Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Based on recent data would you consider adding ATRA to low dose rituximab for steroid refractory ITP?
This is hard to answer in the absence of much more information about the patient. In a steroid refractory patient, it is important to understand why. This puts the patient immediately into a meeting refractory group (not responding to steroids). If there is an immediate need, IVIG is better. If the ...
Would you offer consolidation RT to a young woman with bulky mediastinal DLBCL who achieved early and persistent CR to RCHOP on PET?
Dr. @Dr. First Last has modestly omitted one salient trial in his answer, namely the Duke trial which he led evaluating low dose consolidation RT (20 Gy) following CR to induction chemotherapy, i.e. PET negative response (Kelsey et al., PMID 30858144). To recapitulate briefly, 62 patients with stage...
For patients receiving outpatient venetoclax/azacitidine who develop profound neutropenia with ANC <200, do you admit for monitoring during the nadir in the absence of fever?
I don't think I would admit these patients. My recommendation would be to monitor temperature daily or feel febrile and let the clinic know if they have any symptoms of localizing infection. The NCCN and IDSA guidelines talk that only neutropenic patients with fever, even amongst those who have the ...
Would you consider CAR-T therapy without autologous transplant in a patient with multiple myeloma whose best response to induction therapy is a partial response?
Excellent question that will be even more pressing in ~2024 (maybe earlier!) as we get more data and possibly more FDA/insurance approvals here. For now, the only way to get second-line CAR-T for inadequate response to frontline induction is on a clinical trial - and several such single-arm trials a...