NCI-CCC Tumor Board Question&nbsp;&nbsp;&nbsp;

In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?

If CCRT is pursued, would you move forward with durvalumab consolidation? Assume the patient with ECOG PS 0 and no co-morbidities. How might this chan...

Is post-mastectomy chest wall radiotherapy indicated for DCIS with very close (<1 mm) or positive margins?

In which scenarios do you stage breast cancer using CT and nuclear bone scans versus PET-CT?

Would you offer definitive local therapy to a patient with ER/PR+, Her2 neg breast cancer with oligometastatic disease that responded well to CDK 4/6 inhibitor +AI, despite NRG-BR002 results?

Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...

How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?

Patients are understandably concerned about the risks and benefits of radiation to an oozing, bleeding, and ulcerated breast.

Do you ever consider local therapy to oligometastatic hormone-receptor positive breast cancer?

6 Answers available

Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?

If so, when and to what extent?

What systemic therapy do you recommend for prostate cancer pelvic nodal recurrence on PSMA PET-CT after prostatectomy and salvage radiation?

If ADT +/- ARPI + RT, what duration of systemic therapy do you recommend?

In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?

What is your approach to young healthy women with locally advanced breast cancer and biopsy-proven low cervical lymph nodes?

Would you treat this as a locally advanced breast cancer and offer surgery, radiation, and systemic therapy? Does your management change depending on ...

How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?

NGS without any actionable mutations and PD-L1 TPS 15%. Would you offer chemotherapy, radiation, or immunotherapy and, if so, in what order?

What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?

How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?

Do you routinely offer post-operative adjuvant radiation in addition to chemotherapy? Are the results of the recently published negative phase II...

10 Answers available

How does urinary obstruction impact your choice of therapy for metastatic or locally advanced prostate cancer?

When would you use PSMA PET over conventional imaging for prostate cancer?

Would you use it for initial staging or at time of biochemical recurrence?

For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?

CNS recurrence occurred within two years of prior neoadjuvant therapy

Would you recommend surgery or radiation for newly diagnosed localized prostate cancer diagnosed on a urethral lesion biopsy?

GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease. Prostate MRI pending.

For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?

Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.

5 Answers available

When do you add an adjuvant bone-modifying agent in patients with history of localized breast cancer?

Is there any role for denosumab? How do you counsel patients regarding the benefit of bisphosphonates on breast cancer outcomes?

What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?

Does patient age effect your approach? Would you consider RPLND for any patients in light of the phase II SEMS trial presented at the 2021 ASCO GU Ca...

Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?

How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?

History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis. Vaginal tumor completely resp...

Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?

Gleason 4+3=7 and PSA 4

When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?

What clinicopathological features would need to be present for you to recommend adjuvant chemotherapy? Would you treat pT3 disease? Any specific histo...

For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?

Specifically, would you offer salvage radiation to a patient who underwent a prostatectomy with PLND and had a post-op PSA of 12 with pathology reveal...

What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?

Specifically, for cT2N0M0 small cell bladder cancer without response to neoadjuvant cisplatin and etoposide on imaging, would you proceed with cystect...

How would you manage a clinically inoperable, stage IIIB, MMR deficient uterine cancer?

Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement. ER/PR and HER2 testing are pending.

How would you manage a patient with localized prostate cancer treated with radical prostatectomy and found to have a single involved pelvic lymph node on final pathology and a detectable postoperative PSA?

When do you offer adjuvant radiation in addition to chemotherapy for patients with high risk localized gastric adenocarcinoma who did not receive pre-operative therapy?

The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease. Both ARTIST and Inte...

In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?

Would you recommend PMRT for a patient with a right breast mastectomy with closest margin less than 0.1cm?

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

How should our selection for neoadjuvant chemotherapy for breast cancer change in light of COVID-19?

Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?

Is there evidence to support the use of definitive CRT in patients with NSCLC in separate ipsilateral lobes and mediastinal lymph node involvement?

Most trials establishing CRT as standard of care for IIIB NSCLC excluded patients with separate ipsilateral lung nodules given that they were categori...

Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?

In clinical practice, consolidation chemotherapy is sometimes used, though this was not implemented in the PACIFIC trial.Antonia et al., PMID 28885881...

Would you extrapolate data from PACIFIC trial for unresectable disease to consider consolidation therapy with durvalumab for Stage III NSCLC with single-station N2 disease amenable to lobectomy?

When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?

How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?

No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.

How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?

Do your recommendations differ if patients are pre or postmenopausal given the data?

How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?

What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?

Pt clinically has inflammatory breast cancer making mastectomy a poor option.

How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?

When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?

Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?

These patients have been largely excluded from these trials. What if the infection is well controlled?

Do you intentionally modify your breast cancer treatment plans for those on chronic immunosuppression to avoid secondary cancers?

This is in regards to the risk of secondary cancers after radiation therapy or cytotoxic chemotherapy (such as anthracyclines) in an immunosuppre...

Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?

How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?

What is the best management for a local recurrence for a stage I NSCLC treated previously with SBRT?

Should fractionated EBRT be administered or can repeat SBRT be used?