Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How would you manage T3N0M0 sarcomatoid carcinoma of the prostate with adenosquamous differentiation s/p prostatectomy?
Sarcomatoid prostate cancer is an aggressive histological subtype. It may be locally aggressive, and post-operative PSA monitoring may be less helpful for this histologic subtype, which interferes with the usual trigger for initiation of salvage RT (Grignon, PMID 14976541). Despite the lack of high-...
Do you still recommend consolidative allogeneic stem cell transplants for patients with Richter transformation in CR after frontline treatment in the modern era of therapies?
The optimal treatment of diffuse large B-cell lymphoma (DLBCL) emerging in the context of underlying chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) (e.g. Richter’s syndrome) is an area of ongoing debate. For initial treatment, I typically administer standard DLBCL chemoimmunothe...
What is your approach to treatment of mantle cell lymphoma in someone with a mutated gene downstream of the BTK receptor, such as mutated CARD11?
For those with primary refractory MCL after a cBTKi, I would still not proceed with chemotherapy, given the limited data to support benefit after a patient progresses on a cBTKi. Only data thus far is with a bendamustine/cytarabine-based regimen, which, if/when they relapse, would potentially impact...
What is your approach to treatment of mantle cell lymphoma in someone with a mutated gene downstream of the BTK receptor, such as mutated CARD11?
For those with primary refractory MCL after a cBTKi, I would still not proceed with chemotherapy, given the limited data to support benefit after a patient progresses on a cBTKi. Only data thus far is with a bendamustine/cytarabine-based regimen, which, if/when they relapse, would potentially impact...
Do you utilize ctDNA-based MRD testing after frontline chemotherapy for DLBCL?
I do not, as part of the standard of care, in part because of limitations of the ClonoSeq assay in this setting, and in part because of a lack of clarity around how best to manage a positive. However, there are a number of sophisticated clinical trials exploring this question prospectively, with a f...
Do you utilize ctDNA-based MRD testing after frontline chemotherapy for DLBCL?
I do not, as part of the standard of care, in part because of limitations of the ClonoSeq assay in this setting, and in part because of a lack of clarity around how best to manage a positive. However, there are a number of sophisticated clinical trials exploring this question prospectively, with a f...
What are your top takeaways in Breast Cancer from ASCO 2025?
My Top 3 takeaways in Breast Cancer from ASCO 2025 ASCENT-04: Sacituzumab Govitecan Plus Pembrolizumab as a New First-Line Standard for Metastatic PD-L1-Positive Triple Negative Breast Cancer (TNBC): The treatment landscape for metastatic TNBC continues to evolve rapidly. At ASCO 2025, presentation ...
In light of the NSABP B-51 data presented at SABCS, will you defer RNI in all patients with negative nodes after chemotherapy?
Results of the NSABP B-51 trial were presented at the 2023 San Antonio Breast Cancer Symposium (Mamounas et al., abstract GS-02-07). This trial was designed to test the value of postoperative radiation therapy in patients who presented with clinical T1-3N1 tumors with biopsy-proven axillary node inv...