NCI-CCC Tumor Board Question   

Is there anything to differentiate the two agents? CNS penetration reportedly with adagrasib, FDA accelerated approval has been given with sotorasib.&...

If so, when and to what extent? 

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...

Based on subgroup analysis, do you have a preference for cisplatin over carboplatin? 

Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients that have been...

Does your management change if symptomatic or asymptomatic?

In light of CheckMate 816 and IMpower010 and FDA approval for neoadjuvant chemo-nivolumab and adjuvant chemo-atezolizumab, how do you decide which sys...

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

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

Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation. 

Does the 2020 approval of Nivolumab and Ipilimumab for mNSCLC with PDL1 >1% impact your decision?

Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear. 

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?

Pathology is not carcinoid or small cell.

Chemoradiation completed 1.5 years prior

SRS done to the single brain met, PD-L1 5%,  BRAF G469A mutation

The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...

Is there an advantage to early diagnosis and intervention versus observation until the nodules are amenable to percutaneous biopsy?

Would you treated with local therapies (RFA or SRS) and continue pembrolizumab or would you move to second line treatment?

What are the risks of infection with COVID-19 if using immunotherapy?  

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

If so, how long is too long to wait?

Do you ever consider stopping if stable disease and good tolerance?

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

How, if any, do you utilize genomic testing to guide systemic therapy?

Especially if you don't have trials available at the moment. Would you try off-label erdafitinib (given recent data on bladder cancer) or 2nd line ge...

PET-CT and Brain MRI are negative for other evidence of disease.

Would nivo + Ipi be appropriate in this situation, especially if high TMB?

In the absence of a frontline clinical trial, would you treat with carboplatin+pemetrexed+pembrolizumab or consider IMPOWER 150 or other?

In a patient with lung cancer with both NSCLC and SCLC components, would you offer carbo/pem/pembro or carbo/etoposide/atezolizumab? Or any other alte...

The NCCN guidelines regard  MET exon 14 skip mutation   as an emerging biomarker but no formal recommendation to start crizotinib. If high P...

Is there any advantage of one regimen over the others?

Given the potential high risk of developing pneumonitis with TKI post checkpoint inhibitor, do you avoid TKIs and try a different regimen (ex carbo/pa...

If so, what is your approach to sequencing and timing of targeted therapy and local therapy?

If so do you favor repeat tumor biopsy or cfDNA?

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

http://abstracts.asco.org/239/AbstView_239_262655.html

If so, would you combine them vs monotherapy? Patient ECOG is 1

Retrospective data suggest clinically significant disease flare after tyrosine kinase inhibitor discontinuation in patients with EGFR-mutant lung canc...

If it is still within the 12 month period and no disease recurrence?

Would you give adjuvant chemotherapy or start osimertinib?

Some retrospective data reports that STK11 (AKA LKB1) makes NSCLC resistant to immunotherapy. 

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

What if the patient has thymoma-associated myasthenia gravis?

Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?

All tumors in this case were <2cm in size.

There is no evidence of disease outside the lung on PET, and the patient is completely asymptomatic with negative EGFR, ALK, ROS1, and BRAF and a PD-L...

PD-L1 < 50% and no targetable mutations. Would you use carbo/pemetrexed/pembrolizumab or Nivolumab or pembrolizumab?

Lung primary is inaccessible for biopsy and metastatic sites are only 2 small bone lesions. In a non-smoker, a driver mutation is suspected but would ...

Would you offer adjuvant therapy post resection?

Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...

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

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

Would you offer adjuvant TKI following ADAURA data?  Or proceed with durvalumab based on PACIFIC data?

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