Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you decide between CPX-351 and HMA + Venetoclax in treating transplant eligible AML-MRC?
I would consider CPX-351 (liposomal daunorubicin and cytarabine) in anyone who you would consider to be an induction chemotherapy (7+3) candidate. The indication is for newly diagnosed MDS/AML (AML-MRC) or treatment related MN (t-AML). Benefit is the response can be seen quicker in 1 cycle as oppose...
Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?
Given that oral contraceptives are considered a provoking event (Ortel et al., PMID 33007077), ASH Choosing Wisely guidelines recommend against thrombophilia testing since the recommended duration of anticoagulation is only 3 months. (Hicks et al., PMID 24307720 & Hicks et al., PMID 25472968).
How do you approach the treatment of ITP in a pregnant patient who did not respond to prednisone?
We usually stay away from dex because of the toxicity and use the absolutely smallest dose of prednisone we can. Usually, unless the count is very low, I start at about 20mg since we’re just trying to get the count up not get a CR. We manage a lot of patients with IVIg alone, but it can get expensiv...
Would you consider adding midostaurin to azacitadine in elderly patients with newly diagnosed AML with FLT3-ITD mutations in the frontline setting?
Yes, would consider adding midostaurin to azacitidine in an elderly patient with newly diagnosed AML with FLT3 as long as if ITD allelic ratio is high where benefit outweighs risks of cytopenias and infections. Dose reductions can be considered based on tolerance. I would use the same regimen as stu...
How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?
Nijland et al., PMID 29083044. This shows that you can use either option, 3 cycles RCHOP+ XRT or 6 cycles RCHOP with no difference in relapse or DFS.My bias would be to treat with 6 cycles of RCHOP as I look at DLBCL as a systemic disease and risk for systemic relapse even with early presentation.If...
When do you consider iron chelation in elderly patients with transfusion-dependent MDS?
When the ferritin is >1500 or if LFTs due to iron are abnormal between 1250-1500. You have to be careful with chelation at lower levels due to chelation of other micronutrient heavy metals.
Would you initiate chemoimmunotherapy (e.g. RCHOP) in a symptomatic patient with DLBCL who tested positive for COVID19?
It will depend on if he is symptomatic from covid infection or just positive but asymptomatic. If asymptomatic from covid, I would treat. DLBCL is the one which is symptomatic and active disease without treatment is equally immunosuppressive. I would suggest giving rituximab with cycle 2 rather than...
Would you ever consider prophylactic anticoagulation in patients with CKD requiring ESA therapy?
I would not start anticoagulation in this setting solely because the patient is to receive ESA treatment, but would advocate for adjusting the ESA dose to maintain a hemoglobin of 9-10 g/dL, since a number of studies suggest that targeting higher hemoglobin levels is associated with increased risk o...
How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?
Agree with Dr. @Dr. First Last. If on immunosuppression, would stop immunosuppression. HIDAC q12 hours x 5-6 days reinduction is a regimen that can be used for relapsed AML. There is some data in adding venetoclax to chemo induction and should be considered.If starting venetoclax single agent to add...
How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?
Most of the literature (although not prospective) supports treating with an R-CHOP/EPOCH vs. traditional ABVD. As such, I tend to treat with R-DA-EPOCH. When I have had the unfortunate case of a relapsed/refractory patient, I have tended to treat with some of the newer HL salvage regimens.