Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
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...