Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
When would you add daratumumab to a PI/IMiD/dex backbone for first-line treatment of transplant-eligible multiple myeloma?
Short answer - in patients with low risk disease.Long answer - CASSIOPEIA enrolled fit patients below 65 years of age with adequate kidney function (greater than or equal to 40 mL/min/1.73 m2) with predominantly stage 1 & 2 disease by the revised international staging system (91% in Dara-VTd, 90% VT...
Should consolidation autologous stem cell transplant be considered for de novo follicular lymphoma transformation to DLBCL after achieving a PR with R-CHOP x 6 cycles, if residual disease showed original indolent follicular lymphoma?
First, it is important to make sure that residual disease is FL rather than tFL, which it sounds like you have already done. However, the PET scan should be reviewed; if there is a different node that has very high FDG uptake, then that node should be sampled to rule out residual DLBCL. Historicall...
For an otherwise healthy individual, what would be your front line choice for de novo Richter’s transformation?
The management of de novo transformation of CLL to DLBCL is challenging. For young fit patients, the standard of care remains RCHOP chemoimmunotherapy. Limited data exist exploring other options, including retrospective data sets and small prospective studies, but nothing published convincingly esta...
Based on the SELECT-D trial, would you favor rivaroxaban over LMWH for treating cancer-associated VTE in patients with low risk of bleeding?
Both the SELECT-D trial and the HOKUSAI trial provide evidence that rivaroxaban and edoxaban respectively, have a role in the management of cancer-associated thrombosis (CAT). In addition, an oral presentation from ASH 2018, ADAM VTE trial, also supports a role for consideration of apixaban in the m...
Would using Obinutuzumab and Venetoclax second line after Bendamutine and Rituximab be a reasonable option for a patient with IGHV-unmutated CLL?
BR is still an option for frontline CLL, but since Venetoclax +obinutuzumab was approved for frontline therapy, the question you have posed is very relevant. Now it is more important than ever, for the treating physicians to ask what is the therapeutic objective in each case? If we are dealing with ...
What is your first line treatment of choice for advanced (stage IIIA) follicular lymphoma, histologic grade 1-2 in an otherwise young healthy patient in 2019?
When do you offer consolidative tandem autologous stem cell transplantation for high-risk multiple myeloma?
This is a great deal of debate regarding the question of tandem transplant. In the original IFM 94 study, only patients not achieving a VGPR benefited from a tandem transplant. However, that was in the era of pre-novel therapies. More currently, the BMT CTN 0702 (STAMINA) trial did NOT show a benefi...
Is there a role for ruxolitinib in essential thrombocythemia?
There have been two larger publications supporting the use of ruxolitinib in ET. However, it is only useful in certain situations after standard therapies like hydroxyurea and pegylated interferon. Certainly, if a patient is symptomatic with cytokine-related symptoms, heading towards post-ET MF, or ...
Would you offer chestwall RT after capsultectomy+explant for an implant-related ALCL?
Breast implant-associated ALCL is a provisional entity in the most recent WHO classification system with a relatively low incidence. In contrast to most other lymphomas, surgery plays an integral role in the management of this disease. Most patients present with a spontaneous fluid collection around...
What would be the preferred chemotherapy regimen in elderly patients with advanced stage classical Hodgkin Lymphoma and contraindication to doxorubicin and bleomycin?
First, I’d seek clarification as to what contraindications were present. Contraindications to either can be absolute or more relative. A Hgb-adj DLCO of less than 50% in the presence of known lung disease is an absolute contraindication to bleo, whereas a DLCO of 65 perhaps contributed to by HL itse...