Liver and Pancreas Tumors   

Questions discussed in this category



Post-operative surgical course was complicated by anastomotic leak, septic shock, candidemia, wound infections, PE & DVT. Now recovering well.

Would you treat as cholangiocarcinoma with a gemcitabine/platinum regimen or would you use a more HCC regimen like atezo/bev or durva/trem?

The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, wha...

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice? ...

When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently?  Options for systemic therapy in NCC...

Would portal hypertensive gastropathy or colopathy sway you away from using it?

And is there any role in utilizing FGFR2 inhibitors in first line setting? The PROOF trial utilizing Infigratinib in first line was stopped after the...

Do you continue atezo alone if responding or switch to an alternative therapy such as dual IO or TKI? What about if the patient were experiencing subt...

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

Should Y90 be offered before or after TACE (based on the Northwestern phase 2 study) or sorafenib (based on the SARAH trial)? 

Would you offer single agent immunotherapy or chemo-immunotherapy with gem/cis durva/pembro?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

I can't convince the surgeons to refer their patients for adjuvant RT because the prospective data is messy and doesn’t seem to indicate a benef...

Please specify how your institution is allocating resources now or will be soon.

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

Is data sufficient to adopt this as the new standard of care? Can you comment on the reported regional and race-based variations in outcomes?  ...

The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....

Would the etiology of HCC affect your decision, e.g. non-viral hepatitis since less benefit was shown for this group in IMbrave150?

Would you offer liver transplant in the setting of metastatic disease? 

Colloid is a rare histologic subtype and considered to have more favorable outcomes compared with usual ductal adenocarcinoma, but no dedicated prospe...

Has the recent approval of atezolizumab/bevacizumab impacted your decision making? 

Would you recommend radiation, systemic therapy alone, or chemoRT? What about if this recurrence occurred during or shortly after completion of adjuva...

If so, do you avoid pegfilgrastim given that <12 days will lapse between its administration and the next cycle?

Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?

What parameters do you use to decide to treat beyond progression? Is there any efficacy data from this specific study subgroup in IMbrave150?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?

Patients oftentimes have cardiac co-morbidities with requirement for anti-coagulation making TKIs, including Bevacizumab, difficult to dose. Would the...

Would you consider single agent IO such as Nivolumab, given data are not strong (Checkmate 459)?

Upfront surgery vs neoadjuvant therapy? And if neoadjuvant therapy, which regimen? Patient has a good PS.

Quite often we encounter cholestatic hyperbilirubinemia, wherein GI and IR do not believe ERCP with stents or PTC will alleviate jaundice. If the pati...

With extensive use of NGS testing, it is commonplace to identify mutations that have no validated therapeutic intervention, but strong biologic signal...

In your experience, what approach has been successful to bridge to surgery?

Up to six cycles of treatment were given in the ABC02 trial.  Do you offer other treatments if you don't continue gem/cis beyond 24 weeks?

If so, for what platelet count threshold and do you have a preference as to which agent?

Given the variable and sometimes indolent disease course of these patients, as well as the absence of a clear overall survival benefit in the PROMID&n...

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

If you do employ this strategy, are there a number of liver lesions (eg <4) or duration of response that guide your decision making?

Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?

A number of phase 2 trials support various combinations (e.g. gem/ox, cape/cis, cape/ox, 5-FU based) -- how do you decide either between these regimen...

Would you consider adding trastuzumab to cis/gem in the first line? If not, would you consider adding Her2 directed therapy to FOLFIRI or FOLFOX in th...

Do you continue with FOLFIRI for a period and then switch to olaparib (and if so, when do you make that switch) or do you switch directly after FOLFIR...

Patient characteristics would unarguably be a deciding factor, but outside of these how would you approach the situation?

Do you have any preferred dose fractionation schedules? What kind of margins do you use?

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

What features would make you more likely to recommend radiation therapy with chemotherapy?

The GTX (gemcitabine, docetaxel, capecitabine) regimen is listed as a category 2B recommendation in the NCCN guidelines- when would this be ...

Regorafenib has been approved for patients with advanced HCC post-sorafenib, but the benefits are slight and toxicity substantial.  Nivolumab has...

Have you ever seen toxicity related to diaphragm dose with conventional fractionation?  

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

When planning SBRT cases for primary liver cancers, it is very difficult to see the tumor on the non-contrast 4D scan. How do you use information from...

For cases with positive margins, do you boost to 54 Gy? If so, do you boost the entire tumor bed or only the area of the positive margin? 

I recently had a patient with unresectable disease ask for a PET before starting RT but I’m not sure there is a benefit. 


Papers discussed in this category


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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20

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JAMA, 2008-03-05

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American journal of clinical oncology, 2011-02

International journal of radiation oncology, biology, physics, 2013-12-01

JAMA, 2007 Jan 17

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-03-01

Hepatology (Baltimore, Md.), 2015-06

J. Hepatol., 2016-05-01

Eur. J. Cancer, 2011-09-01

Lancet Oncol., 2015-10-01

Lancet Oncol., 2017 Oct 26

Cancer medicine, 2022 Aug 09

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-11-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-08-20

Lancet Oncol., 2019 Mar 25

N. Engl. J. Med.,

Lancet,

NEJM Evidence, 2022 Jun 1

Practical radiation oncology, 2015

Radiother Oncol, 2014 Jun

J Clin Oncol, 2013 May 1

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-02-10

Practical radiation oncology, 2015

Journal of the National Cancer Institute, 2017-09-01

N. Engl. J. Med.,

JAMA Oncol, 2021 Jan 21

Oncol Lett, 2019 Sep 10

BMC Palliat Care, 2015 Aug 04

Lancet, 2017-03-11

JAMA, 2013 Oct 9

Lancet (London, England), 2018-03-24

J. Clin. Oncol., 2020 Feb 27

Annals of surgery, 2019-04-05

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Sci Rep, 2018 Jun 06

J. Hepatol., 2017 Jan 23

The Journal of pathology, 2019-06

N. Engl. J. Med., 2019 Jun 02

Cancer,

J. Clin. Oncol., 2013 Aug 26

Cancer, 2011-09-01

International journal of radiation oncology, biology, physics, 2015-07-01

Cancer treatment reviews, 2017-02

Strahlenther Onkol, 2019 Feb 08

Radiother Oncol, 2018 Jul 09

Oncologist, 2019 Aug 07

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J Immunother, 2010 Oct

J. Natl. Cancer Inst., 2017 Jan 28

JAMA Oncol,

JAMA Oncol, 2019 Oct 03

J. Hepatol., 2019 Apr 06

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Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-04-01

J Hepatol, 2021 Nov 19

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Gastroenterology, 2018 May 17

Clin. Gastroenterol. Hepatol., 2018 Nov 28

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JAMA oncology, 2019-06-01

Lancet Gastroenterol Hepatol, 2017 Jun 23

Clin. Cancer Res., 2015 Oct 23

Invest New Drugs, 2015 Apr 12

J Hepatol, 2021 May 26

NEJM Evidence, 2022 June 6

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-04-10

Cancer, 2019-09-15

Int J Cancer, 2018 Apr 15

JAMA Oncol, 2019 Oct 31

Eur J Surg Oncol, 2014 Oct 07

Sci Rep, 2016 May 20

JAMA Netw Open, 2020 Feb 05

Clinical cancer research : an official journal of the American Association for Cancer Research, 2007-06-15

Seminars in oncology, 2003-08

Annals of oncology : official journal of the European Society for Medical Oncology, 2003-07

Crit Rev Oncol Hematol, 2017 Mar 29

J. Clin. Oncol., 2020 Jan 24

Lancet Oncol., 2020 Mar 02

Lancet (London, England), 2017-06-24

The Lancet. Oncology, 2018-07

J. Clin. Oncol., 2019 Dec 02

JAMA Oncol, 2020 Dec 10

International journal of radiation oncology, biology, physics, 2016-03-15

Cancer medicine, 2019-05

American journal of clinical oncology, 2019-03

Proceedings of the National Academy of Sciences of the United States of America, 2015-11-03

Oncologist, 2020 Mar 10

Semin Diagn Pathol, 2016 Dec 23

British journal of cancer, 2005-03-14

Case Rep Oncol, 2020 Jan 21

J. Clin. Oncol., 2018 Dec 04

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 2011-08

Am. J. Surg., 2013 Jul 01

J Surg Oncol, 2015 Oct 13

Nature, 2013 Aug 14

Lancet Oncol, 2020 Mar 20

Liver Cancer, 2019 Sep 18

Eur J Intern Med, 2008 Jun 10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2000-07

Gastroenterology clinics of North America, 2018-06

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Oncotarget,

Blood, 2020 Sep 10

Blood Adv,

The New England journal of medicine, 2018-07-05

J Gastroenterol, 2019 Nov 12

Am Heart J, 2010 Sep 18

N Engl J Med,

Lancet (London, England), 2017-01-07

The Lancet. Oncology, 2019-02

Hepatology, 2019 Oct 14

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-01-20

British journal of cancer, 2016-03-29

Pancreatology, 2020 Oct 18

Lancet (London, England), 2016-02-06

European journal of cancer (Oxford, England : 1990), 2019-02

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-06-20

European journal of cancer (Oxford, England : 1990), 2018-01

Lancet,

JAMA oncology, 2018-12-01

Cancer discovery, 2017-03

Hepatology (Baltimore, Md.), 2018-08

Radiology, 2018-06

Hepatology, 2021 Mar 19

Human pathology, 2016-03

Journal of gastrointestinal cancer, 2015-06

Cancers (Basel), 2019 Jul 31

The Lancet. Oncology, 2013-04

Ann Surg,

Int J Radiat Oncol Biol Phys, 2021 Aug 01

J Clin Oncol, 2022 Jan 27

Transpl Int, 2010 May 20

Eur J Surg Oncol,

World J Surg, 2019 Apr

J Surg Oncol, 2020 Sep 24

World J Gastrointest Surg, 2019 Jun 27

Annals of oncology : official journal of the European Society for Medical Oncology, 2024 Feb 19

The New England journal of medicine, 2013-10-31

ESMO Open, 2021 Nov 24

Clin Cancer Res, 2017 Dec 29

J Clin Oncol, 2022 Mar 22

J Clin Oncol, 2021 Dec 20

J Natl Compr Canc Netw,

J Immunother Cancer, 2021 Jun

Ann Oncol, 2022 Oct 18

Cancer, 2019-01-01

HPB : the official journal of the International Hepato Pancreato Biliary Association, 2017-07

JAMA Oncol, 2021 Dec 01

Lancet, 2021 Jun 05

Eur J Cancer, 2018 Aug 24

Journal of the National Cancer Institute, 2016-06

Pediatrics, 2014 Feb 02

N. Engl. J. Med.,

The Journal of urology, 2018-12

Lancet Oncol., 2014 Feb 18

Br J Cancer, 2014 Apr 15

Cancer, 2011-06-15

Eur J Cancer, 2017 Nov 28

N. Engl. J. Med., 2019 Sep 28

Lancet Oncol, 2021 Jan 18

J Clin Oncol, 2021 Apr 19

J Clin Oncol, 2003 Jul 01

N Engl J Med, 2023 Jun 04

Lancet Oncol, 2021 May 04

Lancet Oncol, 2023 Jun 02

Cancer, 2005-01-01

Cancer chemotherapy and pharmacology, 2011-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010 Sep 20

British journal of cancer, 2008 Sep 16

Cancer chemotherapy and pharmacology, 2009 Jan 14

Cancer, 2007 Sep 15

Annals of oncology : official journal of the European Society for Medical Oncology, 2013 Aug 23

NEJM evidence, 2022 Jun 06

Int J Radiat Oncol Biol Phys, 2019 Oct 1

Frontiers in oncology, 2020 Mar 24

International journal of radiation oncology, biology, physics, 2023 Apr 08

Cancer, 2023 Jul 28

Gastrointestinal endoscopy, 2012-01

Gastrointestinal endoscopy, 2012 Feb

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-03-10

N Engl J Med,

Nat Med, 2020 Apr 06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023 Jan 09

JAMA oncology, 2021 Jun 01

Journal of gastrointestinal oncology, 2020 Aug

American journal of clinical oncology, 2023 Dec 22

The oncologist, 2015 Jan 07

PloS one, 2023 Aug 10

Cancer, 2023 Jul 06

The Lancet. Oncology, 2023 Dec 08

Cardiovascular and interventional radiology, 2023 Jul 10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-01-20

Pract Radiat Oncol, 2021 Oct 21

Lancet (London, England), 2023 Apr 16

NEJM evidence, 2022 Jun 01

American journal of clinical oncology, 2023 Apr 10