Liver and Pancreas Tumors   

Questions discussed in this category


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...

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?

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.

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?

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?

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?

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?

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

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Lancet,

NEJM Evidence, 2022 Jun 1

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JAMA Oncol, 2021 Jan 21

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Sci Rep, 2018 Jun 06

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

JAMA oncology, 2018-12-01

Cancer discovery, 2017-03

Hepatology (Baltimore, Md.), 2018-08

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Cancer, 2019-01-01

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

JAMA Oncol, 2021 Dec 01

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Eur J Cancer, 2018 Aug 24

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The Journal of urology, 2018-12

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Eur J Cancer, 2017 Nov 28

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J Clin Oncol, 2021 Apr 19

J Clin Oncol, 2003 Jul 01

N Engl J Med, 2023 Jun 04

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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

N Engl J Med,

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

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Lancet (London, England), 2023 Apr 16

NEJM evidence, 2022 Jun 01