Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Has the data for the ENRICH study changed your practice for the initial treatment of mantle-cell lymphoma?
While the information presented was intriguing, it has not yet caused any change in my approach to initial therapy for MCL. I say this due to the fact that the IR arm did not seem better than BR, save for those with a P53 mutation. I have routinely avoided CIT in this patient population, so this inf...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
Has the data for the ENRICH study changed your practice for the initial treatment of mantle-cell lymphoma?
While the information presented was intriguing, it has not yet caused any change in my approach to initial therapy for MCL. I say this due to the fact that the IR arm did not seem better than BR, save for those with a P53 mutation. I have routinely avoided CIT in this patient population, so this inf...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
What is your preferred strategy for young adults with ITP complicated by recurrent autoimmune neutropenia?
This is a great question, and I'll say that AIN can be particularly difficult to treat! I'd first ask how low the ANC is and if the patient is presenting with frequent infections/hospitalizations. If not, there may not be a need to treat the AIN (we may just be treating ourselves); oftentimes, there...
In ES-SCLC presenting with extensive brain metastases, how do you time whole brain radiation after the first cycle of chemotherapy has already been delivered?
We typically try to wait as long as possible before we start WBRT. It depends on the burden and symptomatology of intracranial disease as well as the initial response to chemo-immunotherapy. If the brain metastases are asymptomatic and deemed OK to monitor closely (i.e., not likely to cause neurolog...
How will you weigh the positive PFS but negative OS benefit when discussing Dato-DXd with patients?
I think it will be increasingly difficult to prove OS in an environment where patients should have access to highly active ADCs at progression. Positive PFS is meaningful for our patients when associated with a well-tolerated regimen that has a favorable dosing schedule and quality of life metrics.
When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?
I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT,...
What are your practical considerations for incorporating bispecific antibody therapy into treatment of relapsed DLBCL?
In relapsed/refractory DLBCL, if the patient has not yet received bispecific antibody (BsAb) and/or CAR T-cells, and the patient is eligible and able to receive CAR T-cells, I favor CAR T-cells before BsAb, given extensive follow-up time demonstrating CAR T-cells are a potentially curative approach ...