Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How long do you treat recurrent classical Hodgkin lymphoma with brentuximab/nivolumab if the patient does not want to proceed to BMT?
The phase 1/2 study of BV/nivolumab combination aimed to maximize response with a goal to proceed with autologous SCT. In the trial protocol, patients would receive 4 cycles of therapy (Blood 2018).If a patient changed their mind and does not want autologous SCT, then I would drop BV (assuming they ...
For inpatient treatment of lymphoma and ALL, can rituximab be delayed?
Although I am not aware of published data on this issue, at least for patient receiving DA-R-EPOCH, I have learned that it is common practice to delay the day 1 rituximab because of the reimbursement issue you refer to. I don't think the effect of this has been studies systematically, but i'm not aw...
What is your preferred TKI and dosing for AYAs or adult patients with Ph+ ALL?
We typically follow the MD Anderson updated approach of adding dasatinib 100mg daily for first 2 weeks in cycle 1 and then 70mg daily starting cycle 2 (Cancer 2015; 121:4158).How long to continue? That’s a tough one with essentially no mature data. The COG study continued for only 2 years, though da...
How would you approach primary CNS lymphoma in an elderly patient over 80 years old?
Patients >70-75 are poorly represented in trials and retrospective studies, and are in need of novel therapies with minimal toxicity. We know that radiation therapy is associated with increased neurocognitive morbidity in patients >60, but is often the only feasible approach if chemotherapy cannot b...
Would you offer next-line systemic therapy to a patient with LGL leukemia with chronic severe neutropenia, who has had treatment failure with methotrexate, cyclophosphamide, cyclosporine, and danazol?
Response can be slow and delayed. Treatment failure is usually considered after 4 months of therapy. Steroids can be used with methotrexate in severe neutropenia with a slow taper over 4-6 weeks. This strategy seems to potentiate the effect of methotrexate. Evidence after these therapies is limited....
What would be your choice for treatment for an HIV positive patient with no detectable viral load with CD20 negative and CD30 positive DLBCL?
I would really question the diagnosis, especially with the CD30 positivity. Consider peripheral T-cell lymphomas, which are typically CD30+ (ALCL, PTCL-NOS, AICL).
Would you offer maintenance lenalidomide or rituximab in a patient with DLBCL transformed from a marginal zone lymphoma in a young, fit patient?
No. There is no role for maintenance therapy in aggressive lymphomas (transformed or not). This is based on the assumption that DLBCL is curable and randomized trials evaluating maintenance therapy in de novo disease did not show an improvement in survival (see HOVON Nordic trial). Dedicated trials ...
How do you diagnose MDS in a patient with equivocal morphological findings?
Cytopenic patients suspected of having MDS may often have equivocal findings in the bone marrow such as insufficient dysplasia and a blast proportion of less than 5%. This does not necessarily preclude a diagnosis if other features are present. For example, persistent, otherwise unexplained monocyto...
For a patient with relapsed FLT3 positive AML on HMA and venetoclax, is there ever a role for the addition of midostaurin to the treatment regimen to improve response rate?
Short answer is no. The safety of the combination is unknown and there’s also not an indication for Midostaurin in relapsed AML. The trial that got Midostaurin approved was for combination with 7+3 in newly diagnosed patients. HMA+ venetoclax has better response frontline compared to relapsed/refrac...
How do you treat a gastric plasmacytoma which is not amenable to radiation?
This is a very difficult case. Plasmacytomas are very responsive to radiation. you need to determine reason for not doing radiation: is it location, active bleeding, Perforation? Location should not be a big problem for Radiation oncologist. they can use precision tools now to avoid other structures...