing and combine those into a single week...