Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How long after high-dose IV methothrexate for chemo-refractory CNS lymphoma do you wait before giving brain radiation?
As was taught by my mentor- "As long as possible!". Of course, the prognosis is extremely poor if the patient is chemo-refractory to IV MTX and longer-term risks of WBRT may be less relevant than present-day symptoms requiring palliation. While I do recommend WBRT, as what is visualized on MRI is ju...
Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?
An abstract presented at the 2017 ASTRO from MD Anderson Cancer Center by Andraos and colleagues (last author Dabaja) addressed this question in a retrospective analysis. Of the 39 patients who underwent complete resection of their nodal low grade FL, "those treated with adjuvant therapy experienced...
Do you offer adjuvant chemoimmunotherapy after IFRT for Stage I to II low grade follicular lymphoma?
I do not. Absent overall survival benefit, which is not seen or reported, this strategy overtreats the subset of patients who are cured with RT alone, and prematurely exposes the other group to the toxicity of chemotherapy.
What is your standard dose for total skin irradiation in a mycosis fungoides patient?
Our standard has been to do the low-dose 12 Gy TSE regimen as it still has good overall response rates with low toxicity.https://www.ncbi.nlm.nih.gov/pubmed/25476993https://www.ncbi.nlm.nih.gov/pubmed/28843374I asked @Dr. First Last to weigh in on this and he agrees that 12 Gy is the standard.
With the recent FDA approvals of Venetoclax and Glasdegib in AML, is one generally preferred over the other for elderly and/or unfit patients in combination with a hypomethylating agent/low-dose cytarabine?
Overall the combination of venetoclax with HMA or LDAC for newly diagnosed older AML patients is generally preferred for treatment of this subset of AML patients due to reports of high overall response rates (60-70%) and prolonged overall survival (median 18 months). Prior studies have shown that gl...
Which regimen do you prefer for patients with newly diagnosed DLBCL that are not candidates for doxorubicin secondary to low ejection fraction?
I like to use R-CEOP per Vancouver experience. Had very good results with it and is very well tolerated. I sometimes use it also in frail older patients who have normal EF. Etoposide substitutes doxorubicin in regimen: 50 mg/m2 on D1 and 100 mg/m2 PO on days 2-3 and can also give peg filgrastim on D...
Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?
AS a general rule, sophisticated RT planning techniques are very useful for some patients but hardly necessary for all. This is particularly true for lymphoma pts where doses are often low, such as favorable HL where 2 cycles of ABVD and 20 gy is the treatment of choice ( see Dr Kelsey's answer to a...
Is there a role for assessing measurable/minimal residual disease (MRD) in multiple myeloma at this time?
MRD assessment in myeloma is challenging. The EuroFlow standard and Adaptive ClonoSEQ technologies seem to be winning out for the moment, but the Mayo Clinic mass spectrometry peripheral blood assay may be the next generation. The advantage of the flow-cytometry based assay is that it involves live ...
With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?
I would say in the light of ECHLON-II data with a PFS and OS advantage specifically in ALCL and Advanced stage ALK positive disease Brentuximab-CHP would be the most beneficial option and standard of care.
Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?
The ECOG 1912 study presented at ASH this week showed better OS and PFS in younger patients with ibrutinib, which was great news. I used to use FCR in these patients as it was said to have a higher rate of MRD but potentially dangerous myelo- and immunotoxicity and of course there's concerning issue...