Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Are you de-escalating treatment for favorable risk Stage I-II DLBCL patients to 4 cycles of R- CHOP with 2 additional rituximab cycles?
In general I could see this being an option in select patients (not localized stage II or patients who have a contraindication to XRT) but for the most part these patients in my practice are not treated with 6 cycles of R-CHOP. I treat most patients with Stage I and localized stage II with 3 cycles ...
What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?
Hypomethylating agent like decitabine and venetoclax will be good options. C1 decitabine for 10 days and venetoclax for 28 days. Then C2 decitabine for 5 days and venetoclax every 28 days. Bone marrow biopsy should be done on day 21. There is, however, no strong literature support regarding pharmaco...
Do you prefer hyper-CVAD or the CALGB 9111 protocol for high intensity remission induction treatment in Ph-negative ALL patients?
It depends on the patient's age. Historically, the adolescents and young adults (AYAs) population, arbitrarily defined by the National Cancer Institute as those between the ages of 15 to 39 years old, had worse outcomes compared to children with B-ALL (EFS of 30-40%). This is largely driven by adver...
What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (< 2 years)?
My approach to POD24 patients is to first ensure there is no evidence of transformed disease. According to a retrospective analysis led by @Dr. First Last at Memorial Sloan Kettering, as many as 40% of the POD24 patients have evidence of transformed disease if a biopsy is pursued. Clinical indicator...
What is your approach to a patient with systemic AL amyloidosis who has achieved a hematologic response but not an organ response with CyBorD?
I would leave them alone. Treating to organ response is wrong and dangerous. Hematologic response is quick, organ response is delayed. The goal is hematologic remission; after that allow the body the time needed to heal the organs.
What is your approach in a transplant-eligible patient with relapsed classical Hodgkin lymphoma who has an area of refractory disease after salvage chemotherapy?
The goal here, especially in Hodgkin's lymphoma, is to achieve complete metabolic remission (CMR) by PET before high dose chemotherapy and autoSCT as data is clear in terms of difference in the outcome in favor of patients achieving CMR vs. those who achieved < CMR. So I would do what it takes to ac...
Do you recommend lenalidomide for high risk smoldering multiple myeloma?
If you want to push the can down the road that is a good approach. High risk SMM is more like early stage myeloma. Treating them with single agent does not make sense as we know that combination therapy and total therapy approach is superior. The ECOG study was perfect 15 years ago but not today.
Do you ever start with lower than standard doses of TKIs when initiating treatment for chronic phase CML?
Not usually with the exception of bosutinib. I specifically start bosutinib at 200 mg and go up by 100 mg every week until the patient is at full dose. I find this helps manage the initial diarrhea associated with the drug. Otherwise, I start at the standard dose for all drugs. I may decrease the do...
Can a rituxumab biosimilar be used for a high grade lymphoma?
Rituximab (Rituximab) was the landmark addition to treatment of B cell-Non Hodgkin Lymphoma in the late 1990s. It changed the treatment for B cell NHL. Rituximab is also used in many other off label indications (as for example ITP, TTP etc.). Recently two bio-similars were approved by US FDA: Truxim...
Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?
Irradiation to the contralateral testis is an important component of any successful curative regimen for patients with all stages of disease.In a survey by IELSG (JCO 2003), patients who did not receive contralateral testicular RT had a 43% incidence of testicular failure after CR to anthracycline b...