Medical Oncology
Questions discussed in this category
Were you using gem/cis or ddMVAC more routinely prior to NIAGRA?
Would you consider omitting radiation in a elderly woman with ER-positive early stage breast cancer who was placed on 4 months of letrozole prior to l...
When now would you consider regimens such as BV-AVD or BrECADD in advanced stage HL?
Patient has a second relapse post alloHCT for high risk APML
Prior guidance was mostly derived in the era of len maintenance +/- adding a PI for high-risk patients. Do you avoid live vaccines?
Would portal hypertensive gastropathy or colopathy sway you away from using it?
Do you offer observation for POLE mutated tumors?
Do you choose Lorlatinib or brigatinib? Or do you try to add chemotherapy to alectinib?
Will you now uniformly start with nivo/ipi > chemotherapy? If so, would you ever reintroduce another checkpoint monotherapy down the line? Or do yo...
How do you approach patients with substance use disorders who require chemotherapy for their cancer?
Are there differences in management for those with stimulant use (e.g., methamphetamine, cocaine)?
What other pathologic features may you use to guide therapy decisions (e.g., mitoses/grade or NGS)? If you decide on adjuvant therapy, what regimen do...
Would you consider neoadjuvant treatment?
As the cost of NGS decreases over time, is there still a need for more focused/targeted panels such as JAK2, CALR, and MPL? Are other genes important ...
Given interim analysis of PEACE V-STORM; also institutional data from SHARP consortium of using 25 Gy/5 fx for pelvic lymphatics. Can we extrapolate?
MSI stable, NGS without targetable mutation. Would you do FOLFIRI or FOLFIRINOX followed by radiation to the lymph node? Would surgery be an opt...
In the setting of CM-8HW and BREAKWATER results, how do you prioritize?
As opposed to Atezolizumab/Bevacizumab or Durvalumab/Tremelimumab.
What timing, what tests?
RTOG 0848 presented at ASCO 2024 in abstract form: Abrams et al., Journal of Clinical Oncology 2024
What pathologic factors if any would you use to m...
If not, would you lean towards adjuvant capecitabine?
Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is there a...
Latest PET-CT shows no evidence of distant metastasis
If the majority of lesions are PSMA positive lesions, do you proceed with Lutetium, and if so, how do you treat or consider therapy to the PSMA negati...
Would you omit treatment for stage IIIA melanoma with negative ctDNA, or add treatment for stage IIA with positive ctDNA?
Oral contrast adds time (2 hours before scan) for both the patient and the facility. Some institutions feel indicated for all outpatients, while other...
So, the injection would be during 5FU infusion?
Does your approach depend on the patient’s response or PD-L1 level? Are there any studies supporting immunotherapy’s use beyond 2 years?
Would you consider using endocrine therapy, pembrolizumab, capecitabine, or CDK 4/6 inhibitor?
Do you routinely use PET/CT during treatment, such as after cycle 2, to evaluate for response? How would nivolumab treatment affect PET/CT interpretat...
If a patient develops central serous retinopathy on a MEK inhibitor despite dose reductions, is it ok to switch to a different BRAF/MEK combination?
Would you consider adding docetaxel to ADT and novel hormonal agents?
If ADT acts as a systemic treatment, we would have expected to see a benefit with an RP just like with radiation. Yet, this is not the case. What are ...
There is conflicting data on whether the "surprise question" performs adequately enough. Do you use this or other screening tools alone, or in c...
Is there a subset of patients you would avoid neoadjuvant CRT and operate first?
Do you need to have the non-contrast study when ordering the CT C/A/P with contrast, and what does the non-contrasted show that requires it in additio...
The primary nivo/ipi arm was q3 wks x4c, whereas the post-chemo crossover arm used q6 wks until progression. Is one schedule clearly more effective or...
Is there any data comparing Nivo/Ipi Vs Pembro or Dostarlimab? Can this be extrapolated from the CM-8HW Nivo/Ipi vs Nivo arm?
I had two prostate cancer patients recently take ivermectin against medical advice. Both of them had their PSA drop by 2-3 ng/ml. Are you seeing this ...
If a patient has clinical or biochemical progression while on either of these radiopharmaceuticals, would you stop the treatment or continue?
Progressive disease involving thorax and abdomen.
What is the harm of waiting for another recurrence after a second GTR to delay the toxicity of radiation and chemotherapy? The patient is a woman <...
Assume the patient is young and active.
The controlled trial below demonstrated improvement in dysphagia among Parkinson's patients. Might this have greater potential for benefit than modifi...
Do you use chemoRT-->cape, gem/cis or gem/cis/durva? And do you include just perihilar or also small Intrahepatic Cholangiocarcinomas as well...
Would you offer definitive radiation/chemoradiation if he is refusing cystectomy?
Is there a role for radiation in this case?
Is there data on neoadjuvant chemo-RT or chemo in this setting?
More specifically, the patient had a single, positive, 3 cm inguinal LN (no ECE, negative margins) removed at the time of APR. If offering RT, would y...
Is your management still guided primarily by risk stratification, or does the triple-negative status impact your decision-making about aspirin or cyto...
Would you consider holding, deferring, or skipping treatment?
For hepatitis, how would determine if toxicity was immunotherapy vs chemotherapy relate...
This is rare but I've seen it twice last year! One with melanoma on nivolumab and one with lung cancer on pembrolizumab (both cases in deep remission)...
If so, will you recommend it universally or only for certain patient population(s)?
RADICALS-HD trial (ESMO 2022) demonstrated metastasis free survival benefit with 24 months compared to 6 months of ADT.
For instance, how would you manage a patient with both EGFR L858R and EGFR A647T mutations? Additionally, does the presence of brain metastasis influe...
What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?
Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...
How do prior chemotherapy, site of disease, and pathological staging inform your decision?
How about molecular markers (PD-L1, ctDNA)?
The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...
For example, if a patient with intermediate risk prostate cancer has a high risk Decipher score (10 year risk of metastasis with standard therapy of &...
Given the improvement in liver function, what factors should be considered before reinitiating immunotherapy?"
Would you offer additional adjuvant treatment (e.g., pelvic EBRT, vaginal brachytherapy, etc.)?
Is there a subgroup of patients who benefited significantly from a specific protocol?
Are there data from trial patients who recurred, especially regarding what treatments they received?
According to NCCN guidelines, extraskeletal osteosarcomas should be treated as soft tissue sarcomas, which further expands the list of treatment optio...
How do you sequence chemotherapy and radiation?
AL amyloid biopsy proven on renal biopsy. Normal SPEP and FLC, bone marrow biopsy with 10-15% plasma cells.
E.g. would it prompt you to offer adjuvant RT in Masaoka IIA? Does the histology have a different prognosis?
Are there other settings where MRI is used for nerve assessment and radiation planning such as for certain definitive RT cases?
Given the POLARIX study data presented at ASH 2021 and subsequent longer term follow up, will this replace R-CHOP as the standard of care therapy in y...
And, for additional information, what are the differences in 5 year survival and disease specific survival for stage I NSCLC between lobectomy vs SBRT...
Would you recommend oncologic resection? Would you do neoadjuvant chemo and/or radiation (concurrent or sequential)? Pre-op radiation volumes would be...
The CROWN, ALTA, and ALEX trials showed improved efficacy with lorlatinib/brigatinib/alectinib vs crizotinib. How do you choose your first line therap...
Are there atypical ALK fusion partners that indicate sensitivity to ALK inhibitors?
Are there any protocols in place? Aside from telling patients to use ice packs or bags or immerse hands/feet in ice water baths from 15" before to 15"...
There are some data indicating the 240 mg daily dose may offer similar (though not statistically equivalent) oncologic outcomes with reduced symptoms ...
Would you give pembrolizumab with chemotherapy or just chemotherapy? The patient had a history of mantle radiation several years ago.
Controlled extracranial disease on trastuzumab+pertuzumab for 2 years. Treatment options include switching systemic rx (T-Dxd, tucatinib) or WBRT. Not...
Would you offer a FOLFIRI based regimen or TDxd?
Is there a role for anticoagulation? Does it affect your surgical plans?
Patient presented with distant nodal disease and solitary liver metastasis and had normalization of CA19-9 from 22,827 at diagnosis, no evidence of di...
Do you consider supportive transfusions, and if so, have you been successful with keeping patients on hospice while receiving transfusions?
Do you us...
Would you consider omitting local therapy?
Cell counts are normal. Bone marrow shows grade 3 fibrosis. Spleen size continues to enlarge.
No history of thrombosis and without other high risk features. Not on phlebotomies.
Would you continue aspirin? Do you consider adding LMWH peripartu...
How do you distinguish whether toxicity is related to the immunotherapy vs the radiation vs both? Are you seeing higher rates of these due to the comb...
Would you continue with RT as planned?
What do you think is the role of radiation for this patient and how should it be timed?
The patient is a female in her 40s. No mucosal changes were evidenced on clinical exam. Chemo-RT is recommended by GynOnc at an academic center. ...
Please comment on toxicity profiles and the insufficient evidence regarding overall survival.
Extrapolating from the ADRIATIC trial.
While RET rearrangements certainly provide strong rationale for targeted therapy, is a point mutation such as this considered actionable? Mutation was...
Margin is less than 1 mm. Would the grade of the tumor affect your decision? Would any other factors go into your decision?
Would you treat similar to small cell carcinoma? What is the suggested chemotherapy regimen? Will you continue ADT?
If no, what would be the next line to use for this patient?
Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor?
When do you switch to an altern...
In light of the 4/2024 JCO publication by Peng et al., PMID 38215354
Would you treat with focal or CSI radiation?
Does your institution prefer use of temporary placement each cycle of a PICC line for 5 days outpatient or long-dwell IV? Do your patients require ser...
What is the current data regarding acquired resistance mutations for ALK?
Should third generation TKIs such as lorlatinib be reserved for late...
Excellent radiographic response to 2 cycles carbo/etoposide.
Have you treated such cases with systemic therapies? If so, which ones (e.g., cytotoxic chemotherapy, anti-CD20 monoclonal antibodies, or targeted age...
This situation can feel uncomfortable. Would this feel safer if the patient is s/p mastectomy and had TNBC?
Patient with iron deficiency anemia from heavy bleeding from advanced uterine cancer. No evidence of hemolysis by smear or CBC profile.
Could such an...
How does the absence of prior EGFR TKI treatment affect the decision to obtain a biopsy?
The approval for vorasidenib was granted for low-grade astrocytomas, but under certain conditions, it can also be recommended for, for example, anapla...
Would you still treat with neoadjuvant KEYNOTE-522?
Can concurrent chemotherapy be avoided in these patients?
Is there objective evidence demonstrating a benefit of consolidative durvalumab or prophylactic cranial irradiation in patients with stage I small cel...
This particular patient previously progressed on platinum and is currently on lurbinectedin for >18 months. She had CR on PET. Now presents with a ...
Previously progressed on platinum and Pembrolizumab
What is your preferred sequencing of available therapies for a patient who remains fit for several lines of treatment?
Given the data from both INTERLACE and KEYNOTE-A18, how would you design a clinical trial to best answer the question on optimal management of locally...
Are there scenarios where one would rely on dual agent immunotherapy alone? Or would one generally err on the side of utilizing some form of metastasi...
What is the optimal management of pain and loss of function due to pathologic compression fractures?
Assume no epidural/cord compromise. Is kypho/vertebroplasty, radiation therapy, or conservative management (brace, antiresorptive therapy) the superio...
If a patient with a positive node just above the common iliac bifurcation, and will be treated with chemoradiation --> pembrolizumab according to A...
Is there a target IgG level to aim for?
What should hematologists be aware of in monitoring these patients?
In particular, in the modern era of multi-parametric prostate MRI and PSMA-PET, certain findings such as EPE, SVI, or pelvic lymphadenopathy may be no...
Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?
Considering DB-12 study's exclusion of patients with leptomeningeal metastases, can T-DXd still be integrated into treatment plans for these patients?...
The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases).
She had disease progression on palbociclib and letrozole. She also has a PIK3CA mutation however, did not tolerate alpelisib due to Grade 3 hyperglyce...
Neither GLOW nor SPOTLIGHT showed a statistically significant improvement in PFS/OS for non-Asian subgroups. It is reasonable to suspect that any PFS/...
Anatomically, the primary tumor is in the duodenum but extends into the gastric pylorus. Would Zolbetuximab be reasonable to offer with FOLFOX, rather...
What factors do you consider in choosing between BV-CHP/BV-CHEP vs DA-EPOCH/CHOEP with or without mogamulizumab?
Do you routinely check EKGs or echocardiograms? Or do you decide only if the patient is at risk for QTc prolongation or other symptoms?
Does the precise location of duodenal cancer even matter given that treatment would be 5-FU/platinum-based? Also, with the knowledge of the impact of ...
Would the lack of treatment response concern you enough to offer adjuvant chemo-RT, despite PROSPECT only pursuing adjuvant chemo-RT in the FOLFOX wit...
If a stage I colon cancer had positive ctDNA after surgery, what treatment, if any, would you recommend and for how long?
Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...
Some patients have declined surgery knowing they achieved cCR. Would you observe or recommend chemoRT?
What is the preferred dose, fractionation, and role of concurrent chemo?
The primary tumor was resected previously.
With first line approvals in both FOLFOX/Nivo and FOLFOX/zolbetuximab, how are you sequencing treatment if both CPS/Claudin markers are adequate to tr...
Do you prefer upfront cisplatin/etoposide for 2 cycles, then 50 Gy with ENI, then resection, or induction chemo followed by definitive chemoradiation?...
Solid tumor patients, other hematologic malignancies, patients with autoimmune diseases on immunosuppressive therapy? Do you consider workup if they a...
Are there specific AR Pathway inhibitors that can be crushed and used through feeding tube or would you just avoid ARPIs in such patients?
What if there is continued thrombocytopenia despite reaching complete remission (with incomplete marrow recovery)?
Do you offer regular treatment breaks and if so, what is the interval/schedule you recommend?
Or is that an absolute contra-indication? What about a stroke 1-2 years prior?
Which patients specifically benefit from both mpMRI and PET-PSMA?
Previously untreated, stage IV GE junction adenocarcinoma with overexpression of HER2 (3+ via IHC) as well as Claudin 18.2. What is the best approach,...
Patient has bilateral common, internal, and external iliac and femoral DVT from obstruction by a large uterine mass that is likely malignant and is pl...
In this recently published phase 3 randomized controlled trial, neoadjuvant nab-paclitaxel/trastuzumab/pertuzumab x6 cycles appear to compare favorabl...
The patient has a recurrence of the disease despite tapering prednisone and cyclosporine. Bone marrow exams x2 without MDS. Testing for all other caus...
Given the results of RADICALS-HD and RADICALS-RT trials, it seems as though there was no benefit to adding ST-ADT to RT, but a DFMS benefit for LT-ADT...
Are the specific Exon 18 mutations that are more sensitive to TKI?
Is there a role for ctDNA?
Is there a minimum time of waiting that is necessary between the completion of cancer treatment and liver transplantation?
E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...
For either patients in general or for patients who will receive regimens with well-described toxicities such as irinotecan/UGT1A1.
If so, do you requ...
What would be the role of an EGFR TKI?
Efficacy and cardiovascular safety appear similar per the PATCH trial updated at ESMO 2024. How would you counsel patients who decline LHRH agonists?
If so, how often do you check?
Bone marrow biopsy showed absent stainable iron. JAK2+ PV can sometimes present with reactive thrombocytosis if very iron deficient. Do you restore ir...
The CARDINAL trial excluded patients with overt malignant disease.
D-TORCH compared topical diclofenac to placebo.
Is there any data on the efficacy of T-Dxd after progression on sacituzumab govitecan?
Does your approach differ by hormone receptor status now that ...
Triplet v. Quadruplet? What regimen?
How would this change for a patient with high risk cytogenetics?
What would be the indications and what considerations are there from the first course of treatment?
The patient is an elderly female with a good KPS who presented with a cT2N1 triple-negative breast cancer.
The patient refused chemotherapy and immun...
How would your recommendation change if the patient has H63 homozygous mutation?
Specifically, what dose and treatment volumes are recommended?
Other than for surgical downstaging or breast conservation.
Goodman et al., PMID 34077237
When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently?
Options for systemic therapy in NCC...
What is the quality of evidence behind these options?
For patients with ER-negative HER2-ultralow breast cancer, how and when would you incorporate T-DXd?
Given that ER-negative patients were not enrolled to the DB06 trial, can results be extrapolated to this population?
NCCN guidelines suggest systemic therapy only or concurrent chemoradiotherapy. What is your approach?
Meattini et al., PMID 39675376
Is there a role for immunotherapy, anti-angiogenesis, or TKIs? Can you use immune checkpoint inhibitors in combination with lenvatinib?
Or do you generally prefer warfarin/non-DOAC agents? Do you consider trialing DOACs and testing anti-Xa DOAC levels to assess for absorption?
(For instance, TCx4 instead of ddAC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemother...
If a patient presents with de novo oligometastatic (i.e., meeting STAMPEDE low met burden criteria) prostate cancer with no prior history of primary t...
Bauman et al., PMID 30959472
USPTF and CMS guidelines differ in age criteria, and NCCN guidelines do not have an upper age limit.
Normal cytogenetics/FISH and negative NGS.
Specifically, in the setting of patients that have had a PR or VGPR and are not actively progressing.
For example, per the IMROZ trial methodology, Isatuximab dosing does not change to monthly dosing until >18 cycles which can impact patient QoL and...
Or can we omit it in older patients given efficacy of these regimens? Is transplant-eligibility still an important distinction up front given options ...
What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?
Tumor is HER2 3+ on IHC staining.
How do you decide to trial a patient off treatment? When do you consider spacing therapy and at what frequency?
Are there any subgroups that would still benefit from RNI?
When do you consider bispecific antibodies?
What dose and fields of treatment would you recommend?
GETUG-AFU V05 VESPER TrialDid the ASCO 2023 overall survival data change your practice?
Hgb is 8 and platelets 10. A very small PNH clone (0.08%) detected. No evidence of hemolysis. No response to steroids. All other anemia/thrombocytopen...
Do you think it works better if incorporated as early as possible in the patient's course, or is it better to "save it" for future recurrences after u...
Specifically, headaches thought not to be related to increased ICP.
How do you decide between ureteral stent and percutaneous nephrostomy for decompression?
For some patients, it may be overburdensome to make an extra trip to an ophthalmologist every other cycle. They may live far away from an ophthalmolog...
Can you elaborate on reasons for a non-quantifiable SPEP and how does one follow the paraprotein?
Are there any circumstances where use of T-DXd would supercede the use of CDK4/6 inhibitors or other non-chemotherapeutic options (PIK3CA etc?)
Both ALK and MSI-high status were noted on a liquid biopsy since there was not enough tissue available for molecular testing.
Some reports suggest lo...
If they have been on IV heparin for 3 days, for example, would you subtract those days from the recommended loading dose time?
Would your considerations change for a man vs a woman?
One particular circumstance involved detecting a ROS1 fusion upon the metastatic recurrence. Is this pneumonitis risk seen with osimertinib alon...
The patient declined palliative measures only and is motivated to receive treatment
If you recommend or use induction chemotherapy, what is your preferred chemotherapy regimen?
What is the reasonable expected benefit to be gained, if any?
With low #s of patients on the durvalumab PACIFIC trial with EGFR mutated disease, and LAURA trial design of osimertinib until progression, should we ...
Are there specific scenarios where it could be considered?
Would your approach change based off of the PDL1 level?
How do you stage and evaluate premenopausal patients with >= cN1 ER+ PR+ HER2- breast cancer prior to surgery to avoid this pitfall?
If a patient is considered high risk for surgery, with another primary cancer (HCC) and has an incidental renal finding that is highly suspicious for ...
Guidelines do not provide strong guidance on who will benefit from temozolomide vs PCV or when to consider re-challenging with temozolomide.
Is there a role for increasing the dose if not yet maximum? (Hb ~8)
Can you explain when would you consider light chain amyloidosis work up with fat pad biopsy?
Data from Massard et al., PMID 20181575 used an abbreviated 3-day course of EP with completion of EP and bleomycin at day 15. Should this approac...
For example, if MRI revealed prostate-confined disease but PSMA had moderate avidity in the bilateral seminal vesicles, would you obtain further biops...
Do you avoid using these agents only in patients with history of medullary thyroid cancer or pancreatic cancer? Are there other cancer risks we should...
PUMP-2 trial combined FUDR via HAIP with gemcitabine and cisplatin, no immunotherapy was on the protocol.
Bone marrow biopsy does not meet criteria for MDS and no other identifiable cause of the cytopenias.
If so, what do you typically prescribe?
I have seen targeted therapies used (and studied) more often in the recurrent setting. However, there may also be some rationale for trying BRAF/MEK E...
If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...
Would you offer adjuvant Pembrolizumab combined with Capecitabine?
For what duration and is there a preferred anticoagulation agent?
How would you sequence these therapies given approval for both?
In non-FGFR mutated patients, would you use cisplatin/gemcitabine or sacituzimab govitecan at this point?
What would be the optimal choice of chemotherapeutic agents and duration?
Does the low ER+ or metaplastic histology affect your recommendations?
What about if the patient has mediastinal disease and ISRT is not an option?
For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cy...
For example: eyeball test, simplified frailty assessment (Facon et al.), IMWG frailty score, ECOG only?
Would you change your radiation therapy treatment dose or volume if you needed to treat a chloroma? If a patient had a separate cancer (e.g., skin can...
Two recent studies show the benefit of up-front abiraterone for metastatic castration-sensitive prostate cancer, although these studies used control a...
These mutations were not eligible in the LAURA trial. Afatinib has a more durable PFS than osimertinib in these patients. How would you choose be...
Do next generation sequencing results influence diagnostic and therapeutic decisions for patients with MDS?
FDG PET, Axumin PET, Bone scan? Or just proceed with salvage ADT/RT?
Does the interval of monitoring change if given with a concomitant immune checkpoint inhibitor?
How do factors such as the stability of the bleed, tumor histology, and patient condition influence your decision?
Ampullary carcinoma is not in the NCCN guidelines. Please address not only the role for therapy but the optimal regimen (i.e. Gem based, vs mFOLFIRINO...
Since the benefit of neoadjuvant chemotherapy is well-defined in muscle-invasive bladder cancer, is it reasonable to consider this in upper-tract tumo...
Additionally, would you consider prophylactic stent placement and/or gastrostomy in anticipation of a fistula?
Most patients with PGNMID have no detectable disease in their marrow or blood and urine protein cannot adequately be monitored.
Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?
Would you consider nivolumab/ipilimumab?
Is there a role for nelarabine and venetoclax in this setting?
Patient with pT2 N2a (6/9 LN+, 5 with macromets, 1 with focal ENE) ER/PR+, Her2- s/p mastectomy.
Is there compelling reason to start PMRT prior...
Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...
Since ECHELON-1 trial showed an improvement in PFS (but not OS), are there any situations where you would replace bleomycin with brentuximab...
Post-operative surgical course was complicated by anastomotic leak, septic shock, candidemia, wound infections, PE & DVT. Now recovering well.
Would you recommend concurrent chemoradiation or targeted therapy with lorlatinib?
Do you discuss the risk of sickle cell crises with G-CSF? What about for patients with sickle cell trait?
Had mild baseline tinnitus, now with significant worsening, and decreased hearing.
How do you advise patients who strongly desire chemotherapy?
Would you offer chemotherapy after radiation is completed?
Is there a role for non-myeloablative regimens?
What would be your approach to a patient who went straight to surgery due to HR+ biopsy, but found to be triple negative on surgical pathology?
Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...
Al-Ibraheem et al., PMID 33731050
Specifically, after chemo and RT to 36.0 Gy/15 fx with stable to slight progression of disease at 6 months, what (if any) regimen of reirradiation wou...
Are there characteristics which could help identify whether a follicular lymphoma might behave more indolently vs aggressively and inform treatment se...
Would you hypofractionate or be more conservative at 2 Gy per fraction? Would your management be affected knowing the patient is on hydroxyurea?
When and how are you incorporating tumor sequencing to plan treatment of metastatic prostate cancer?
Given the FDA approvals for PARP inhibitors and combinations in mCRPC, when do you obtain NGS for mCRPC? Do you have a preferred assay?
Have you encountered changes in prolactin, testosterone, etc?
Or would you sequence a different BTKi?
Chemotherapy is associated with acquiring C diff colitis. Does immunotherapy share that same risk and necessitate ruling out infection prior to anti-d...
Would you treat with curative intent (neoadjuvant chemotherapy, surgery, and radiation to include the sternum)?
Would you be willing to treat an elderly patient on blood thinners who has PSMA+ PET, elevated PSA, and multiple urologists have deemed biopsy too ris...
At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CS...
Would you treat as cholangiocarcinoma with a gemcitabine/platinum regimen or would you use a more HCC regimen like atezo/bev or durva/trem?
Does a certain level of free light chain ratio reassure you against the possibility of AL amyloid? Is there a certain level that makes you more concer...
Would you reduce dose prior to adding supplemental oxygen?
Was this monitored in TOPAZ-1?
NCCN states that all operable NSCLC patients should be evaluated for pre-op therapy with strong consideration of nivolumab + chemotherapy for those wi...
Some consider T4N3 Stage IIIC to be a borderline case. None of these patients were included in either PACIFIC or KEYNOTE-024 for example. Would y...
PFS curves appear similar between the AKT-altered vs overall study population in the trial publication. Is there any additional information available ...
Do you only offer it for patients with a documented IgG < 400? Do you check the IgG at all, or are you doing primary prophylaxis?
Let's assume they have cardiac involvement and transplant may not be feasible.
Do the IMROZ and BENEFIT trials inform choice? In IMROZ, the high-risk population received only revlimid/dexamethasone maintenance. Should they have g...
Are there specific patients where you're more apt to continue versus holding IO while continuing TKI?
Do you pursue screening beyond age-appropriate malignancy screening, especially in younger patients? For how long do you continue to monitor beyond th...
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 is your most and least preferred? In case of cancer in remission and in case of non-remission?
With the advent of PSMA PET/CT, this is my study of choice for high risk prostate cancer. Are there scenarios where standard FDG PET is useful? For ex...
mOS was 53.7 in experimental v. 54.3 in control; however ORR 71.3% vs. 36.7%, and mPFS 23.9 mo vs. 7.2 mo (HR 0.47). Does the lack of OS benefit sway ...
Adjuvant IO therapy, radiation therapy, both, or neither?
The FDA package insert suggests 2.5 mg daily in these settings, while the PrE1003 study demonstrated that a higher dose is feasible. Many oncologists ...
Would the recurrence while already on the checkpoint inhibitor sway you from offering durvalumab?
There are some retrospective data that CPCs are associated with worsened outcomes after transplantation. Anecdotally, CPCs could be collected as part ...
For example, when would you recommend clinical exam for surveillance versus imaging with MRI, CT or PET?
Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction ...
Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.
The patient has extensive disease, and requires palliative radiation to the scapular area (proximal to the brachial plexus) in a region overlapping wi...
Would you be more inclined to use it if a patient had early discontinuation of pembrolizumab due to IRAE?
Since free light chains are removed by dialysis and SPEP can also be impacted, is there a reliable way to monitor patients with ESRD and MM?
I.e. would you offer additional radiotherapy and if so, what technique and dose would you use?
Patient underwent an axillary dissection with ITCs in 1/23 nodes.
Oncotype score in this case was 14.
Add OFS with endocrine therapy plus Taxane-HP combo? What taxane is preferred?
Do you start neoadjuvantly? Concurrently?
Long-term ADT is deleterious to multiple organ systems (bone/sexual/psychiatric) and increases the risk of MACE. What level 1 evidence do we have to c...
Is APLS a contraindication to using interferon?
Specifically, on re-staging imaging, would the tumor regression be strictly defined by reduction in cranio-caudal direction only, or would other measu...
On the EMBARK trial (Freedland et al., PMID 37851874), 25% of men had a prostatectomy and the publication states, "Patients were excluded … if ...
Would you offer radiation and chemotherapy, vorasidenib, or observation?
No clear inciting etiology found.
Would you consider dexamethasone +/- cytokine blockade (IL-1, IL-6, or IFN-g)? What do you think about the data for...
The patient has an asymptomatic metastasis in the left atrial appendage.
Would you start off with immunotherapy then add radiation later, or visa ver...
Are there any recent publications or resources regarding which immunotherapy agents are contra-indicated with the use of RT or that outline interactio...
Do you perform NGS on all specimens? If so, how much do you rely on that alone to determine clonality?
How aggressive should we be in bringing elevated plasma/urine 5HIAA to normal levels in patients whose symptoms are controlled? Before we have the res...
DLCO 65% that is of unclear etiology but not due to disease and no cardiac or pulmonary functional limitations.
Although grade 3 toxicity rates were low, ~10.5% experience some degree of ILD, are there strategies to reduce risk before treatment starts?
Are ther...
Would prior RT (>30 years ago in this case) to the breast or ATM mutation alter your recommendations?
E.g. frequency of Bortezomib, dosing of Bortezomib, length of cycles.
Assume thrombolytics are not indicated. Do you favor early DOAC transition after 24-48 hours of heparin gtt or do you favor LMWH for 10-14 days follow...
Given nationwide shortage in vinblastine, several of my patients under active therapy are facing delays in their therapies. Is it appropriate to subst...
And if so, which one? Does nodal status affect your decision? Is there any evidence for ctDNA in this space?
Would you continue it until progression of disease? Or would you switch immediately to next line systemic therapy?
How would you counsel the patient given the drug interactions present?
Any pitfalls to be aware of?
Would clinical stage or nodal status affect your decision?
How would you approach treatment with systemic therapy, surgery, and radiation if there is evidence of little treatment response, tumor growth, and ne...
Do you do additional workup for venous obstruction or any other different testing/evaluation?
Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs?
Do you s...
What clinical factors do you take into consideration?
Would you recommend chemo-immunotherapy regimens for a fit patient who relapses at 6 mos post-t...
Per NCCN exclusion of EGFR/ALK alterations at a minimum is recommended prior to consideration of neoadjuvant chemoimmunotherapy.
Would chemoRT be preferred over surgery if there is LVI or PNI?
As immune checkpoint inhibitors have expanded into the neoadjuvant breast cancer setting, severe and unexpected autoimmune toxicities may cause delays...
The NCCN lists concurrent chemoradiotherapy as a primary treatment option in these patients. If so, what total dose do you deliver to involved ly...
What factors would influence your decision?
Given the results of DESTINY-Breast03, and T-DXd's labeled indication in second-line, what is now the role of TDM1 in the treatment armamentarium of H...
While ESOPEC excluded squamous cell carcinoma, the Japanese JCOG1109 NExT trial also showed superiority of fluoropyrimidine/platinum/taxane over chemo...
If triplet chemotherapy is likely too morbid, would you prefer neoadjuvant chemoradiation per CROSS in this setting?
WBC and Hb values are normal, and normal JAK2, CALR, BCR-ABL.
Or do you start with systemic therapy and then reassess?
Should testing for germline mutations -- eg. saliva sample -- occur before or after the completion of chemotherapy - or the timing does not matter?&nb...
Is there data supporting the idea that chemotherapy must be onboard prior to delivering radiation for maximal radiosensitization (particularly for hea...
STAMPEDE answer is yes, intuitively it seems there must be a line somewhere though.
For patients staged only with PET that is widely M1, should a CT ...
Would treatment be palliative (i.e. for ureteral obstruction) or definitive? Is there a role for chemotherapy or hypofractionation/SBRT?
Current NCCN guidelines recommended not combining relugolix with these agents until more data is available.
Any drug interaction concerns or ot...
Since HR low-positive, HER2 neg tumors behave aggressively similar to TNBC, does the degree of HR positivity factor into your decision-making?
How do the results affect your recommendations for workup and management?
Are there other mutations/biomarkers in CLL which may specifically predict for response or resistance to pirtobrutinib?
How does the changing landscape of first-line treatment impact your decision making for second line therapy?
Would you use nivolumab or a taxane? Is the data from the ATTRACTION-3 trial with an all-Asian patient population applicable to practice to the US pop...
A female in her 60s who has been on afatinib for 6 years. Has been NED on CT, PET, and MRI for > 5 years. Had isolated T-spine mets (radiated) and ...
Assume the patient is a good surgical candidate, and the perforation happened prior to initiating any treatment. Is the stent enough reason to avoid c...
Do you consider "bridging" therapy prior to transplant, and if so, what are your thoughts on the intensity of the chemotherapy?
When, if ever, do you utilize adjuvant RT or chemotherapy?
Does the type of breast cancer factor into your decision making?
Do you increase the dosage of the TKI or switch to a different generation TKI? How does your answer differ for EGFR vs. ALK, and for discrete brain me...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
Can adjuvant radiation therapy compensate for the potential increased local recurrence risk?
No disease elsewhere. Previous history of treated rectal cancer a few years ago.
Given the limited # of patients with PALB2 mutation on the PROfound trial (de Bono et al., PMID 32343890) and the benefit primarily driven by Cohort A...
For example, do you favor using different induction chemotherapy (gemcitabine/cisplatin or TPF) for endemic vs non-endemic disease?
Do you favor usin...
Tumor is PD-L1 positive and HER2 positive
ESOPEC compared perioperative FLOT vs neoadjuvant chemoradiation per the CROSS trial, and showed superior OS with perioperative FLOT. What concerns do...
And would your answer be different if you had used pre-op nivolumab (CM-816)?
What are your absolute & relative contraindications for bevacizumab use?
Given that LU002 has failed to meet its progression free survival benefit in results presented at ASCO, will you offer consolidative radiotherapy for ...
If using adjuvant chemotherapy, should the patient receive carboplatin or use a more intensive regimen because of the positive margin status?
Would you no longer trust the prognostic value of Mammaprint knowing the poor response to endocrine therapy?
How do you decide between entrectinib or crizotinib? Since no head-to-head comparison, can real-world datasets (such as Doebele et al., Journal of Cli...
Would you recommend post operative radiation in an adult patient with a thoracic spine osteosarcoma?
S/P neoadjuvant chemotherapy and followed by oncologic surgical resection but with positive margins.
Why does this differ when treating extracranial sites (lung, pelvis) where we hold bevacizumab prior to RT?
If so, when and to what extent?
In a patient with no evidence of bleeding, do you use a platelet cutoff? Do you utilize genomic testing (eg CALR, MPL, JAK2, etc.) to decide on cytore...
What is your treatment algorithm?
Ropeginterferon is now a preferred therapy for Polycythemia Vera (PV) as per a recent update to the NCCN guidelines.
Nivo 3 + Ipi 1 Q2W x3 then Nivo alone? Or Nivo 3 Q2W & Ipi 1 Q6W until POD or toxicity? Or other?
Are there factors which would make you more likely to use atezo/bev vs durva/treme vs TKI?
How would the duration of 5FU infusion impact response?
What would be your approach while deciding among the various combinations available?
I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...
Would you consider administering Keytruda (pembrolizumab) concurrently with radiation therapy for the treatment of a patient with an ER-negative, PR-n...
As expected triple negative.
Is there data on the long-term effects of abemaciclib on future fertility and pregnancy after its discontinuation?
Does the patient's desire for futu...
Patient in their 60s with TP53 mutation by NGS, treated 12 years ago with FCR, then at first relapse 2 years ago started ibrutinib. Bone marrow biopsy...
Most would argue that gain(1q) in combination with another high-risk feature constitutes ultra-high-risk multiple myeloma, and most would argue (with ...
Such as those meeting the eligibility criteria for NRG HN002, <10 pack years, HPV+ T1-2N1-2b, T3N0-N2b
When would you consider a bone marrow biopsy?
Given the recent update from the NAPOLI-3 trial presented at GI ASCO 2023, the two regimens appear to have similar OS.
Can you explain the expansion cohorts into larger trials and the current amendments to the the protocol?
The OS benefit with Zometa was seen only in patients with myeloma bone disease achieving less than or equal to a partial response. SRE risk reduction ...
Are there specific safety or efficacy benefits associated with prolonged infusion times in this population?
Are there specific patient factors for which you would more preferentially use this regimen?
TRIANGLE study
Is there a role for loco-regional treatment in this scenario? If a young patient with ER/PR positive cT2N2M1 IDC presents with a single bone metastasi...
With that smoking history, wanting to avoid BEP.
Patient has multiple adverse features on pathology, however, PSA just became detectable one year after surgery. SPPORT included patients with PSA>0...
In the setting of the recent TailorRx data, would these patients be considered more high risk?
KEYNOTE-564 required CrCl 30 or above. Not having a baseline/stable CrCl may make it difficult to diagnose or treat IO nephritis.
For many clinical trials, a screening bone marrow biopsy is necessary to get a new baseline. Do you do the same in real-world practice?
Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?
Would you ever consider this approach for an initially polymetastatic patient?
Previous questions have focused on the newly diagnosed setting and choice of bisphosphonate versus denosumab. IMWG guidelines do recommend resuming zo...
For a patient with high risk disease and a severe enough reaction that additional taxane-based therapy is contraindicated, do you consider alternate c...
And if delayed, should chemotherapy be started?
If so, what dose-fractionation do you utilize? What other factors do you take into consideration?
Would you recommend aiming for the postmenopausal range as per the lab reference range or do you have a specific goal?
For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?
If so, do you modify your external beam dose?
How do we approach patients with rare tumors given the paucity of data?
What is the role of adjuvant radiation therapy for stage III melanoma in the era of adjuvant Opdivo?
Burnmeister data from 2012 showed a local control benefit for radiation therapy in selected patients, but that was without immunotherapy. Is adjuvant ...
Does the presence of other cardiac risk factors change your recommendation?
Initial path was T1cN0, and recurrence shows 2/21 ALN involved with ENE, what would you recommend for therapy?
Would you give neoadjuvant chemo or hormonal therapy or go with surgery first? What chemotherapy would you use?
Or other therapy - e.g., tolvaptan? Free water restriction may hinder QOL. Salt tablets may raise levels more quickly but have risks of edema and hype...
Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additiona...
Is there a role for adjuvant chemotherapy or radiation?
If so, what regimen? At what point is it safe to start chemo in a freshly transplanted liver?
Confirmatory tests with DRVVT, hexagonal phase assay, and PNP are all normal. No bleeding history
Patient with stage IV ER+PR+Her2- breast cancer progressed after CDK4/6 inhibitor+AI and then on Elacestrant. Guardant 360 showed ESR1 mutation and PI...
What is the ferritin target that you would aim for? What would be your approach for a ferritin >500? When do you order an MRI liver for iron quanti...
Would you consider radiation following surgical resection of an intramedullary benign nerve sheath tumor with a small amount of residual tumor (9 mm) ...
Given pelvic RT is likely to induce ovarian dysfunction/menopause, would you consider systemic options?
This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo
There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?
Do you insist on ambulatory/home blood pressures to rule in/out white coat hypertension? Does your practice have a system to log patients' BPs to supp...
What does it add beyond a serum electrophoresis or light chain testing?
Are there certain types of patients where monitoring immunoglobulins is parti...
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...
Only the mCRPC population was included in the Fizazi et al. study, but the FDA approval is for prevention of skeletal related events from any solid tu...
In MONALEESA-2, it appears ~22% of those in the ribcociclib group received a subsequent CDK4/6 inhibitor. What was the rationale and could this have i...
The patient was initially treated with Carboplatin/Paclitaxel and progressed after 1 year. She was switched to pembrolizumab and had significant progr...
Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?
Do you have a preference on the regimen or cycle number, and how and when do you assess response prior to transplant?
Are there other systemic therapy considerations to help achieve sufficient CNS control?
What criteria do you use to define steroid-refractory disease?
Does your management different by organ system involved - GI vs skin vs other?
Given OlympiA trial with olaparib benefit for gBRCA+ patients?What are barriers that you foresee? In your practice who performs mutation testing and w...
For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?
Do you consider dose escalating to 160 mg or do you add chemotherapy to osimertinib?
Would you offer adjuvant radiation therapy if pCR is confirmed?
Would you wait until bowel symptoms are controlled or ever pursue diversion before starting treatment?
Group 3 being ratio < 2, copy # >6, and IHC 2+
Would you consider using repretinib as first line therapy given its novel mechanism of action versus other treatment options?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical prac...
Are there other measures, pharmocologic or adjunctive, that can be used or are under investigation to mitigate cardiotoxicity related to chemo- or rad...
My understanding is that if someone isn’t medically operable, the default is to offer systemic therapy palliatively because breast cancer is tho...
This patient had a T1N0, ER/PR negative, HER2 negative breast cancer
Patient developed atrial fibrillation on Ibrutinib, severe fatigue and intolerance to Zanubrutinib and a maculopapular rash (grade 2) on Acalabrutinib
If yes, would you go with Zidovudine monotherapy versus combining with interferon-alpha? And what would be the preferred dose and duration?
The patient presented with a numb chin, more to the right of his face; an MRI did report mandibular nerve opacity, which is non-specific per neuro-rad...
If a patient had a CPS-EG of 2 after neoadjuvant therapy, would you offer that patient olaparib even though she wouldn't have met entry criteria? If t...
If a patient has already received ADT+ARSI would you use PARPi over chemotherapy in 2nd line?
How do you choose between RIC compared to MAC? Is there evidence for one over the other in an otherwise healthy, young patient?
Do you include hypome...
Does age influence your choice of regimen?
Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...
Are there certain patient subgroups for whom you would use the IO+PARPi?
Is there data from DUO-E regarding BRCA status and its potential impact on ...
NCCN says "consider autologous HCT" while retrospective data seems to support SCT in most histologies like AITL
How does it affect your calculation of risk stratification?
Do you give first-line CDK 4/6 inhibitors with Tamoxifen or Aromatase Inhibitor (+/- GnRH analog)?
Should we switch to a new TKI?
Would you offer adjuvant nivolumab?
Have you changed your practice given BMT-CTN 1506/Morpho results?
Would you utilize maintenance therapy in patients who achieve MRD- remission?
Are there any precautions or pre-medications that may permit this treatment in patients who are fit for therapy but have exhausted all other treatment...
Is T4 disease a contraindication?
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 there data to support this approach?
Would you offer consolidative brain SRS, SRS + consolidative RT to the primary (e.g. lung), consolidative RT to the primary alone?
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...
Does the site of treatment factor into your decision?
Would the grade of the lesion affect your decision?
ARSI may be controlling a hormone sensitive clone. Some patients flare after stopping the drug.
Should these patients have a different threshold for utilizing a CDK4/6 inhibitor in the front line metastatic or as part of adjuvant therapy, or SERD...
Do you recommend adjuvant chemotherapy after radiation treatment?
Would you continue R-CHOP or would you switch therapy?
Transplant is not part of the trial but is the standard outside of the trial. A041501 is a phase III trial to evaluate the efficacy of the addition of...
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...
For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...
Please assume that IVIG is fine (as it is for many Jehovah's Witness patients, since IgG is often not considered a blood product per se).
Would a PET avid pelvic lymph node without distant metastatic disease change your management?
The patient had a prior right-sided ER+ HER2-ve breast cancer, treated with neoadjuvant chemotherapy, MRM with ALND, and PMRT
They recently developed...
If so, would you recommend adjuvant chemotherapy and PCI after?
How would it change your risk group or management? Does Decipher help further inform treatment?
Do you feel differently about using these in patients with a history of HR-negative breast cancer?
Specifically, do you offer closer follow-up for certain patients after local radiation?
Would you consider stopping therapy versus doxorubicin + dacarbazine/doxorubicin alone versus alternative chemotherapy ?
Many options for vasomotor symptoms of menopause do not work well for men on ADT. However, fezolinetant is a neurokinin B blocker, so theoretically, s...
Have you been able to deliver standard of care treatment?
If yes, would you apply this broadly or reserve the addition of IO to chemotherapy for patients with high-risk histologies (e.g., carcinosarcoma) or o...
Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?In light of relevant trials including RUBY, GY018, ...
DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease.Would your decision change based on the mis...
Are there patients for whom you would still reserve IO for salvage/recurrent setting (eg IO + lenvatinib)? Would you base this on MMR status or other ...
I have a pair of patients with MRI+ and biopsy+ disease who have staging PSMA PET/CT that do not show disease within the prostate (or anywhere else).&...
Is there a specific tyrosine kinase inhibitor that you would prefer to use?
With the recent publication in IJROBP showing a greater than 50% response rate, have you started integrating this into your practice?
At the time of count recovery or do you continue it throughout induction and consolidation?
Comorbidities: morbid obesity, diabetes, hypertension
Patient refuses further mFOLFIRINOX but may be open to less aggressive regimens. Is there any role for PARP inhibitors?
Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?
Would you start with endocrine therapy + CDK 4/6 inhibitor or a chemotherapy based regimen?
If so, in what situations?
Based on the KEYNOTE-716 study and Dec 2021 FDA approval
RIGHT Choice trial presented at SABCS 2022
The patient also has transfusion-dependent anemia secondary to the LGL leukemia.
Given CPX-351 was given to elderly patients ages 60-75 with a lower dose (60 mg/m2) Daunorubicin, can one generalize from this study to younger adults...
Does reducing the rate of infusion, or adding Montelukast reduce chances of future reactions?
For radiation oncologists, how do you ameliorate the risk for radiation-related injury to epicardial coronaries during treatment sessions?
NGS results are pending
When (if ever) would you consider immune checkpoint inhibitor up front? Would you be less inclined to offer triple drug therapy? (Some thought that ta...
Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...
This would be for the "locally advanced unresectable" indication. Consider an older patient who is not eligible for NAC nor TMT due to nodal disease a...
How does this change for patients with elevated bilirubin?
Would you transplant a patient over the age of 70 with newly diagnosed myeloma? Does the risk category impact your decision?
The patient was recently diagnosed with pre-B ALL and is on day 10 of CALGB 10403. He is expectedly neutropenic as he received daunorubicin and vincri...
Are there any chemotherapy regimens that can be used in elderly patients with poor PS who are not candidates for BEP?
Is completing nodal dissection warranted for surgical management?
Would you follow an algorithm such as the one proposed by Hall et al., PMID 29940062?How do you decide between intrathecal chemotherapy vs systemic th...
Does obstructive hydronephrosis allow for clinical upstaging to stages 2-3?
What factors might play into this decision?
There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...
While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...
How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...
Both sets of CT scans pre and post- chemoimmunotherapy show no evidence of distant mets.
Is there a role for circulating tumor DNA in this setting?
What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...
Do you proceed with sequential, concurrent, or sandwich treatment?
And if so, would you offer it pre or post-metastasectomy? Would time to recurrence or ctDNA play a role?
How does data from PADA-1 and EMERALD trials impact your decision-making?
E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody respons...
If baseline testosterone is at castrate levels (e.g. <50), would you consider patient to have castrate-resistant disease?
Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm.
Her gynecologist wants her on hormone replacement therapy.
For example, a patient has had multiple dose reductions for neutropenia and required an admission for infection while on palbociclib. Would you switch...
For instance, do you factor availability of RNAseq, inclusion of normal blood controls, and QNS rates into your decision?
Especially as the study was done before the adoption of total neoadjuvant therapy
Would you treat with immunotherapy ?
Sarcoma arose from Castleman disease
Would you prefer doxorubicin based chemotherapy or are alternative TKIs useful in this scenario?
Or offer resection followed by adjuvant therapy?
Has this recent retrospective analysis published in Lancet Oncology changed your practice?
Does the anagrelide shortage play a role in your decision-making? Do you avoid anagrelide in general?
Is there benefit to radiation on top of systemic therapy?
How are you incorporating CONTACT-03 data presented at #ASCO2023 (Pal et al., PMID 37290461) into your practice? Would you consider immunotherapy re-c...
For example, do you think young patients might potentially benefit from the addition of cisplatin, knowing the average age in this study was 65.
The patient previously received endocrine therapy alone and in combination with CDK 4/6 inhibitor. She does not have any targetable mutations on NGS. ...
Do you take PR percent into account?
What data may support the routine escalation of endocrine therapy? Should HER2 therapy be prioritized instead?
Would you treat with 1st line ET + CDK4/6 inhibitor if the patient is only low or moderately ER positive?
Practice varies among oncologists and institutions
How does margin positive influence your decision?
Would you only give three cycles with radiation, or are you adding two more cycles of FOLFOX afterwards?
Would you consider OFS this far out from diagnosis and treatment in a young patient with high grade IDC was treated during pregnancy with neoadjuvant ...
Does DOTATATE scan results/burden of disease change your preference?
Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?
Do you preferentially use Ra-223 first given the RALU study?
Would you offer single agent immunotherapy or chemo-immunotherapy with gem/cis durva/pembro?
Assuming no symptoms of TB, should patients be treated for latent TB prior to starting TNF inhibitors or other immunosuppressive agents?
Work-up was performed for isolated anemia which resolved to >11 g/dl after the reversible cause was treated.
In a patient with metastatic cancer to the lumbar spine and epidural disease on CT who presents back pain and leg weakness:
Is a whole spine MRI in...
Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?
If so, what would be your approach to radiation? Could SBRT be an option?
Does tumor size, age, or performance status play a role in your decision-making?
The SWOG 1801 trial showed improved event-free survival (EFS) in patients receiving neoadjuvant pembrolizumab followed by 15 cycles of adjuvant pembro...
Example: in a patient with a non-resectable pelvic mass involving the vagina but without evidence of distant disease, would you favor pelvic RT (as on...
How do you reconcile the apparent benefit in all patients in this group as opposed to the differential effects in premenopausal HR+ node-negative pati...
Would you consider dose reduction versus adding C-GSF?
Are you more worried about QT prolongation in this subset of patients?
Are you concerned about cases where radiation has to be started urgently before leukapheresis?
Will you await manuscript publication and formal regulatory approval prior to routinely instituting this treatment?
What type of adjuvant chemotherapy would you offer? Would clinically positive lymph nodes or residual disease at the time of surgery change your decis...
Do anticipated fields affect whether extractions are required i.e., limited field glottic larynx could forego?
Do you recommend observation, APBI, whole breast or whole breast with low axilla treatment?
Would you consider doing this in patients with adverse features such as grade 3 or PR negative status?
In a patient who relapsed following 2nd line transplant, how do you select CAR-T vs bispecifics vs non-T-cell-mediated therapies as outlined in NCCN? ...
Do you speak to different expectations re: ability to achieve PR/CR and/or how this will impact ability to get to later therapies for a patient with p...
Presuming the patient is not a transplant candidate due to comorbidities, PS, and age.
Do you prefer single agent PD-1 inhibitor or combination immunotherapy?
Following SRS to the brain lesions, is it safe to closely follow the patient for recurrence?
If there are light chain deposits on the kidney, is that conclusive of MGRS?
If yes, how does that affect management?
If no, what are your indications for BM biopsy?
Per the new data from the COMMANDS trial, Platzbecker et al., PMID 37311468
Very-low-risk stage IIIA disease includes non-ulcerated lesions, primary ≤2 mm thickness, SLN metastasis <1 mm. Per NCCN the toxicity of adjuvan...
How will you translate treatment recommendations from older studies to the new staging system?
Can cisplatin be used again with chemo-radiation?
As SCLC in never smokers is extremely rare, do you consider NGS testing, or do you modify treatment in any way?
Would you biopsy a metastatic site?
Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?
Galsky criteria are for metastatic disease, can they be relaxed in localized MIBC setting given curative intent of therapy?
Would you approach with curative intent with locoregional treatment or systemic treatment alone?
What is the work up and what is the duration of anticoagulation if used?
Would you continue KEYNOTE-522 neoadjuvant therapy? The patient has a PMH of sarcoidosis with no stroke risk factors. No residual deficits.
This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispeci...
Do you always avoid heparin/enoxaparin or rechallenge if antibodies are negative?
PD-L1 CPS of 1, no other actionable mutations except HER2.
Can chemoradiation be curative without maximal debulking TURBT?
Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer.
For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...
Do all patients with brain metastases get started on anticonvulsants?
Do you decide based on extent of edema, tumor size, or something else?&nb...
The patient's current PET scan showed no systemic disease. Due to his age, there is a concern of whether the patient would tolerate dual immunotherapy...
Would you treat both at the same time? Does one need to be prioritized over the other?
Does Xeloda have any efficacy against Merkel cell cancer?
How...
MONARCHE added an amendment to their protocol to exclude inflammatory breast cancer so they technically would not qualify for the trial though it's ha...
If yes, how do you assess the tumor response and how frequently while on neoadjuvant chemoimmunotherapy?
Severe lymphopenia can develop during treatment and increase the risk of Candida/HSV superinfection, along with potential challenges for any procedure...
Does the presence of parametrial or cervical involvement impact your decision?
How do you sequence treatment modalities?
Is liquid biopsy helpful? Would you treat if this shows somatic mutation?
Do you routinely check tumor markers between cycles when managing NSGCT?
This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...
Will you use it rather than a carboplatin-containing regimen?
Is there any role for immunotherapy?
What workup do you typically recommend?
The ICI adjuvant data we have so far doesn't clearly separate MSI-H disease from all comers.
Yaeger et al., PMID 36546659
Would you offer as first line treatment mitomycin/5FU with radiation or single agent immunotherapy?
Patient is pre-menopausal and has cT3cN1, grade 2, ER positive, Her 2 negative IDC. Metastatic disease to axillary LNs was biopsy-proven. Patient was ...
Would you consider offering ovarian suppression?
The left breast cancer is an ER-negative, PR-negative, HER2-negative cT2N0 invasive ductal carcinoma, while the left lung primary is a cT2N1 squamous ...
This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...
Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...
Is deferring chemotherapy based on low oncotype acceptable in setting of recurrence?
Would you recommend using a different AI, Tam...
How would you integrate RT with molecular agents?
Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.
Do you feel comfortable stopped abiraterone after 2 years?
Would you recommend using chemotherapy based on RxPonder regardless of Oncotype score in a premenopausal patient? Or would you hold chemotherapy since...
After initial induction chemo, how do you choose between radiation alone or concurrent CRT?
Aside from chemoradiation, are there situations in which you might consider this alternate schedule?
Would non-gastric GISTs, high mitotic rate, large size, and young age of patient affect your decision? Especially knowing that TKIs suppress cell grow...
Or use baseline PET followed by serial MRI/CT for monitoring?
In general: when would you recommend adjuvant radiation and capecitabine for a colon cancer?
Would you test for bone marrow failure syndromes before beginning the conditioning regimen?
With the recent announcement that the phase 3 MonarchE trial met its primary endpoint.
How do you decide when to “pull the trigger” in these cases where the growth trajectory is slow?
How did the SWOG 1505 clinical trial influence your clinical practice?
Is there a potential role for concurrent radiation therapy? What if the tumor is BRAF mutated?
Is there any data to support the use of immune checkpoint inhibitors either preoperatively or even definitively, similar to rectal or gastric?
Is it necessary to delay the start of radiation therapy for males planning on sperm banking for fertility preservation?
Is there absolute LVEF threshold you would not use HER2 targeted therapies?
Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?
Such as in a patient with essential thrombocythemia with a CALR mutation, younger than age 60, no history of thrombosis, no bleeding or vasomotor symp...
How frequently and what type of testing/sample are you performing MRD assessment?
Does your approach differ between transplant-eligible and transplan...
Is there any role for targeted therapy, or would you consider consolidation durvalumab for these patients?
Is the data sufficient to change your practice?
Does cumulative exposure to BTKi increase potential risk of cardiac toxicity?
Should pirtobrutinib be viewed as a bridge to CAR-T or transplant or a destination therapy?
How do you predict which patients may be in a high risk group and less likely to benefit from a second BTKi?
Is there a specific Ki67 percentage? P53-negativity?
For a node positive, triple negative patient that underwent neoadjuvant chemotherapy followed by breast conservation with a complete pathologic respon...
How do you pursue fertility preservation in younger females with this presentation?
Are you more inclined to use non cytotoxic regimens such as R2 or PI3K inhibitors?
What systemic therapy is most appropriate, how would you sequence, and what RT dose fractionation would you use?
Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?
I.e. dosing regimen frequency, side effect profile, duration of follow up, etc.
What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...
Is there any role for RAI?
Are there concerns for under-staging with bladder cancer in diverticulum?
While I am encouraged by the results of the LUMINA trial with respect to identifying patients who are less likely to benefit from radiation therapy wh...
Patient already on methotrexate and plaquenil.
Assuming the patient had no prior radiation and has no evidence of metastatic disease, would you start with adjuvant radiotherapy or adjuvant systemic...
24 months ADT + abiraterone + definitive RT is indicated for cN1 disease but not for pN1 disease per NCCN. Can the data be extrapolated to this popula...
Notably, the patient presented with renal failure due to ureteral obstruction and hydronephrosis, receives hemodialysis, and has limited systemic opti...
Modified HyperCVAD? V(R)D-PACE? DCEP? Are there any data to favor one over the other?
If so, which checkpoint inhibitor would you use?
Do you utilize rituximab or any other specific management strategies?
What precautions, if any, should be instituted with the prior cisplatin exposure?
Which group of patients will benefit with observation versus adjuvant immunotherapy?
What XRT dose do you use? Does the location of the disease (e.g., mediastinum) affect your decision when taking toxicity into account? would you offer...
Had mastectomy resulting in ypT1cN1a. Post menopausal female with good PS.
Garcia-Manero et al., PMID 32285126Given the convenience of oral therapy, would you depend on the patient's ability to safely comply with the schedule...
Would a negative NGS eliminate the possibility of MDS?
Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?
If so, under what circumstances?
Based on subgroup analysis, do you have a preference for cisplatin over carboplatin?
Do you also give neoadjuvant, concurrent, and adjuvant ADT in the same manner as for non-SBRT EBRT?
If so, which patients would you extend treatment?
Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion?
Staging/pre-op MRI only showed mild non-specific thickening.
If NGS was positive would you treat with HER2 directed therapy? How, if at all, would you incorporate T-DXd into this treatment paradigm?
For example, initial imaging shows numerous bilateral nodal mets extending into the low neck but after induction gem/cis, originally involved nodes ar...
Exploratory analysis of the MAGIC trial suggested perioperative chemotherapy was detrimental in this subset of patients. Has availability of IO altere...
Pretreatment PSA 25.3 with Gleason 4+3=7 and MRI suspicious for ECE. Eight months after pelvic nodal and prostate XRT to 79 Gy, PSA is 5.02 (down from...
What factors do you consider - perforation, size?
Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...
And is it different when using pembrolizumab or a combination of ipilimumab/nivolumab?
Several patients with inability to access oral cyclophosphamide or lenalidomide, have attempted assistance and grants to no avail.
She achieved PCR with NAC with TCHP and is now on adjuvant HP.
Do you add VEGFR/EGFR antibodies? Or switch to another regimen?
If so, what alterations would be helpful to narrow the diagnosis?
Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...
MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative.
Is there any ...
Given recent retrospective study showing potential lack of benefit with bortezomib-based maintenance therapy (Bumma et al., PMID 37021929).High-risk a...
Which PI and at what dosing intervals? Dexamethasone or not?
Emory has now published data with VRd consolidation as well as KPd consolidation, while ...
Do you extrapolate from first line maintenance studies for duration of therapy?
Taking into account follow up from NEO, OPERA and other organ preservation trials?
Does the patient's MMR status affect your opinions? What is/are your current preferred second-line regimen(s)?
In this scenario do we use the actual tumor size for "T staging".
Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.
Do you ever consider bridging with chemotherapy, and if so for how long?
Do you re-challenge them? If so, what pre-medications do you give? Do you dose reduce the cytarabine? Or do you switch another regimen?
If using cetuximab, would you recommend accelerated fractionation?
If so, why?
Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...
Considering updated trials, such as final OS data from NOVA, and recent society guideline updates?
Front-line PARP inhibitor maintenance therapy discontinued without progression.
In patients with no apparent skin involvement but lymph-node showing basal cell carcinoma with extracapsular extension. Would this warrant radiation o...
A recent NCBD analysis (Rusthoven et al., PMID 27325855) suggests that the addition of prostate RT significantly improves survival compared to AD...
E.g. TET2 mutation at < 10% allele frequency
Specifically if metastatic risk estimate approached the failure rate in control arm of STAMPEDE for high-risk non-metastatic disease (69% MFS at 6 yea...
4 months of Neoadjuvant GAP resulted in conversion from unresectable to resectable.
Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...
Does your approach change depending on the patients initial somatic BRCA status?
How is this entity distinct from other secondary HLH entities?
If so, how long are they on degarelix before the switch?
Do you use the same high risk factors as adenocarcinoma when deciding on adjuvant treatment for early stage disease?
In which scenarios would you consider a parp inhibitor as the first line treatment of choice?
Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again afte...
Bleomycin omitted due to asymptomatic decline in DLCO
Tumor 3 cm, grade 2 with Ki-67 25%
Please specify how your institution is allocating resources now or will be soon.
How do you reconcile these findings with the ABC trials?
Majority of patients on the seminal trial (Gross et al., PMID 36094839) had tumors isolated to head & neck, what was the rationale for this?
What role, if any, does molecular testing play in diagnosis and management in the absence of available clinical trials?
Do you base your decision on extent of residual disease?
Does the use of (neo)adjuvant immunotherapy have an impact on surgical site size or he...
(i.e. frequency of serial BNP, troponin, cMRI)
If so, would you do bone marrow biopsy or send for NGS panel in blood to look for high risk mutations? NCCN lists this as the risk criteria.
(Assuming they meet MonarchE criteria)
For example, if the patient is in year 2, 3, 4, or 5 of adjuvant endocrine therapy versus 9 months out, would ...
Is there a role for KEYNOTE-522 since ER + metaplastic breast cancer have similar behavior to triple negative metaplastic breast cancer?
What is your approach to try to persuade her that photons would be a better option?
IMPower110 data add further support to use of checkpoint monotherapy; however guidelines continue to support either I/O monotherapy vs chemo-immunothe...
Assuming the patient had no contraindications to immunotherapy and no other significant comorbidities.
Based on GI regimen or urothelial carcinoma regimens?
Are you waiting until drug availability or changing to a preferred non-cisplatin radiosensitizer? If you're utilizing an alternative to cisplatin, wha...
Would you biopsy lymph node to confirm recurrence/histology?
If confirmed, how do you decide between RT vs chemotherapy? If chemo - BEP x3 vs E...
Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?
How do you use this information in clinical practice?
If yes, where in sequence would you use it?
Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...
Does your approach differ across the HER2 IHC spectrum?
Assuming there is clear laboratory and/or imaging evidence of disease progression, and assuming FISH data is already available from a prior biopsy, do...
Do you use a q4 week or q12 week formulation? If you use both in your practice, what factors into your decision making for either one?
Are there any instances where you would prefer a biosimilar rather than the reference product?
Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone
If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...
If ADT +/- ARPI + RT, what duration of systemic therapy do you recommend?
i.e., 60+% bone marrow plasmacytosis, light chain ratio >100, and/or >1 MRI lesion
How strongly would you recommend it for a grade 1, < 1 cm DCIS?
> 30s, female with metastatic colon cancer. Presented with a headache. Metastatic hemorrhagic mets per MRI 10/2022. Had radiation. Kras mutated, Br...
Data exists for imatinib Dasatinib and nolotinib
Assume the patient is not a candidate for surgery. What dose would you use? Would you recommend a lower dose to not damage the patient's kidney functi...
How would you add radiation in your treatment paradigm? No clinical trials available due to age.
Do you wait to monitor response to empiric corticosteroids before pursuing a kidney biopsy?
If the patient received <2 months of immunotherapy, would you continue immunotherapy alone or transition to enfortumab monotherapy or EV+Pembro?
Normal CBC, CMP, SPEP, serum light chains, and FISH. Young otherwise fit patient.
Are there exceptions?
The surgeons at our institution are asking for repeat markers but I am not aware of any data or guidelines to support this.
How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?
I.e. based on the findings of ADAURA in surgically managed patients.
How do you reconcile the differences between the two studies?
MonarchE trial criteria includes "patients with four or more positive nodes, or one to three nodes and either tumor size ≥ 5 cm, histologic grade 3...
Assuming aromatase inhibitor is not an option due to severe osteoporosis or if it is a man with breast cancer.
Presuming there are no matched unrelated donors.
Given the published results of the PRODIGE 23 trial where FOLFORINOX was used neoadjuvantly with FOLFOX post-op
240-300 mg/m2 prior exposure. How would your management change in young fit/older individuals with comorbidities? Would you obtain interval TTE during...
What imaging modality do you use (conventional, PSMA PET, etc.)? When do you image (ex: a PSA threshold or PSADT)?
Lately I have seen patients with a concurrent gynecologic (requiring chemoRT), head and neck (requiring surgery), and early stage NSCLC (requiring SBR...
Would your approach differ for a 30 year old and a 70 year old?
Are there scenarios in which you would proceed with checkpoint inhibitor for PDL1+ disease before having full molecular testing results?
Dose-escalation RT trials have had mixed results in the past for advanced rectal cancer, while in the early rectal stage there is a tendency towards a...
How do you weigh definitive chemoRT vs minimally invasive surgical approach with neoadjuvant chemo followed by transanal excision, in light of results...
Would sidedness matter? Do you use ctDNA assays to evaluate for acquired RAS mutations to guide this decision?
Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?
If the patient had no nodal sampling, would this influence your decision?
Is there any role for AI + OS? What duration of therapy do you recommend?
CheckMate 511 trial showed reduced toxicity with flipped dosing of ipilimumab/ nivolumab (ipi 1 mg/kg and nivo 3 mg/kg instead of ipi 3 mg/kg and nivo...
Does the patient's young age affect your decision when applying data from the IDEA collaboration?
Do you worry about their marrow reserve and response to neulasta in terms of lymphocytosis and decreased ANC response?
Would you advocate for a targeted gene approach or a fully comprehensive NGS panel?
Do the overall survival results of PARADIGM presented at ASCO 2022 change the standard of care?
Instead of FOLFOXIRI and bevacizumab as per TRIBE trial
Fertility preservation already complete with embryo cryopreservation
Would your recommendation change in a patient having pain from disease and you wanted a quick response?
For instance, carboplatin/etoposide in extensive-stage SCLC
How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...
Would you recommend pembrolizumab prior to surgery? Or after? Is there a role for FOLFOX?
How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?
Would you consider these as metastatic sites? Would you biopsy to confirm?
Is your approach different than that to a primary essential tremor?
E.g. loss of PMS2 expression by IHC only but MSI stable by PCR.
What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?
E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?
Regimen currently 25 mg lenalidomide D1-21 of D28 day cycles, Daratumumab 16 mg/kg every 2 weeks.
For example, if low GAIL and high Tyrer-Cuzick?
The patient has also acquired mutations in BCR-ABL, namely p.Met244Val, (c.730A>G); 3.7%, which may confer resistance, and p.Phe359Cys, (c.1076T>...
If so, how long would you treat?
Patient on JAK2i, ESA, transfusion dependent
Would you use a different chemotherapy regimen than mitomycin/5FU?
History of 4th ventricle choroid plexus papilloma s/p GTR, now with recurrent disease in the 4th ventricle and the left lateral ventricle (7 nodules i...
Are you more likely to consider a trans-anal resection?
How can these interactions be improved?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?
Would you switch to enzalutamide or apalutamide if not giving docetaxel given darolutamide data for mCSPC is only from ARASENS trial with docetaxel?
How would you recommend proceeding if there are no other actionable variants on NGS?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...
This would “combine” approaches from both CheckMate 816 and IMpower010.
There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (Cousino et al., PMID 23071225).
Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?
And if so, would you offer FOLFOX or Immunotherapy?
She had been initially treated with neoadjuvant AC-T followed by BCS and RT with high burden residual disease in the breast and lymph nodes.
Would you offer EGFR inhibitors as second line?
For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...
The results presented by Sudeep Gupta (from the Tata Memorial Breast Group at 2022 San Antonio Breast Cancer Symposium #GS5-01) showed no benefit (pCR...
Do you consider any neoadjuvant therapy or proceed to surgery followed by adjuvant chemotherapy and osimertinib? Does the type of mutation (ex a rare ...
If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...
What specific platforms do you use, individual biomarker/PD-L1 status vs NGS, tissue vs liquid or both?
Must you wait for PD-L1 testing if mutation t...
Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?
Does your choice of agent differ, or are you more or less likely to offer maintenance than if the patient had multiple myeloma alone?
Or would you conduct tissue or blood testing if no actionable results are found?
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...
Do you incorporate PEG-asparaginase or brentuximab vedotin (for CD30-expressing malignant cells) into anthracycline-based induction regimens? Do you c...
If so, which patient population would you use this in?
Is there a role for ctDNA in this case? Would the approach change if the patient is MSI-H?
Would you biopsy another site or treat the patient?
Would you prescribe ADT for a patient with dementia who has biochemical recurrent, non-metastatic prostate cancer, but otherwise good physical PS?
Reference: TROG 05.01 Trial
Markers from surgical path showed ER0PR0 HER2 2+ and positive via FISH in 5% of total tumor population.
Would you continue FOLFOX or switch to another agent?
KRAS WT, MSS, no targetable mutations
Concordant low EPO level and bone marrow with megakaryocyte hyperplasia
Specifically, would you consider either neoadjuvant or adjuvant immunotherapy in this setting, or only after recurrence?
How do you choose between CAR-T and autoSCT, for example?
This is a recently described entity with poor prognosis, so even with a CR after RCHOPx6 cycles, is your bias to push for ISRT due to EBV being poor p...
In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...
It is understood that the trial's experience was to keep on treatment indefinitely until progression or unacceptable toxicity. We are asking about rea...
How would your choice of therapy differ (if at all) for high vs low risk disease?
Would the specific anti-platelet agents used influence your choice ...
Are there specific clinical, patient, or disease factors you focus on?
Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?
Would you consider using an IO-based treatment or move on to TKI? Does the presence of sarcomatoid or rhabdoid features impact your approach?
Would you recommend standard definitive chemoradiation followed by adjuvant durvalumab? Would you treat pre- or post-systemic therapy volumes?
Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...
If yes, would you offer neoadjuvant or adjuvant, concurrent or sequential?
Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...
How does your approach differ for patients under age 60, between 60-70, and over age 70?
Do we wait and watch vs start treatment based on ctDNA results?
Given that pembrolizumab/trastuzumab with chemotherapy is new SOC for metastatic disease, how would you approach those with recent fluoropyrimidine + ...
Does PET avidity factor in your decision?
Do you have a number/volume threshold for SRS vs WBRT?
Does it assist in prognosis in any way?
If the patient had PSC and baseline atrophy preventing brachytherapy boost (received SBRT boost instead), would this change your threshold for stentin...
For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?
In addition to reversing hypercalcemia, initiating myeloma therapy, etc.
There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?
Masuda et al. NEJM 2017
If so, how do you sequence it with adjuvant radiotherapy?
Since both pregnancy and cancer are risk factors for VTE, is there data to guide when or if we should prophylactically anticoagulate? If so, what shou...
If indefinite treatment is recommended, is there an optimal maintenance dose?
Are there specific patient populations in which you may feel comfortable with a patient selecting only one adjuvant therapy approach (tamoxifen vs RT)...
The patient was a >70-year-old with right-sided cT3N1M0, ypT0N0 TNBC s/p NAC pembro/taxol x 4 cycles followed by mastectomy w SLN (0/4); post-opera...
Patients with deficient mismatch repair (dMMR) and microsatellite instability high (MSI-H) harbor high tumor mutational burden which tends to have fav...
Margins are negative (closest 4mm), grade 2, 3 of 23 lymph nodes positive with no extranodal extension. What is your preferred chemotherapy approach a...
The patient presented with spinal cord compression, had subtotal resection and instrumentation with metallic hardware. Main concern is that post op su...
4 cm with negative LN
Is there a subset of patients for which you consider one regimen over the other (i.e. AC-THP v.TCHP)? If using an anthracycline regimen, do you u...
Would you consider empiric SRS if biopsy/resection is not feasible?
When would you consider liquid biopsy?
How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?
With studies showing non inferiority to zoledronic acid q 3 months in support of bone metastatic disease, would you consider extrapolating this data a...
Would you intercalate HD-MTX with her CHOEP?
Ide-cel? Cilta-cel? Teclistamab?
Patients with gastric cancer can acquire new targetable mutations on progression. This could aid in additional treatment options in this group which t...
The prior recommendations were between 6-12 months, but also were based on chemotherapy after surgery.
When do you order PSMA PET? Do you preferably order Locametz (gallium Ga 68 gozetotide) PET?
Would you treat this as a locally advanced breast cancer and offer surgery, radiation, and systemic therapy? Does your management change depending on ...
Does your treatment approach differ from Waldenstrom's Macroglobulinemia?
Does the presence/absence of a MYD88 L265P and/or CXCR4 mutation change you...
In a woman with high-grade, clinically node positive invasive ductal carcinoma who receives neoadjuvant chemotherapy and breast conserving surgery, wo...
For example, would you use a tool like the Hydrashift assay? Would this change your management?
Is there data on efficacy or toxicity when chemotherapy is added to Proton beam therapy for head and neck cancer like there is data to support adding ...
If tolerated through Cycle #1, how aggressively do you try to titrate the selinexor dose up toward 100mg weekly or 80mg twice-weekly?
And does your a...
What other molecular tests do you routinely order on such tumors?
How do you generally think about sequencing treatment among available options?
Would your choice be affected by a patient's eligibility for transplan...
If so, how often do you check these labs?
According to the NCCN guidelines, there is a highly selected group of T4a glottic larynx patients that can undergo observation instead of postoperativ...
ESMO Congress 2022 Abstract
Encouraging aggressive PO intake in patients with swallowing dysfunction may place them at risk for aspiration pneumonia, especially risky if undergoi...
Do you have a certain immunoglobulin level which you would use to determine this?
NCCN discusses targeted therapies (Everolimus) but also Temodar / Xeloda combination.
If so, what dose-fractionation regimen do you utilize? What are your target volumes?
Do you rebiopsy or use a liquid assay?
If a patient with endometrial stromal sarcoma managed with fulverstrant has a single oligoprogressive lung nodule, is there any contraindication to tr...
PSMA PET vs Conventional imaging vs combined imaging?
How is your approach different from or similar to those who undergo surgical menopause?
How would you approach the treatment if the tumor is PDL1+?
Does your management change if symptomatic or asymptomatic?
Is there an optimal chemotherapy regimen that optimizes cure rates while minimizing side effects?
How do you compare their efficacy overall?
Are there factors that would lead you to select either ramucirumab +/- paclitaxel vs T-Dxd vs chemo?
Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...
Given strong TDXd efficacy in these patients is there a role to use it earlier than 2nd line?
How does prior Her2-directed and/or taxane therapy...
What is your preferred dose/fractionation following a previous course of radiotherapy?
No evidence of distant disease elsewhere. Surgical resection is not possible. Would you recommend metastasis direct therapy to the liver (i.e. SBRT or...
What parameters/goals/targets do you use?
Do you treat PV, ET, and MF differently?
Would you use a trial of dexamethasone for a patient with thrombocytopenia?
While rare, these patients were excluded from all frontline CDK4/6 inhibitor trials. Is there any data on the efficacy of ribociclib in the CNS or abi...
Would you change to a different CDK4/6 inhibitor or avoid the entire class of drugs?
Results with fulvestrant and letrozole backbone in MONALEESA and MONARCH trials seem comparable, but PALOMA data is somewhat mixed. How do these trial...
Subgroup analyses in MONALEESA-2 suggest more benefit in de novo treatment naive patients, which is in contrast to MONARCH-3 data presented at ESMO 20...
If so, how do you incorporate GCSF into treatment of these patients?
What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?
If so, what assay would you use in this population?
Do we have data on TMB/PDL1 status of long-term survivors?
In light of recent trials showing no difference in outcomes with RT+cetuximab vs RT+IO, does this potentially lead us to use immunotherapy in cisplati...
Are you waiting for BCG to become available or are you using other bridging therapies such as pembrolizumab?
Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?
I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...
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?
Is this stage IS or IIA? Is chemotherapy or RT preferred?
What is your preferred agent (DOAC, warfarin, enoxaparin), and is periprocedural bridging necessary?
What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?
If considering systemic therapy, would you consider standard chemotherapy or use biomarker-directed therapy (e.g., imatinib if ckit+, larotrectinib/en...
Do you wait for radiographic progression? What is your preferred imaging modality for re-staging?
No actionable genetic alterations were identified for this patient. Would you consider FOLFOX + durva, or even single-agent durva?
What subsequent adjuvant therapy would you recommend?
Are there specific clinical factors, efficacy, or treatment tolerability issues that lead you to favor one agent over another?
How do you compare or ...
How do you decide between downstaging chemotherapy or upfront concurrent chemoradiotherapy? Both are listed as NCCN options.
How does your approach vary based on residual disease left at the time of surgery? Please specify your approach for the amount of residual disease at ...
Would you use immunotherapy based on the TOPAZ trial?
Would you recommend adjuvant chemotherapy for pT4 disease regardless of Oncotype score?
Would you favor the use of any particular biologics over others?
Has topical dapsone worked?
How would you treat such a patient?
For nodes just inferior to the celiac/SMA axis and no other distant metastatic disease? Stage is formally M1, but just barely. The patient is otherwis...
TOPAZ-1 trial allowed for up to 8 cycles of gem/cis. Were there differences in chemotherapy duration/# cycles between treatment groups? Does use of du...
For a patient, who has received SBRT & WBRT for CNS disease, is there a role of autoSCT and HD-chemo in this setting (no residual extra-CNS diseas...
No preop therapy; dMMR in poorly cohesive and mucinous carcinoma component, pMMR in tubular adenocarcinoma component
Would you offer it to a woman with a history of a provoked DVT?
What contraindications or concerns do you have in this scenario beyond assessing the Child Pugh Score?
What VAF burden would be considered significant prognostically or for treatment decisions?
If a patient previously received taxane-based chemotherapy for the initial cancer, is additional chemotherapy recommended or can HER2-directed and hor...
Is the marginal advantage of AC/T in 1-3 node positive outweighed by toxicity such as risk of cardiotoxicity and leukemia, regardless of RS?
Based on results of the recently published study.
Would you give additional treatment after surgery?
What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...
There have been reports of pembrolizumab leading to lichen planus (my understanding is lichen planus pathophysiology unclear, but potentially autoimmu...
If borderline resectable, can the TOPAZ regimen be considered for downstaging effects?
Can you use 50 mg BID if intolerant to 150 mg and 100 mg dosing? Any tips for side effect management to help patients stay on full duration?
MonarchE shows statistically significant improvement in IDFS and DRFS, but the magnitude of absolute benefit is modest (3-year IDFS and DRFS rates = 5...
C diff infection ruled out and CT abdomen pelvis shows diffuse enterocolitis extending far beyond the bowel-sparing IMRT radiotherapy field.
How much weight do you give to a hgb/hct threshold versus symptoms?
General recommendations on dose and management presuming unresectable.
Would surgical margins, evidence of angiolymphatic spread, number of lymph nodes removed during surgery inform your decision?
Would the checkpoint inhibitor still work if blocking only that portion of the inflammatory cascade as opposed to more global blockade with steroids?
Some payors prefer leuprolide acetate injectable suspension (eligard) for ovarian suppression. This is not the preparation that was used in SOFT/Text ...
What is the risk of pregnancy loss in absence of anticoagulation? What would you suggest if the patient had anticoagulation in prior pregnancies and r...
Traditionally these patients may have received chemotherapy prior to chemoRT.
What would you use after platinum/taxane/IO first line therapy?
If the patient has had prior prostate radiation and is not a surgical candidate, would you treat with systemic therapy alone?
What is the natural his...
It is not clear from CREATE-X whether radiation was before or after capecitabine. Is there a preferred approach?
What is the potential risk of immunotherapy toxicity in combining palliative RT in a patient already on immunotherapy?
Confirmed no urothelial carcinoma and muscle in specimen without involvement.
Is there a difference in efficacy if dose is given later point during the course of therapy?
Assuming chemotherapy is indicated because of the Oncotype score.
If not, how do you choose GVHD prophylaxis regimen? Is there a preference?
Would you avoid combination with TKI given possible higher risk of osteonecrosis of the jaw?
Would you give anthracycline based regimen in a patient with stage III TNBC?
Are there agents (eg. bendamustine) or modalities to avoid?
Does washout times prior to collection vary between modalities?
Based on this review (Melamed and Lee, PMID 31998289), patients with MS on several DMTs may be at higher risk for certain cancers. How does this play ...
In what situations would you use a neuroendocrine chemotherapy regimen over carboplatin+paclitaxel?
Majority of patients on MonarchE received neoadjuvant/adjuvant chemo.
Does the availability of abemaciclib impact your decision to offer chemo ...
How would you balance the OS benefit from TOPAZ-1 with the risks of immunotherapy in this or other high-risk populations?
Please specify your approach in elective and emergency surgical situations
Patient had estradiol level checked by her gynecologist due to recent irregular bleeding. Estradiol level was markedly elevated on initial testing (90...
Would you offer adjuvant atezolizumab, osimertinib, or neither? Both IMpower010 and ADAURA only had patients with EGFR exon 19 deletion or L858R mutat...
E.g. would you dose-reduce or continue at same dose?
Baseline ANC was in the normal range
Patient is young. Bilirubin normalizes when tucatinib is held, but again increases to grade 2 when it is restarted. Evaluation for hemolysis was negat...
Would you switch to VIP or TIP? If so, how many cycles?
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? ...
Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?
E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?
Any adjustments in terms of elective nodal coverage?
Do you look into their stage/risk to decide? Since patients can experience bone loss after stopping denosumab, how do you plan to discontinue?
Do you proceed with chemotherapy alone, neoadjuvant chemoRT, or definitive chemoRT? How do you communicate treatment intent to the patient?
Are there specific clinical or social scenarios that would preclude the use of this treatment?
In the KEYNOTE-775 study, what was the proportion of patients who had a recurrence free interval ≥1 year from platinum-based cytotoxic chemotherapy...
Are there any planned trials to compare lenvatinib + pembrolizumab and platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial can...
Does your approach to the number of cycles vary based on plan to include radiation therapy or presence of certain histopathologic features?
Anecdotally, I have seen more serious IRAEs in patients I'm treating with this regimen than anticipated. Is there higher risk with this drug combinati...
Do the results of the unplanned subset analysis of the PACIFIC trial showing no OS benefit in this population lean you away from consolidation?
i.e. similar to CKD anemia?
Very rare tumor with sparse literature
Would you use gem/docetaxel, anthracycline-based regimens or targeted therapies?
Would a negative dotatate PET change management for a patient for whom you were planning to start SSAs?
Should the dose still be given after completion of RT?
How reliable is somatic testing to detect an underlying germline predisposition?
For example, portion is seen above and below the mesorectal fascia. Do you feel comfortable treating as colon cancer with surgery upfront?
Would you extrapolate from the DESTINY-CRC01 study, even though RAS/RAF mutations were excluded?
Any role for adjuvant therapy? If so, with what agent?
In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...
Will you be using the IPSS-M in place of the IPSS-R? How will you be using IPSS-M in practice?
Is there concern for increased toxicity from erdafitinib following avelumab similar to osimertinib toxicity following pembrolizumab in NSCLC? Does FGF...
Are there certain patient or disease related factors that would lead you to incorporate lenvatinib + pembrolizumab earlier?
Would you use an FDG PET to further inform decision?
What steps should be taken when switching premenopausal women from tamoxifen to AI? In this case, the change is due to newly discovered endometrial th...
Does your answer change based on clinical or molecular risk factors, and if so how?
Does your answer change if MRD status after induction is unknown?
Infection is not part of the criteria for starting treatment both in UpToDate and in NCCN guidelines.
How do you determine whether to add intrathecal chemotherapy in patients with +CSF? Would your approach change for primary vs secondary CNS lymphoma?
Is skin testing advised prior to trialing alternative?
Would you treat with ADT if no metastatic disease?
Does absolute PSA (e.g. PSA<2) inform decision?
iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.
For example, if the primary breast tumor was HER2 IHC 1+, but a metastatic site was HER2 IHC 0, would you still recommend using T-DXd?
Will you chang...
Does ADT affect the results of a biopsy?
And if so which?
Louis et al., PMID 34185076
If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?
And if the tumor is MSI-H, does that alter your thoughts?
Additional imaging of the potential lesions, biopsy or assume negative given normal PSMA PET/CT.
Do you have a BMI threshold where you would convert to weight-based dosing over flat dosing? Are certain agents of more or less concern - PD-1, PD-L1,...
Ewing sarcoma of the right lung, status post bi-lobectomy and adjuvant VDC/IE, with recurrence 6 years in the right lung only. He has reached a cumula...
For this example, Ki-67 of 80, MSS, low TMB
Patient with initially stage IIIC right sided colon cancer s/p resection found to have metastatic disease prior to starting adjuvant therapy. MSI-H an...
What treatment margins/set-up/on-board imaging would you use?
Is there evidence that T-DXd crosses the blood-brain barrier?
Does specific mixed histology variant change recommendation?
If radiation is indicated, what dose would you use?
How do you assess if a patient may be a candidate for CAR-T cell therapy?
Prior studies have shown that there can be significant variation between grading pathologists as to which samples are defined as HER2 IHC +1 versus HE...
Patient is a post-menopausal woman with 4 lymph node mets that was strongly ER+/PR+, HER2-negative invasive ductal carcinoma with a high Ki-67 w...
Would you use a different endocrine therapy treatment? Would you use indicators other than Oncotype to guide the need for chemotherapy?
Do you routinely offer post-operative adjuvant radiation in addition to chemotherapy? Are the results of the recently published negative phase II...
Does this differ for a patient who had a longer remission before relapse?
When is this discussed? What are the common/less common toxicities you advise patients on? Are there best practices for coordination with referring on...
Given the results of ZUMA-7, TRANSFORM, and BELINDA - how does this inform your current practice? What are the currently approved indications for CAR-...
Does sequence matter?
Would you consider Dara-CyBorD or a MM triplet/quadruplet such as VRd or Dara-VRd?
Or would you proceed with cabazitaxel or other therapy? Initial chemo-hormonal therapy was ADT + Docetaxel x6 cycles.Docetaxel rechallenge at time of ...
Multiple positive nodes
Do you find the ibPFS endpoint sufficient to change practice for any or all patients, or will you await OS or other data/trials?
Specifically, how do you consider T-DXd use in setting of other antibody-drug conjugates (e.g. sacituzumab vedotin)? Are there any special considerati...
Do you offer more chemotherapy during this time interval?
ALC<200
- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...
What factors do you use to decide between weekly low-dose carboplatin and paclitaxel combination vs cisplatin based doublet, and do you routinelt...
Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?
Would you utilize radiation along with systemic therapy?
If a patient has a painful breast lesion in the setting of rapidly progressing systemic disease treated with weekly taxol (60 mg/m2), would you feel c...
Alternatively, is a biopsy of a metastatic bone lesion preferred in a patient who has already progressed on chemo and hormonal therapy and has bone-on...
Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...
The CALGB regimen is quite complicated.
Do somatotatin analogues work in this scenario?
Do you drop or adjust the temozolomide at any point, or rather continue to progression as long as temozolomide is well tolerated?
Would you still use ram/doce in 3rd or later lines after ram/pembro?
Did S1800a stratify by prior treatment response? Would you choose different 2L treatment for a patient who progresses rapidlly on pembro + platinum do...
How do you counsel patients on the available second line options?
Is there anything to differentiate the two agents? CNS penetration reportedly with adagrasib, FDA accelerated approval has been given with sotorasib.&...
For example, in a patient on steroids for CNS or spinal metastases - would you use IO-IO vs IO-TKI or TKI monotherapy?
How do you differentiate between olaparib, rucaparib, niraparib, talazoparib?
If yes, would you directly add olaparib at progression on abiraterone vs waiting to use abi/olaparib at a later line of therapy?
Is the benefit in PROpel driven by BRCA1/2 or ATM mutated tumors vs all comers?
Would you offer adjuvant radiation? (Dose? Target?) vs Salvage?
Would you add ADT? Would you add abiraterone?
Would the number of lymph nodes involv...
Would you consider using them in patients with CHEK2 mutations?
Do you have a preferred way to incorporate advanced androgen blockade vs chemo vs sip-T vs Lu-PSMA vs PARP vs other targeted agents?
- monarchE included <1% Stage IA and < 5% patients with no chemotherapy.Ex: 64 yo, ER/PR 95%, Ki67 20%, cT1c N0 but pT1c N1a at lumpectomy/SLN b...
For example, are you more likely to incorporate T-DXd earlier in sequence for 2+ vs 1+?
Is there any justification to change our approach in HER2-zer...
What precautions can be taken to limit infestation of the department?
Do you implement a treatment delay and if so how do you decide when...
Does the safety profile impact your choice significantly?
Does your first choice vary by disease histology?
Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...
What factors (i.e. timing from transplant, dose, prior therapy) impact your decision?
Considering the treatment of platinum resistant ovarian cancer as done in the AURELIA trial (Pujade-Lauraine et al., PMID 24637997).
What would your approach be in a patient with a mid-esophageal squamous cell carcinoma treated with chemoradiation therapy followed by surgery, with P...
Would you consider switching to a different regimen?
Secondary MF such as post-PV, for example.
Do you apply the same prognostic scoring systems?
My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...
Endocrine therapy is usually not indicated for DCIS s/p bilateral mastectomy, but would the fact that residual tissue (nipple-sparing) alter your deci...
How often are you scanning the brain and what is your trigger to treat?
We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to ach...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...
Would you consider the BEACON regimen (i.e., encorafenib/binimetinib + cetuximab) in this setting?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
Is prior Ra-223 a contraindication for treatment?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...
Patient has ED unresponsive to cialis/viagra; would you recommend testosterone replacement therapy?
No evidence of palpable splenomegaly, normal hematocrit and platelet count
If you do recommend adjuvant therapy, what regimen would you use?
Do the results change your clinical practice?
Which patients would you recommend active surveillance alone, a less morbid procedure such as enucleation, or a Whipple surgery? How does age influenc...
If so, what would you consider ordering?
The said patient has been on Imatinib for 2.5 years and is In MMR. Last rt-PCR was 0.04.
Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT
How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...
In patients with prior perioperative immunotherapy with early relapse, would re-introduction of immunotherapy be reasonable with high TMB?
Is there role for IVIG? Would you alter the dose or time course of steroid therapy?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling?
Given POLE mutation status can currently o...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
At initial diagnosis she had T1cN0 disease treated with lumpectomy and SLNB followed by 12 weeks of paclitaxel with 1 year of trastuzumab.
I recently saw a patient who had been treated with concurrent pembrolizumab-RT elsewhere. Is this an acceptable practice outside the setting of a clin...
How do you operationalize finding biomarker information in EHRs/testing portals, either for your own patients or if they have changed providers?
If a...
Do you have a preference for bicalutamide? Can abiraterone be used instead?
Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...
Presuming strong indication for ASA - eg history of NSTEMI
Do you perceive a difference between somatic vs germline BRCA mutations?
What if Medical Oncology wants to give more systemic therapy and further delay XRT start date?What should we be telling the Breast/Plastic surgeon/Med...
If you do not use prophylaxis, what skin care strategy do you employ?
At what PSA would you become suspicious for biochemical recurrence and pursue restaging? Is there a threshold value?
What imaging modality would you ...
NCCN states to consider adjuvant chemotherapy similar to muscle invasive bladder cancer in this scenario, but one would avert adjuvant chemotherapy in...
Would you give trastuzumab every 2 or 3 weeks, pembrolizumab every 3 or 6 weeks?
Would you use it for initial staging or at time of biochemical recurrence?
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
Would you debulk with neoadjuvant therapy to achieve resectability?
Would you consider gem+Abraxane to avoid FOLFIRINOX toxicity in a small, node-negative tumor?
Would you consider definitive local therapy (surgery, radiation?) if she achieved a good response to initial systemic therapy?
Would you include a CDK4/6 inhibitor knowing the patient doesn't meet criteria of monarchE trial but still is Stage IV?
Would you ever consider using these in sequence?
Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?
Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2...
eg. eGFR < 30 ml
Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.
If radiation, what type? EBRT or brachytherapy? Any other techniques you would recommend, such as rectal balloon?
In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?
Assuming minimal toxicities except fatigue from long, recurrent infusions.
Is there evidence or experience to support use of targeted therapy for KRAS G12C mutated NSCLC as first line in place of chemotherapy?
OlympiA trial did not include her2+ breast cancer.
Do you use specific PDL-1 assays for each approach?
Any data to support this combination for non-clear cell RCC?
The Intergroup 0162 trial did not demonstrate noninferiority, although OS difference only 5.1 vs. 5.8 yrs. Would pattern of spread affect your d...
The OncotypeDx score was 51 in this scenario.
Residual GEJ mass and progression in local lymph nodes after carbo+taxol chemoRT without distant metastases.
Stage is cT4N2M0.
If not, what instructions do you give to patients regarding checking temperature at home/return precautions?
ER low being 1-9% (<10%), PR 20%
If so, would you adjust 5-FU dosing?
Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.
If so, what regimen do you utilize?
Would you proceed with KEYNOTE 522 regimen and add anti-HER2 targeted therapy adjuvantly?
What would you offer a premenopausal woman with clinical T2N1 ER positive breast cancer for adjuvant therapy after she achieves a pathologic complete ...
What do you do if LFTs are elevated after one dose of neoadjuvant TCHP (highest ALT >13 times upper limit of normal, normal bilirubin) with prior n...
Would T or N group change your recommendation?
Would your thinking change if the patient continues to be NED after an unplanned chemo break, e.g. for insurance issues?
Would you consider the discontinuation of either anti-HER2 agent or both?
I have a patient in her 60s with CHEK2 mutation, diagnosed with bilateral breast cancer. Lumpectomy showed b/l tumors <10mm both ER/PR+, HER2-, but...
Does measuring serum free-light chains make a 24-hour UPEP unnecessary?
Is it necessary to test CPS given the FDA approvals are not contingent on CPS %?
If you do test, do you check 28-8 (nivolumab), 22C3 (pembroliz...
Would you treat with adjuvant chemotherapy or immunotherapy?
Are there data for using checkpoint inhibitors in this setting?
Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...
Weekly (20 mg/m2 D1, D2) and q 3 wks (70 mg/m2 x 3c or 100 mg/m2 x 3c) regimens have all been listed as acceptable. For reference, RTOG 97&...
The trial inclusion criteria was essentially "docetaxel candidate per the treating oncologist"
If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology?
Would you attempt targeted therapy or would you choose chemo-immunotherapy?
What agents would have sufficient efficacy overlap to treat both?
Would the timing of the relapse (eg within 6 months) impact your decision making?
Assuming no overlap with prior RT doses, would a history of necrosis cause you to hypofractionate rather than deliver single fraction SRS?
ET is JAK2+
Is there a concern regarding rarer side effect emergence (cardiac, bone, muscle, cognitive) of long term exposure to "maximal" androgen deprivation? I...
Should these cancers be treated like hormone positive breast cancer or triple negative breast cancer?
She is pre menopausal with cT1c grade 2 disease...
What scenarios would you do second neoadjuvant treatment vs surgery?
Do you stop therapy at 2 years or continue until progression of disease?
Is it reasonable to dose de-escalate since survival will likely depend on the metastatic lung cancer?
Would you give R-CHOP without knowing if there was use of prior anthracycline?
Pathology did not meet criteria for a well-differentiated nor dedifferentiated liposarcoma, nor a spindle cell sarcoma.
The forest plot from CheckMate 274 did not show a benefit for such patients?
How would you select between adjuvant chemotherapy and adjuvant nivoluma...
How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...
How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?
Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...
VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked.
If said patient was known to be gBRCA mutated, would you use neoadjuvant chemotherapy to enable adjuvant olaparib for those that did not have a pCR? &...
Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outco...
Do you go by FDA approval alone, or incorporate other data into your treatment decisions? How do you view updated recent presentation of CM-649 ...
Are there meaningful differences in the CHECKMATE 649 and KEYNOTE 590 studies to guide this decision?
Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full do...
Would you consider boosting the nodes? What dose? Would this change your recommendation for length of ADT?
Would you consider chemotherapy, androgen blockade or triple therapy (chemo and AR targeting)?
Ref: Geyer et al, Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and hi...
Do you have a preferred sequence of therapies for diffuse skin limited MF?
What would you consider as contra-indications to Cladribine?
Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation.
Would you consider re-challenging with a different TKI?
How much of the benefit of adjuvant chemotherapy do you expect to be due to ovarian function suppression due to the chemotherapy?
What is the impact among patients and providers?
Has your documentation been adjusted now that patients can readily review?
Previously untreated
Is dose modification of docetaxel necessary with Gilbert's when giving TCHP?
Which agents would you select and for how long would you treat them?
NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP?
What ...
Patient is young and reoccurrence is one year after initial diagnosis of T1cN0 ER/PR positive, HER2-negative breast cancer treated with mastectomy, bu...
With conflicting data from the EORTC RCT and the Sarcoma meta-analysis collaboration, what factors determine when you would offer adjuvant chemotherap...
In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...
When chemotherapy is indicated in early stage soft tissue sarcoma, would you prefer to use AD or AI?
AD: doxorubicin + dacarbazine
AI: doxorubicin + ifosfamide
ER 95%
Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis.
Would you avoid imid's given reported association with transplant rejection?
For pts w/ eGFR between 30-60
What combination of fluoropyrimidine, PD-1 inhibitor, or trastuzumab do you use?
Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?
HR+ = ER 34%, PR 0%
RCB2 = no nodal involvement
In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...
Would you restart hormonal therapy in a patient with a new diagnosis of LCIS 2 years after they have completed 5 yrs of AI for stage 1A IDC in the oth...
Would pegylated interferon be preferred?
Does the degree of resectability affect your management?
Patient underwent mastectomy for DCIS in the setting of previous lumpectomy and adjuvant radiation for the invasive breast cancer.
How would you modify therapy for a younger, fit patient versus an older, frail patient?
Lesions in stomach, small intestine, colon resulting in bleed...
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
NCCN lists PCV as category 1 (and now with analysis in Abstract 2002 from ASCO 2019 showing benefit in IDH mutated), and temozolomide as 2B, yet temoz...
HCG 850, AFP normal, LDH ~500 pre-orchiectomy.
If tumor thrombus, would you favor 4c of BEP? Would you try biopsy it? How common is IVC thrombu...
Are there contraindications to drugs like oxaliplatin or abraxane?
Does chronicity or severity of the patient's underlying symptoms play a role in yo...
What factors may favor RET inhibition versus observation?
E.g. One NSCLC with N2 disease, and additional ipsilateral small nodule that is a biopsy-proven second primary. When do you consider SBRT to a nodule ...
Can atezo be used even if patient has completed chemotherapy preoperatively?
The patient is intolerant to trastuzumab deruxtecan. In which clinical settings would you consider reintroduction of TDM1?
Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...
Based on the results of the phase 2GORTEC study reference; Sun et al., PMID 32758455.
How would you proceed given that cT1c didn't meet the study criteria?
Currently on C2 of doxorubicin/cylophosphomide/pembro. Would you expedite surgery?
KEYNOTE 811 showed improved response rate with the addition of pembrolizumab, but very few patients in this study had low PDL1.
Would the results of PEACE-1 trial justify this?
Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence?
Given multidisciplinary discussion has occurred and SBRT has been agreed upon as local therapy, how do you approach the presence of moderate/significa...
Would you always offer an FGFR inhibitor as second line therapy in these patients instead of a second line chemotherapy regimen?
Should this be sent on initial biopsy or on surgical pathology? What if an initially high risk patient has good risk findings post-operatively?What ha...
Are you offering patients beta-emitters (Samarium-153 lexidronam, strontium-89) to any patients?
Is a 3 month delay too long in someone who had postoperative complications?
i.e. treatment-refractory PV, prior to progression to PMF or AML
Are there clinical features (post-op PSA, Decipher score, pN+, pT3, etc) that would inform your decision?
Assume normal cardiac function and no obvious co-morbidities. No anthracycline previously due to age alone. The patient’s BRCA status is unknown...
If an older patient is only fit enough for single agent fluoropyrimidine therapy, would you prefer to give this neoadjuvantly or adjuvantly?
40 yo adult patient with a~6cm mass with concern for skull base bony involvement (group III and stage III, no nodal involvement )
Would you ever consider adjuvant chemotherapy rather than adjuvant immunotherapy after the publication of the CM-577 results? If so, in which pop...
For instance, the foci found were pN1mi (0.5 mm) deposit in 1st SNL (1/13 LN) and mpT1mi (8 foci). Would you consider single or dual anti-HER2 blockad...
Is there any utility in monitoring serum tamoxifen levels?
Do you worry about false negatives on PET, CT, MRI if ADT is started before the scan? Scheduling scans can sometimes book 2-4 weeks out.
Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?
For instance, ER/PR >1% but <10% and Ki67 >50%
Do you allow pre-RT treatment with the CDK 4/6i and hold during RT, vs. allow concurrent with breast/chest wall RT, vs. delay starting CDK 4/6i until ...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
If a patient is asymptomatic at presentation, how do you incorporate local treatment options (RT/surgery) and when?
If multi-agent systemic therapy, i.e. FOLFIRINOX, is also planned, is there a preferred sequence of therapies?
Does the 2020 approval of Nivolumab and Ipilimumab for mNSCLC with PDL1 >1% impact your decision?
e.g. DITP from eptifibatide after a cardiac intervention
Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...
How does cirrhosis and/or underlying thrombophilia affect your decision?
IVIG, TPO, or other agents?
Would you treat with PARP inhibitor or Check-Point Inhibitor?
Patient is ypT2N1
Would you recommend 6 months of FOLFOX or just surveillance?
Patient has already received neo/adjuvant treatment with AC, paclitaxel, capecitabine, docetaxel, and carboplatin.
Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...
Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?
Do you consider size > 2cm, visceral pleural invasion or vascular invasion as indications for cisplatin-based chemotherapy?
Patient previously received neoadjuvant ddAC-T with residual disease at surgery, followed by adjuvant capecitabine which was completed 2 months prior ...
Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient ha...
Does not meet Olympia trial indication
For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...
In high-risk, node-positive HR+ Her-2 neg breast cancer patients who received neoadjuvant chemotherapy with residual disease, would you give capecitab...
Received optimal pre-op denosumab; only option is now amputation
How do you manage low libido in women with breast cancer on endocrine therapy? Other than managing vaginal dryness/dyspareunia, if just a desire/libid...
Resected small bilateral tonsil SCC & base of tongue SCC.
The patient received 6 cycles of BEP 30 years ago for testicular cancer, and suffers fr...
Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?
Is Crohn's diagnosis an absolute contraindication for immunotherapy?
Conversion tables suggest starting the new drug with the next dose but do not seem to answer this question (i.e. if switching from rivaroxaban 20 mg d...
G1 neuropathy and G3 neutropenia were observed with cycle 12 FOLFOX + bev.
Would you reintroduce oxali at a lower dose or switch to irinotecan+EGFRi ...
Has your practice changed based on the randomized, phase 3 study showing prophylactic gabapentin is not effective?
Please share your thoughts and exp...
For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.
What about for a patient with complete radiographic response who declines surgical management?
How do you decide how long to continue?
Will degree of PD-L1 status impact your decision?
Would you ever offer to stage IB patients as per study enrollment? Do AJCC v8 staging guideli...
Would you consider second line nivo-ipi for patients with a specific histology or tumor PD-L1 expression?
How would you manage endocrine therapy 7 years after the original ER+/PR+/HER2- IDC, while on adjuvant tamoxifen/OFS develops a contralateral ER+/PR+/...
If you had a patient with otherwise average risk stage 2 colon cancer but had signet ring or mucinous components to their pathology, would this sway y...
How do you maintain a trusting relationship with your patients when this relapse occurs?
What about changing standard regimens for TCL with HLH?
Does PDL1 status impact your decision?
For patients who were not neoadjuvantly on pembrolizumab, is it safe to initiate it concurrently with radiation?
Are there factors to explain why MonarchE was a positive study and PALLAS was not?
Of note - the tumor tissue biopsy NGS did not show KRAS or BRAF mutations. Microsatellite stable. Patient received first line FOLFOXIRI + Avastin .
Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.
Does severity of dementia play a factor in recommending ADT?
For patients who have already undergone trimodality treatment, what time frame do you consider for adjuvant IO?
NGS of TURBT specimen had high TMB (18 Muts/Mb).
Do you observe, offer adjuvant pembrolizumab, or give a first-line metastatic regimen (IO/IO or IO/TKI)? Does your recommendation vary based on risk c...
How do HPV-positive patients respond to ICI compared to HPV-negative in your experience?
e.g. IS < 0.002% by qPCR
Is there a certain time interval where you would feel comfortable to rechallenge with immunotherapy at recurrence (6m vs 1y vs 2y?) Does degree of PDL...
Are the experts convinced by DFS when the OS is immature?
How many in BSC arm went on to receive immunotherapy and was that adequate?
What would you do for a patient with a non-EGFR actionable mutation?IMpower010 included EGFR and ALK mutated NSCLC. Is there any concern in the use of...
How does your treatment approach vary depending on the underlying predisposition?
In elderly patients (>70-75) with a good performance status, does the risk of neurocognitive decline outweigh the benefit of PCI?
High-risk criteria meaning >4 positive nodes and Ki67 >20%
CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?
Is a repeatedly abnormal serum immunofixation all it takes for MGUS?
In a patient with a history of VTE (now off anticoagulants), is it safe to administer fulvestrant?
Do you initially start with systemic therapy alone or do you proceed directly to chemo-radiation?
Given arguments exist between the FDA and ASCO, where do you stand?
Does VAF <1% make you want to do a BM biopsy for confirmation?
Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as ca...
Would you stop all treatment after 4 cycles, or proceed with pembrolizumab alone, and would PD-L1 expression factor into your decision?
Would you do consolidation radiation or active surveillance?
Would presence of variant histology change your recommendation?
This involves the primary site responding but progression with new bone marrow involvement with resulting cytopenias.
Given sacituzumab is an antibody drug conjugate of the active metabolite of irinotecan
In light of updated monarchE trial data, it seems a SLNB would help delineate adjuvant treatment options in this population. However, Choosing Wisely ...
Grade 2 DCIS, post mastectomy with negative margins, sentinel nodes negative
This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...
Is there any role for radiation therapy alone?
How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?
If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...
PSA rose from 25 to 30 ng/mL over 6 months on darolutamide for M0 CRPC, prompting scans which showed oligometastatic disease to bone, not amenable to ...
If yes, how many cycles?
For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...
How do you weigh the various efficacy endpoints in the trials of novel combinations in ccRCC?
Are there specific clinical populations that you ...
How and when do you plan to perform HER2 testing in patients with NSCLC?
Many of the patients on ASCENT trial were heavily pre-treated and require growth factors. With the day 1,8 treatment cycle, is there a way to minimize...
Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?
If so, when do you consider this?
Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?
Do you give adjuvant chemotherapy to a patient with a completely resected mediastinal pure seminoma?
What is your approach to a patient who underwent surgery for what was thought to be a thymoma, but ended up being a pure seminoma? No disease elsewher...
How would need for anticoagulation change your consideration?
Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?
After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...
For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...
How do you decide if it may be safe to continue immunotherapy?
What would be the treatment duration if using oral TKI?
How does trastuzumab deruxtecan compare to other HER2 targeted strategies?
What clinical criteria would make you prefer TORS as the initial treatment approach?
What factors would influence your approach?
Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...
BRCA mutant, ER/PR positive and HER2 positive T2N0M0 breast cancer diagnosed 5 years ago, treated with bilateral mastectomy, BSO, 1 year of adjuvant a...
Does disease response (CR vs PR vs SD) or IO-TKI combination factor into your consideration?
CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.
Ki67 = 90% with multiple small nodes on PET scan and normal CBC
Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?
Patient received full dose concurrent cis + RT previously.
How do you stage? Like nasopharynx or p16+ oropharynx?
Do you treat it like npx ca with chemo xrt + adj chemo or like opx p16+ with definitive chemo ...
Please also discuss the type and duration of anticoagulation.
For patients with hormone negative breast cancer and HER2 positive only by copy number, do you give TDM1 for residual disease or capecitabine?
No oncotype was sent on the original breast cancer.
How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...
Would you think differently about chemotherapy based on %teratoma or size of lymph nodes vs number of lymph nodes (eg. multiple small LN vs single 2-5...
Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?
Do you feel the dosing used in...
If not carboplatin, would you recommend nivolumab instead?
When is the optimal time (if ever) for cytoreductive nephrectomy?
Do you add on additional cycles of 5-FU/capecitabine to go beyond 3 months of treatment? Or would you stop at 3 months of therapy, dropping the oxalip...
What is your general rationale for selecting from available options?
If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?
Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? ...
Are there specific patient cohorts in whom you will more preferentially use sacituzumab govitecan?
Can data from ASCENT be applied to patients with C...
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 topotecan, lurbinectedin, or another agent given the CNS progression as well?
How do you interpret the comparative efficacy in squamous cell subsets among the CM vs KN vs EMPOWER studies?
Based on the SCORAD III trial, will you now be treating patients with spinal cord compression with single-fraction radiotherapy? Is there anyone ...
Or with other available IO/TKI combinations should this be strictly reserved for intermediate/high risk patients only?
If selecting IO/TKI, do ...
Or what is your preferred regimen for stage IV ccRCC following progression on IO/IO?
Has anyone tried this approach with success?
Would you use immunosuppression in patients several years after curative treatment for melanoma?
Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...
If you do recommend resuming carfilzomib, what dose and frequency would you use?
If any clinical benefit (ie. CR, PR or SD) would you consider switch maintenance avelumab, surveillance until progression, or an alternate regimen?
Molecular profiling revealed no targetable alterations, however tumor mutational burden was >10 mut/Mb.
Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...
Largest invasive focus is 0.4mm
What about multiple anaplastic plasmacytoma without bone marrow involvement?
Do you select treatment based on toxicity profile since efficacy of regimens will likely never be directly compared?
Are there QOL indices that can ...
Do you try to keep Hb> 10 or 12? Or somewhere in between?
Patient has progression of liver metastases while on pembrolzumab/axitinib. ECOG PS 1 and limited comorbidities.
Are there differences in outcome among the BRCA mutated subgroup, or others?
Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...
To what degree do you factor in patient preference when choosing among available treatments? Are there features of each regimen that you emphasize in ...
What would be your radiation volumes/dose and choice of chemotherapy?
Or would you restrict such treatment to patients with known pathogenic germline BRCA mutations?
Given ductal histology, is docetaxel preferred over NHT?
Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...
For example, does a higher recurrence score influence your choice of TC versus AC-T? Or your choice to add ovarian suppression to a premenopausa...
E.g. disease burden causing airway or vascular compression.
Ki-67 > 95%, PET-CT negative for any additional disease.
Are there other high or very high risk features that would also contribute to your decision making?
CNS recurrence occurred within two years of prior neoadjuvant therapy
If blood counts are sustained, do you continue or delay?
Do you treat with radiation therapy and what dose do you use? What dose do you accept to the duodenum?
Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...
In which situations would you consider this a reasonable treatment option?
NSABP B51 and B52 specifically prohibit this.
Lymph node is 4.5cm with no reported ECE. Does the size of the LN or presence or absence of ECE affect your decision?
Would you offer adjuvant RT or chemotherapy? If so, what chemotherapy would you prefer?
Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...
Do you routinely recommend any dietary changes or is the evidence not convincing?
Are there other supportive care interventions that would otherwise be covered by hospice?
Should patients with moderate penetrance pathogenic variants be managed similar to BRCA patients and consider risk reducing contralateral mastectomy?&...
Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...
Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...
What about a higher penetrance PV such as PALB2?
See JCO OGR 8/2021 by @Mark E. Robson discussing management of non-BRCA pathogenic va...
Would you prioritize the head and neck cancer or treat the lung cancer first with SBRT to take care of it first? How about if there is mediastinal inv...
GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease. Prostate MRI pending.
Would your decision be influenced by whether a pathologic complete response was attained?
Would you elect for concurrent chemoRT or RT alone?
In a scenario where patient's other clinical/familial risk does not sufficiently qualify them?
See JCO OGR 8/2021 by @Mark E. Robson discussing manag...
The recommended concurrent chemotherapy regimens (cisplatin/paclitaxel and cisplatin/FU) in NCCN are based on BID fractionation of radiation as in RTO...
Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?
Specifically do we know by how much each intervention reduces the risk of developing MBC or increase breast cancer specific as well as overall surviva...
Insurance won't pay for harvesting if the transplant is not done within a year.
The patient initially received definitive therapy with AC-T and RT to the breast as well as RT to a solitary bone lesion. She has been on AI for the l...
Does this data change your preferred first line treatment regimens when considering other options such as mAb combos, cytotoxic chemotherapy?
Is the non-inferiority margin of 1.429 sufficient, how was this selected?
Is the open label (rather than blinded) study design of any concern?
Is th...
Can experts comment on fungal pneumonia risk with individual BTK inhibitors as seen in ELEVATE-RR and whether this impacts their management decisions?
Do you feel comfortable with BTK inhibitors in these patients?
In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...
Such as patients with specific underlying cardiovascular risk factors or other medical comorbidities?
Would you use MRD status to guide your decision making?
Can the ipsilateral supraclavicular field and bilateral hilar nodes still be limited stage?
Patient previously had prostatectomy and salvage RT
How would non-regional adenopathy change management? What about poor surgical candidacy?
Is leukocytosis and thrombocytosis alone an indication for treatment?
If so, venetoclax/dexamethasone by itself or do you include a PI?
The patient was started on a beta blocker, as this is standard in the area.
Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?
Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?
Would you consider using infigratinib after progression on pemigatinib?
Would you recommend surgery first or neoadjuvant therapy such as concurrent cisplatin/RT or another regimen?
The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting.
In the case of subtle single lineage dysplasia with normal cytogenetics, do you routinely perform NGS testing for CHIP-type clonal mutations?
Do you ...
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
How do you balance the risk of an EGFR flare while holding osimertinib vs the risk of pneumonitis when continuing?
The patient has an intact uterus and has failed all available AI therapies due to multiple intolerances.
Did you change your practice given the SRE results in the control arm of EORTC 1333 at ASCO 2021?
When using bisphosphonates or denosumab, what dosin...
What if the patient is no longer responding to steroids?
Do you allow patients with breast cancer on tamoxifen to use black cohosh?
Would radical prostatectomy and PLND suffice or would a cystectomy be warranted (even in the absence of bladder involvement) as well?
Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...
Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.
If no direct invasion into prostate from bladder or urethra, is there any role for systemic therapy?
Any role for surgical extirpation vs systemic treatment?
Is there data that it actually helps?
Do your recommendations differ between those who receive ABVD and escalated BEACOPP?
Do you recommend consultation with fertility specialists for all...
When do you use mitotane?
Is there any role for denosumab? How do you counsel patients regarding the benefit of bisphosphonates on breast cancer outcomes?
Especially with the current drug shortage of nelarabine.
ER <1%; PR 45%, Her2 negative by IHC and FISH. Grade 3, Ki67: 80%.
Patient was on tamoxifen when progression occurred; unable to tolerate adjuvant AI.
How would this affect adjuvant radiation plan in breast conservation therapy patients and mastectomy patients?
Will you incorporate carboplatin into the backbone as it was done in the KEYNOTE trial?
Patient had an initial tumor response to TCHP, but still had significant residual disease present, including positive lymph nodes and residual breast ...
What therapy would you offer if the patient had a baseline grade 2 neuropathy?
While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...
In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...
Is it safe to challenge with other CD20 monoclonal antibodies such as obinutuzumab?
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...
What determines duration of therapy in patients who achieve stable disease or no evidence of disease on imaging?
Is there any role for radiation in t...
This question arises from a case of a patient with multifocal nodular melanoma with circumferential involvement of the perianal region.
Or would you recommend upfront resection as long as borderline resectable?
Do you have a specific age cutoff?
The patient was started on chemoimmunotherapy 3 years ago. Recent scans show small treated brain metastases (s/p RT several years ago) and no disease ...
Presuming that work-up for cardioembolic sources is negative, how would you proceed?
Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?
Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?
Would appreciate expert opinion on when to reimage and when to restart anticoagulation depending on findings.
Patient is <60 years old
Patient with T2N1 disease and isolated liver metastases. Axilla and liver completely responded to chemo + IO, but limited residual breast enhancement ...
Would there be any benefit to surgery in a healthy/good PS patient? There is so little data on pulmonary atypical carcinoid and radiation respons...
E.g. for a 7cm central NSCLC, would you offer 8 fx SBRT or ChemoRT? Patient is not a surgical candidate.
One example of this scenario would be a patient receiving consolidative durvalumab after chemoRT for stage III NSCLC who develops a new peripheral lun...
AIM or doxorubicin/cisplatin? Would you recommend adding methotrexate?
Would your treatment approach be similar for a patient with suboptimal performance status?
If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?
Has the recently published interim analysis of the CATNON trial altered your utilization of temozolomide?Does IDH status change your treatment approac...
Is this a reason to start hydrea? Would you give oral iron after adequate control on hydrea?
Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?
Length of temozolomide course when given with adjuvant radiotherapy
How would you approach a patient who is intolerant of AI and develops thrombosis while on SERM?
If not, how often do you repeat pelvic imaging?
Does the answer change on proximity/distance from breast (i.e. what if pelvis or lower extremity?)
No sentinel lymph node biopsy was performed
How would the use of Oncotype guide your management in the neoadjuvant setting?
Based on pCR and EFS data from KEYNOTE 522 and recent FDA approval?
Can adjuvant durvalumab or other I/O or osimertinib (if EGFR+) be considered?
While there are many factors involving:- type (DVT vs PE, unprovoked vs provoked) and severity of venous thromboembolism (VTE) size- duration of antic...
Do prior treatments for mHSPC change your thinking on whether or not to use sipuleucel-T?
Patient has not had any prior systemic treatment and is cisplatin-eligible.
Although a small subset, do you generally move these patients directly on to chemotherapy +/- immunotherapy or does it depend on the specific mutation...
If all work-up including peripheral flow, bone marrow biopsy, PET-CT returns negative, what additional management (if any) would be recommended?
When do you start treatment in this case?
Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...
In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?
Given that risk definitions are based on size, mitotic activity, location and not necessarily genetics/biology, would an otherwise low-risk GIST, who ...
What factors make you more likely to offer or omit chemotherapy?
What is the role for adjuvant versus neoadjuvant chemotherapy?
While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...
Would active vasculitis present a contraindication to therapy?
What doses and constraints do you use?
If a patient has a large femoral metastasis that cannot be resected, but is to be stabilized with ORIF which will push tumor into the distal end of th...
In reviewing the data, LDH does not upstage to intermediate risk but those patients tend to do worse.
Would one treat this patient as intermediate ri...
Given that olaparib was given within 12 weeks of completion of standard adjuvant therapy on the trial, will you still offer it to patients outside tha...
Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)?
Would this change with someone who is more fit vs more frail?
Patient has been treated with carbo/etop/atezo, WBRT, and maintenance atezo. Currently on high-dose steroids. Would you consider hospice or trial chem...
Results of AHOD1331 are not yet known, but adults have started using Brentuximab upfront for high risk patients
Patient with hepC and advanced cirrhosis with multiple liver mets, but may be able to tolerate oral TKI or PARP. Would you offer this or focus on hosp...
Such as patients who are frail, elderly, renally impaired?
Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...
How does age play a role in this decision? If you do intensify therapy, how do you explain the negative results of CALGB/Alliance 50303?
What adjuvant therapies would you recommend?
If starting with entrectinib would you still try crizotinib, or move to lorlatinib or another novel TKI? Or change entirely to chemotherapy, immunothe...
Are there any clinical features that can inform etiology/which medication to hold?
No targetable mutations detected
How often do you monitor ADAMTS-13 levels off therapy?
For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?
Is there any role of radiation therapy for these patient for symptomatic relief?
Performance status is excellent. Second surgical opinion has also confirmed need for amputation, as the recurrence is now breaching intra and extra ar...
Negative surgical margin, normal post-orchiectomy markers and no lymph node and distant metastasis
In addition to ADT, would you treat with abiraterone, enzalutamide or docetaxel? Or other treatment - platinum/taxane?
Osteosarcoma conventional type of the distal right femur. cT1N0M0 G3 Stage IIA on MAP protocol completed NACT followed by surgery on radical resection...
The patient was diagnosed with Ewing’s Sarcoma at the age of 10 and completed 6 cycles of vincristine, ifosfamide, etoposide, adriamycin 75 mg/m...
How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...
How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features?
Do you still consider CyBorD or R...
Is DFS benefit in KN-564 in ASCO2021 sufficient evidence to change practice?
History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis.
Vaginal tumor completely resp...
e.g. a genetic mutation picked up through a family member
In patients who have completed all adjuvant therapy. Similar test to what is available for stage 2 and 3 colon cancer patients by Natera.
Do any studies support this rationale? Does the presence of a somatic vs germline BRCA mutation impact your decision?
In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?
Would you extrapolate treatment from the paradigm of anal SCC?
Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...
Post-treatment PET/CT and MRI Pelvis at 3 months showed near resolution of iliac and inguinal lymphadenopathy but new avid retroperitoneal lymph nodes...
Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear.
In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.
How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring?
What is your experience of subse...
Is your decision swayed by RB1 status or by duration since platinum therapy?
MiT subfamily translocations = TFE3, TFEB, TFC, or MiTF
Colloid is a rare histologic subtype and considered to have more favorable outcomes compared with usual ductal adenocarcinoma, but no dedicated prospe...
Patient is on fulvestrant+CDK 4/6 inhibitor and with NED for 5 years. In which cases would you consider stopping CDK 4/6 inhibitor?
Given long term data from Keynote 052 for pembrolizumab presented at ASCO 2021.
What factors impact your treatment decisions?
For cis-ineligible PD-...
Gleason 4+3=7 and PSA 4
Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.
Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...
If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...
NCCN guideline V4.2021 DLBCL page BCEL-3 states stage I-II, bulky >= 7.5cm should be treated with 6 cycles of RCHOP, but most bone lymphoma studies...
This patient had resection of the primary, requiring multiple resections to obtain an R0 resection, followed by adjuvant radiation to the primary. The...
Are there scenarios where you would use a higher dose of lenalidomide in a novel doublet or triplet (eg. relapse on lenalidomide maintenance)?
Given recent data in Blood (Moik et al, 2021), and the potentially overlapping risks with other clinical factors associated with NSCLC.
Will you alte...
How would your management differ in pre- and post-menopausal females?
Would your approach differ if patient is premenopausal or postmenopausal?
Do you discuss patient visits and associated costs when making this decision?
Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?
There are many delivery methods of cannabis, including smoking, ingesting it through food, or inhaling it. Is one method more effective than another?
We usually recommend copper IUDs, but that's not feasible in all women.
Is there a role for empiric antibiotics if there is history of opportunistic infection?
Would you test for resistance mutations in this setting, using blood-based sample if no progression outside CNS?
<40y/o female w/ initial biopsy showing G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 copies/nucleus.)...
Are there other adverse features aside from seminal vesicle invasion, positive margins, or extraprostatic extension that you consider?
Would you radiate? Surgery? Chemo? Follow with short interval scans?
How would size of adenopathy (e.g. <2cm vs larger) and time of recurrence (wi...
Lung is biopsy proven met cervix, SBRT is planned.
Patient did not previously receive para-aortic radiation. Considering RT vs RT + chemo vs chemo alone
Are there any effective non-pharm or pharm interventions?
Does your decision for 3 vs 6 months of treatment change for low risk stage III colon cancer?
Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...
Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...
Biopsy of other sites is more consistent with carcinoid tumor.
Is chemoradiation a viable strategy in osteosarcoma?
Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...
s/p optimal debulking.
If this was an early-stage cancer would it change your adjuvant therapy recommendations?
Healthy 67 y/o woman, 1.5cm tumor, grade 3
Would you consider induction: TPF vs cis/gem or would you proceed with chemoradiation with cis/RT and consider adjuvant cis/5FU?
eg LVI/PNI, poorly differentiated? If so, what regimen and for how long?
Does the rate of progression of IgM influence your decision?
If so, how do you sequence it? Would you consider before adjuvant radiation vs concurrent with adjuvant (chemo)radiation vs after adjuvant radiation? ...
Given antiangiogenic activity, is any TKI an option?
Does having a concurrent consumptive process e.g. DIC change your management?
If confirmed neuroendocrine and PD-L1 pending, how would you treat?
Any special precautions needed?
Has the recent approval of atezolizumab/bevacizumab impacted your decision making?
Eg T2N2 who required management of cardiac comorbidities leading to months-long delay but scans are still clear.
Are you routinely performing molecular sequencing? Would you modify your treatment approach in first or later lines based on PDL1 status?
Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?
Since desmoid tumors are associated with high estrogen states, is there an optimal contraception approach? Is there an optimal time for pregnancy? How...
When would you consider utilizing autologous SCT in those with a PR or SD?
Is there a potential role for BCMA-directed CAR-T or bispecific therapy in...
Such as dysgeusia, headache, rash, fatigue, etc
In this case, nivo/ipi discontinued for immune-related arthralgias requiring steroids and an anti-TNFa agent, now off all immunosuppression.
Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative.
PET confirmed isolated recurrence
Would you recommend radiation, systemic therapy alone, or chemoRT? What about if this recurrence occurred during or shortly after completion of adjuva...
The site of oligometastatic disease was to a supra-clavicular node and was biopsy proven.
Is there an age cutoff below which you would offer adjuvant chemotherapy regardless of Oncotype results?
(Example: A 35 y/o woman with T2N0, ER+, sen...
Would you consider SBRT and continue osimertinib?
What would you offer in the setting of bulky liver metastases?
This patient had a Ki67 of 27%. However, the inclusion criteria for the NETTER-1 Trial was Ki67<20%. Would Lutathera be an option if labs are withi...
Does it differ in the curative vs palliative setting? Specifically thinking about adjuvant CAPOX in a patient with a BSA of 3. ~400 mg of oxaliplatin ...
Patient was given ddAC + T
Presuming that imaging does not show distant metastatic disease, what would you offer? What about if the patient were PD-L1 negative?
What is your strategy to prevent and treat constipation in patients initiating or receiving opioids?
What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...
What other agents would have activity in a patient with NGS without actionable mutations?
Would you use ALK inhibitors such as crizotinib based on recent phase II data?
Are there any research efforts to combine ALK inhibitors with current ...
How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?
Review of literature suggests that most of these pa...
What clinicopathological features would need to be present for you to recommend adjuvant chemotherapy? Would you treat pT3 disease? Any specific histo...
Does post docetaxel PSA influence your decision?
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...
Would you consider doing a pre-op RT prior to possible re-excision? If yes, what dose would you give? If the location is between L4-L5 spine.
Are there any subsets of patients that you're more inclined to offer maintenance?
In particular, for frail patients to avoid toxicity or for those that do not want chemotherapy
Bulky hepatic metastasis
What line would you give pembrolizumab?
Benefit of oxaliplatin in patients >70 years of age is not proven and only 5FU/capecitabine in a MSI-H tumor is of questionable efficacy. What woul...
What would your treatment approach be- surgery or chemoRT? What is your preferred chemo regimen?
Is there a % threshold other than 100% (e.g. 95%) th...
Would you use a small cell regimen over a more traditional FOLFOX-esque approach?
Would you use trastuzumab/pertuzumab, trastuzumab followed by neratinib, or another strategy?
Would you offer this patient chemotherapy? What are your thoughts about OFS plus AI and avoiding chemotherapy?
Do you aim to give a total of 26 doses or do you stop at one year from first dose no matter how many were given?
What regimens would you consider combining it with?
Any specific combinations to avoid or special considerations?
Initial diagnosis was 15+ years ago
Would you choose to incorporate HER2-targeting agents, chemotherapy, endocrine therapy, or a mix of these?
Would you offer low dose or standard dose aspirin instead?
If so, do you allow a period of "washout" between immunotherapy and radiation?
Are there other regimens you employ for patients unsuitable for standard chemotherapy?
The GeparSixto, CALGB 40603, and more recently Prospero support doing it; however, it is not currently endorsed by NCCN and the latter Prospero s...
At what lower end of recurrence risk do you offer adjuvant imatinib for patients with resected GIST?
What is your preferred risk stratification model?
There does not appear to be a consensus among experts as to what cutoff in recurrence risk ju...
How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospi...
Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?
Assuming the patient is a candidate for all anticoagulation options (no mechanical valve, antiphospholipid syndrome, patient-specific contraindication...
Is Ommaya placement with CNS-directed therapy preferred to intrathecal or cranial irradiation? How do you interweave this therapy with systemic therap...
Excluding clinical trials
Assuming all other factors are favorable (pT1-2, TME, negative margins).
Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?
Mets to spine and s/p RT
How would your plan differ if the patient could eventually receive mastectomy once co-morbidities improve?
While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?
Masuda et al., NEJM 2017
Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses?
Is there a threshold of when you would use chemo/radiation?
Is it essential to wait one week after loading dose of erbitux to start RT for head and neck cancer?
In the post-op setting, would you delay 1 week even if it took them out of the 6 weeks post-op window? Meaning the loading dose of erbitux was given d...
i.e. 1/1 node with ECE
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 ...
What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?
Assuming no actionable mutations?
There was an abstract in European J of Cancer (Srinivasan R, 2014:50: S6, P8) showing a good response rate with Bevacizumab and Erlotinib. Would you u...
Are MMR deficient tumors more resistant to cisplatin/carboplatin?
Current guidelines for breast cancer do not recommend periodic staging scans in absence of clinical indications.
Would you use R-CHOP or a more intensive chemotherapy regimen? Would you consolidate with radiation therapy after 3 cycles or use systemic thera...
While the CKD population is at high thrombotic and bleeding risk, would you consider anticoagulating a patient prophylactically if they had a history ...
Conversely: In a patient with N2 EGFR+ NSCLC receiving radiation, would you still consider use of osimertinib?
What tumor or patient characteristics lead you to consider the use of neoadjuvant hormonal therapy without chemotherapy?
Would you recommend the patient stop testosterone upon this new diagnosis? If the patient is not amenable to stopping, would you incorporate an AI in ...
How do you decide on resumption or change of therapy?
In primary surgical resection, ENE on surgical path would be indication to add adjuvant chemoradiation. After progression through definitive chemoradi...
How would you approach chemoprevention if tamoxifen is
Are there particular patient characteristics (e.g. age, ER%, Ki67, grade) that make you more likely to choose neoadjuvant endocrine therapy?
Would a pCR to neoadjuvant chemotherapy change your management? (ER <5%, PR <5%)
If you do test, do you have a preferred testing method?
Is the short time to recurrence a reason to not consider definitive management with surgery/radiation?
Should systemic therapy be added if pursuing d...
If so, do you avoid pegfilgrastim given that <12 days will lapse between its administration and the next cycle?
How does dialysis affect PSA lab values?
Based on available results from the IMMUNED trial, which evaluated the role of adjuvant nivolumab/ipilimumab or nivolumab monotherapy vs placebo in re...
Do features such as nodal involvement, Ki-67, degree of ER positivity, etc. change your management? Would you use any gene expression assays to help y...
Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?
Would you offer for T2N0 G3 resected disease with LVI?
Would you prefer TCHP over TCH? Would you consider adding an anthracycline?
If yes, what type of testing platform would you use?
Are there clinical factors which help stratify? Does your practice vary based on mutation status (BRCA+ vs HRD+?)
Does germline vs somatic BRCA mutation affect your decision?
How many cycles do you prefer before and after? How long do you tend to wait before starting radiation after initial chemo and after radiation to resu...
How would you approach additional systemic therapy? Would the clinical stage of the cancer affect your management?
Specifically, for cT2N0M0 small cell bladder cancer without response to neoadjuvant cisplatin and etoposide on imaging, would you proceed with cystect...
Do you switch to alternative TKI? Dose reduce?
Post-auricular cutaneous angiosarcoma, pT1 (19 mm) with negative margins. Unclear if there is any indication for systemic therapy, given early stage a...
If no anthracycline, what alternative regimen would you consider?
Would you differentiate between patients with measurable disease vs NED? Are there specific data to guide us?
E.g. chemo/durvalumab vs chemo/atezolizumab?
What was the magnitude of benefit for patients with EGFRm NSCLC by stage?
Are you still considering adjuvant osimertinib for patients with earl...
Would you consider high-dose dexamethasone (deliberating adverse effects of antenatal steroids) or move to next-line therapies?
In GEJ or gastric cancers, do you routinely image after surgery, prior to resuming systemic therapy?
If so, how long do you wait after surgery prior to imaging to avoid post-operative findings?
If yes, do you re-biopsy for tissue, or perform blood-based sequencing?
Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?
Is adjuvant radiation and/or adjuvant chemotherapy indicated?
The current NCCN guideline version 2.2021 is a little confusing. On page HODG-2, the clinical staging/risk classification did not include ESR, b...
Is there any safety data to proceed with TKIs/TDM-1 or to proceed as standard with THP?
For patients who remain NED for years, when would you feel it's appropriate to hold therapy?
Ref: EINSTEIN-CHOICE and AMPLIFY-EXT
Would you approach this differently in patients with inherited thrombophilias?
If advanced stage do you follow same guidelines as Scc? Do you use same Cth regimen? Role of total laryngectomy ?
How do you assess the risk of complications from including bevacizumab vs the known benefits of including it with chemotherapy?
For patients who have progressed on first line checkpoint inhibitor (e.g. Nivo/Ipi) and second line TKI (e.g. Cabozantinib)
Would you try atezolizumab/bevacizumab or switch to a TKI?
Does your recommendation differ between autologous and allogeneic transplants?
Does your recommendation differ in allogeneic transplant recipients wh...
For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.
Are you performing repeat molecular sequencing after progression on targeted therapy? If so, are you obtaining tissue biopsy vs liquid platform?
Is data available regarding the percentages of patients in each arm who underwent staging PET or the breakdown of CNS imaging modalities?
If patients do recur, do you perform these tests on the initial surgical specimen or on tissue from a fresh biopsy (or both?)
Would you offer refractory doses (40-50 Gy) to the RPnodes and send for splenectomy? Or would you offer refractory doses to both RP nodes and spleen?&...
What would you offer if the patient is not a candidate for cytotoxic therapy?
What systemic therapy options are available for ESRD patients?
Would you consider an Oncotype or Mammaprint? Would your management change if the patient had 1-3 positive LNs on SLNBx (as opposed to ALND)?
The woman was on on a GnRH agonist + AI due to her premenopausal status at diagnosis and now wants to know if she continues to need the GnRH agonist.&...
During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?
Assuming no access to clinical trial
Would your decision for anthracycline change if the patient were elderly?
Would you add abiraterone or enzalutamide?
i.e. CA 19-9 >100
Are the rates of adjuvant chemotherapy used in ADAURA consistent with real-world practice?
What factors into your decision making and what systemic therapy would you offer?
What neoadjuvant or adjuvant therapy would you give?
When would you consider gemcitabine/abraxane as an alternative treatment?
Does your management change based on the type of end-organ involvement at the time of diagnosis?
Are there any reports of CNS involvement with non-se...
I know many centers are exercising extra precautions in light of the new concerns with coronavirus. How are people explaining things to their patients...
Have the RAPID or CALGB 5064 studies changed your treatment approach?
For example, gastric GIST, < 5 mitoses/hpf and size > 5 cm but < 10 cm is intermediate by NIH criteria but low by NCCN/CAP criteria. Th...
In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...
Are there effective therapy options that do not include steroids?
Would you send Oncotype during chemotherapy if not sent already? Would you stop adjuvant chemotherapy if a prior Oncotype was 25 or less?
When do you consider splenectomy? Is there a role for splenic radiation in non-surgical candidates?
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
If post-op with clear margins would you prefer adjuvant RT or close observation with surgery for optimal reduction of local recurrence? This particula...
Patient has progressed through prior lines of endocrine therapy.
For patients with low risk, early stage, HR+/HER2- breast cancer who initiated endocrine therapy in order to delay their surgery due to the COVID 19 e...
Do you use specific tools or take into account certain factors when considering treatment options for older adults?
Patient has tolerated combination therapy well to date.
What is your specific therapy choice and duration?
Assuming no clinical trial, no actionable mutation, and PD-L1 < 50%, do you consider the patient to be primary refractory to platinum and move to s...
Would you send an Oncotype RS to determine the role of adjuvant chemotherapy and/or endocrine therapy?
This includes handling saliva, vomit, sweat, vaginal secretions, semen, urine, and stool. Are there recommendations for intimacy, sex, laundry, and&nb...
I know that many advocate using vaginal estrogen in this situation. Most of the studies of vaginal estrogen in this situation have been small an...
Are there particular mutations (eg SF3B1) or syndromes (eg MDS/MPN overlaps such as MDS/MPN-RS-T) where you are more apt to using lenalidomide?
Would chemotherapy alone suffice? Repeat biopsy and EUS were negative for residual disease.
Would you consider gene profiling to determine need for chemotherapy?
If so, what is your time threshold for when you'll start PCP prophylaxis--when you anticipate steroid courses greater than 1 week? 1 month? 3 months?&...
Knowing the differential effect seen with menopausal status in RxPONDER, would you avoid chemotherapy or still offer chemotherapy, given that only 15....
Would you recommend re-excision or proceed to adjuvant therapy if the tissue margin is negative? Pathologist states that tumor foci at margin was only...
How would you balance the competing risks of these two diagnoses in her treatment?
Patient had a clinical T2N0 cancer at diagnosis, completed 6 cycles TCHP, and had 0.2mm residual disease with 80% cellularity, negative sentinel node.
Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...
Do you have any experience with intra-pericardial chemotherapy administration, and if so, in what cases?
Presented at ASH: FLIGHT trial
Patient is 34yo and G0 referred from surgical oncology. Laparoscopic specimens of myoma and what appeared to be adhesions were significant for maligna...
If patient meets high intermediate risk criteria, would you consider chemotherapy in addition to radiation?
An otherwise healthy patient with spleen only diffuse large B cell lymphoma with mild spleenomegaly, Spleenectomy plus Rchop or Rchop plus RT?
Does not technically meet high intermediate risk criteria.
If standard of care BEP chemo, tandem transplant, and radiation to primary site have been done previously.
Referring to a high risk patient with cT3N1 disease and ypT2N0 disease following neoadjuvant chemotherapy.
Any difference in recommendations if the patient was asymptomatic from her metastatic ER+ disease? (eg bone mets)
How do clinical risk and Mammaprint/Oncotype scores affect your decision?
> 7cm, grade 3. If chemotherapy offered, what is your preferred adjuvant therapy?
If on pembrolizumab or nivolumab, when would you escalate to ipilimumab/nivolumab?
For example, will you recommend a certain vaccination timing in relationship to their treatment? Any concerns for reduced immune response or risks of ...
Or the converse: changing to IV formulation after starting on subcutaneous pertuzumab/trastuzumab?
Conversely, is there any situation where you would prefer the IV over the subcutaneous formulation?
Tolerated first line, however now with rising Beta-HCG, new mass in uterus, and pulmonary metastases.
ASCO 2016 guidelines specified that SLNB was not recommended for T3/T4 N0 patients but uptodate allows it.
For example, a patient on cytoreductive therapy and aspirin BID, but suffers an arterial event, or a patient who is already on therapeutic anticoagula...
Specifically, would you consider incorporating immunotherapy in this setting?
What is the risk of perforation / fistulization?
Is there concern for impaired healing? Do you pause therapy and for how long?
Ex: TKI alone, TKI + checkpoint inhibitor, checkpoint inhibitor alone, TKI + mTOR inhibitor. Please specify drug regimen, if applicable.
How do you incorporate surveillance imaging for patients with ovarian cancer on maintenance therapy?
Does your strategy differ if the patient is on maintenance PARP inhibitor, bevacizumab, both, or neither?
Pathology is not carcinoid or small cell.
Would it change your decision if they had progressed on a first-line trial with cisplatin followed by pembrolizumab plus enfortumab vedotin maintenanc...
Is there a distinction between these tumors and patients with breast cancer with neuroendocrine features?
Given that trials excluded patients with low ER, PR for this approach.
Given the data from KEYNOTE-522, would you try to incorporate chemotherapy in the treatment regimen?
>10 cm, no metastatic disease identified on staging scans
No high risk features such as: lymphovascular invasion, perforation, or involved margins
What schedule do you use?
Does tumor size impact your recommendation? High grade? Young patient age?
Would it affect your decision whether original primary tumor and treatment was hormone positive or negative?
Does the advent of more effective therapies like peptide receptor radioligand therapy (PRRT) and capecitabine and temozolomide (CAPTEM) dampen enthusi...
For example in a patient with a history of PE?
In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...
Would gross ENE or R1 resection trigger you to consider adding chemo? If so, do you use weekly cisplatin or cisplatin/etoposide?
2 populations of cells with 95% negative by FISH (ratio 1.07) and 5% positive by FISH (ratio 10)
What is the lowest level you have seen with uncomplicated or complicated crises?
Do you consider placing an Ommaya for IT chemo with methotrexate or cytarabine? Knowing that leptomeningeal carcinomatosis carries such...
Can results from emerging AML data be extrapolated to high risk MDS populations?
Is there data to guide the choice of continuing the HMA in combinati...
i.e. EGD surveillance for varices?
Based on MINDACT update from 2020, a 5% difference in DMFS for patients 50 years or younger was noted, favoring treatment with chemotherapy (93.6%; 95...
Relapsed disease occurred 3.5 years after initial treatment
For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?
What clinical scenario(s) do you find results to be the most beneficial?
Is there a role for neoadjuvant cisplatin-based chemotherapy?
Do patients with sarcomatoid histology respond to checkpoint inhibitors?
What parameters do you use to decide to treat beyond progression? Is there any efficacy data from this specific study subgroup in IMbrave150?
Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?
What considerations do you take for post-lumpectomy radiation and endocrine therapy?
The trial included only a small percentage of these patients.
Does lymph node positivity change your management?
ex. VEGFR2 expression, inflammatory signature, PDL1, etc.
Would you consider ALND and /or XRT to axilla?
Do you continue atezolizumab alone? Would you avoid anticoagulation?
How do you sequence systemic therapy with radiation and surgery?
For e.g. how many cycles of ifos/doxorubicin do you administer in this context?
Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued
After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...
Patient with ECOG 0-1
Would you consider adjuvant chemotherapy?
Nearly 11 cm in size
Does the recent CROWN trial affect your first line treatment decision?
Options:
1) ddAC-T- surgery- adjuvant capecitabine if residual disease
2) weekly taxol/carbo x 12 followed by dd AC x 4
3) Keynote 522- pembro/taxo...
Patient case is triple positive inflammatory breast cancer
In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?
Do you prescribe creams (e.g., urea) to prevent HFS, or is their use generally more reactive?
Are there any studies that compare them?
Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?
There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.
If there are a low-risk patients who can be monitored, how would you do so?
If unprovoked, would you consider stopping anticoagulation?
NCCN recommends either ISRT with rituximab/chemotherapy or ISRT alone in this scenario. What factors help your decision making?
How would your treatment change given pCR rates are reportedly much lower in triple positive patients?
Do you screen even asymptomatic patients?
In addition to TSH suppression, would you opt for RAI, targeted treatment based off NGS, or lenvatinib?
Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?
No primary thoracic mass identified. Knowing these often following an aggressive clinical course, would you consider concurrent chemo/RT, incorporate ...
Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.
No actionable mutation on NGS testing. What approved therapy do you prefer? Are there specific investigational agents currently in clinical trial...
Many patients have had prior chemotherapy exposure with newly diagnosed AML that may not have classic therapy-related cytogenetics. How do you a...
Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?
Any role of neoadjuvant chemotherapy?
Would you use FOLFIRINOX as in Prodige 23 or FOLFOX as in RAPIDO?
Initial treatment with Taxane-Trastuzumab-Pertuzumab with then maintenance with the two anti-HER2 agents and and an aromatase inhibitor. Would you bio...
Following chemoradiation, would you consider maintenance durvaluamb as for NSCLC even given the SCLC component?
Is there any data justifying the use of systemic therapy over localized therapy (e.g. radiation or surgery) in this situation prior to a progression e...
exam is + for ascites
The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...
Especially if the patient had advanced N3 disease and is reluctant to pursue surgery?
If no testicular mass on exam or ultrasound - is there a role for orchiectomy? What chemotherapy regimen would you use and how many cycles?
Rituximab has entered the treatment algorithm in the first-line setting for the initial treatment of TTP. However, in remission, the role of adjuvant ...
How does histology, time to distant Mets affect your decision?
In patients with symptomatic disease that observation would not be appropriate, what is your preferred treatment?
Which Radiation modality, if any, would be preferred?
Typical chemotherapy does not work for SFT. In which circumstance would you use VEGF ( Temozolo...
Patient is on anti-hormonal agent (exemestane) with anti-HER 2 agents (trastuzumab and pertuzumab)
Based on recent PAOLA-1
What if this was "triple-negative" antiphospholipid syndrome?
Does the specimen (blood vs tissue) used to detect mutation affect your consideration?
When would you consider use of ctDNA to help with this decision?
Or would you consider IO agent be given only after progression on platinum + fluoropyrimidine?
For example, is there any data to suggest a benefit to starting with immunotherapy prior to TKI or the alternative?
If you would elect for adjuvant therapy, which study helps guide your choice of regimen?
Are you employing more or less primary chemoRT v. surgery for some cancers? Are you dose de-escalating? What are issues radiation oncologists should b...
Are there particular populations in whom you would add an AR targeted agent after docetaxel?
Assuming patient received appropriate local therapy for brain metastases, which agent would you use?
Chemoradiation completed 1.5 years prior
She had already completed ddAC and two cycles of paclitaxel before the reaction.
HERO study - https://clinicaltrials.gov/ct2/show/NCT03085095
For example: do you use docetaxel + cyclophosphamide (TC) x4 and what is the evidence for using such a regimen
surgically confirmed node negative disease
Do you only give intrathecal chemotherapy or systemic therapy?
i.e. Cisplatin + Etoposide
Recent EBCTCG meta-analysis published in Lancet 4/2023. https://doi.org/10.1016/S0140-6736(23)00285-4
Is there any specific precautions or concerns to consider with TKI initiation if the patient has vasogenic edema?
Do you treat as you would a B-ALL? Does amount of nodal stations/disease matter?
What are the scenarios in which a rebiopsy is warranted for follicular lymphoma?
Would you modify the radiation dose or field in this setting?
Would you pre-emptively dose reduce chemotherapy, or modify the dosing of ruxolitinib?
I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?
Potentially, if metastasis responds, could be treated with surgery or radiotherapy
The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease.
Both ARTIST and Inte...
Would you do systemic treatment or observe?
(assuming that the patient is int-poor risk, has measurable disease outside of the CNS, warrants treatment with appropriate PS)
Do you repeat the loading dose of trastuzumab?
Would you offer SBRT to both sites, SBRT to the primary and standard fractionation to the node due to proximity to the main bronchus/proximal lobar br...
Pre-menopausal women make progesterone and their menses are typically lighter on tamoxifen because it's a mild endometrial ER stimulant blocking their...
Would it matter the site of recurrence (ie lung nodule vs bone lesion)?
Patient had a solitary lung metastasis
Given that ADT + abiraterone and ADT + docetaxel have not been directly compared.
How has your practice been impacted by the ECOG 2108 (Khan et al. ASCO 2020 Abst LBA2)? Are there sites or distribution of disease that prompt you to ...
Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.
After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...
BRCA status unknown currently
Is there data to support proceeding directly to cystectomy?
Does the absence of an OS benefit in the AG221-AML-005 presented at ASCO 2020 deter you from this strategy?
How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.)
Would you use Cetuximab?
Altered fractiona...
What is the time window in which you would consider adding AR targeted therapy?
Is there a time frame in which you would NOT consider introducing sin...
Given the changing landscape of treatment, some patients may have already received capecitabine previously. Would this impact your treatment rec...
Would you test initial core biopsy (prior to neoadjuvant anastrozole) or surgical specimen? Any preference for Oncotype vs. Mammaprint?
Does the reported positive endpoint in OS for Checkmate 743 change your practice?
SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation
Would your answer change if the new lesion is ALH/ADH?
Presented with mass projecting into right/left anterior ethmoid complex
For example, a FANC mutation
Would you consider use of immunotherapy with checking PDL1? What chemotherapy agents would you consider along with mastectomy/radiation?
What do you do/say when a discussion of evidence-based information doesn't convince a patient that this is her best chance of cure? Some patients even...
The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...
Interest in approach for elderly population especially
Does residual grade 1-2 neuropathy from Taxol/ carbo 10 years ago affect your recommendation?
CT scans show omental and pelvic disease.
Would you consider an anthracycline based substitution vs changing to nab-paclitaxel or a combination with platinum agent?
Would you choose a platinum based agent? Other chemotherapy combinations?
Chemotherapy - Carbo/Gem (2nd line). PDL1 and BRCA negative.
In patients who are intolerant to hydroxyurea, anagrelide and interferon
Would you consider “bridging” therapy with something like an HMA?
No known cardiac risk factors
Has anyone omitted post path fracture radiation of pelvis/long bone in favor of starting endocrine treatment first? Or would one omit RT and start a C...
Would you recommend additional cytotoxic chemotherapy and/or switch her anti-Her therapy to T-DM1?
Would age influence your decision?
Data suggest patients with D842V-mutated or KIT/PDGFRA WT GIST do not respond to imatinib, but NCCN guidelines does not take into consideration mutati...
Ie for patients who are inoperable due to comorbidities?
If so, what regimen would you use? Would a carboplatin-based regimen be acceptable or only cisplatin?
Do you prefer surgery vs radiation?
For surgical patients, do you offer neoadjuvant chemotherapy? If so what regimen?
Is there an optimal strategy to minimize unnecesary steroid use?For example, pre-treatment dexamethasone or 3 day dexamethasone? Prednisone only conti...
How do you counsel regarding uterine sarcoma risk?
Would it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?
Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?
If so, for how long would you treat?
What timeframe would you suggest to stop breastfeeding? From affected breast or both breasts?
Especially if HER2 negative on pathological specimen
What is your standard approach for patients with platinum and ICI refractory small cell lung cancer?
Topotecan, nivolumab/ipilimumab and others are listed within NCCN guidelines, and lurbinectedin was recently approved in this space. How do you decide...
Are there specific considerations you/your tumor board take into account?
Asymptomatic brain progression despite CNS surgery and SRS x2 over the past 2 years.
Progression was observed only in the breast and required palliative mastectomy (T4b TNBC)
Is there data and FDA approval for this indication?
What about for nodal failure after radiation?
Is there an advantage to early diagnosis and intervention versus observation until the nodules are amenable to percutaneous biopsy?
The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...
Liver and skeletal metastasis with no disease in the lung.
She had had 4 prior biopsies. Would the fact that she received 2 months of neoadjuvant tamoxifen due to COVID change your approach?
Patient completed adjuvant AC-T 8 months prior to recurrence. BRCA negative, foundation medicine NGS pending.
Would you consider this refractory disease and go on to salvage regimen and auto-SCT, or is there a role for definitive XRT to the site of residual di...
PD-L1 is low and she has residual neuropathy from neoadjuvant paclitaxel.
The recent NELSON trial evaluates screening in a slightly different population than the USPSTF/NLST criteria. Which will you follow?
For example- do you have experience using a LHRH agonist along with tamoxifen?
Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...
While the KATHERINE trial for HER2+ used path staging, CREATE-X for TNBC with capecitabine used the Japanese Breast Cancer Society response criteria. ...
>5cm. If so, what is your preferred regimen?
Does acute leukemia sub-type affect your decision?
If neurologic symptoms are absent or controlled, does that affect your treatment decision?
How do you balance risk of chemo after surgery with risk of progression of disease while waiting for healing after surgery before starting chemo?
MRI? Endoscopy? Physical exam?
Is there evidence for radiation therapy in this setting?
What are there most evidence-based options?
E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?
What is the added benefit of Chemo-RT vs RT alone?
Out of curiosity, I did tumor testing, and she does not have an activating ESR1 mutation.
Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed pat...
Is there any evidence for sacituzumab govitecan (IMMU-132) in this situation with progressive systemic disease after prior anthracycline and taxane?
In cases where patient received 6 cycles of THP and 1 year of HP
Patient received adjuvant chemotherapy and anti-Her2 therapy 3 years ago.
If yes, would you offer tamoxifen or ovarian suppression plus AI?
Do you offer adjuvant chemoimmunotherapy after IFRT for Stage I to II low grade follicular lymphoma?
TROG 99.03 showed nearly 20% improved PFS at 10 years with chemoimmunotherapy despite 31/75 patients assigned R-CVP vs 44/75 assigned CVP without ritu...
How would the sidedness of the tumor, BRAF, RAS,HER2 or MSI status affect your decision?
Is there evidence for daratumumab-based doublet regimens?
Would your choice differ based on the patient's transplant eligibility?
Received adjuvant HER2 directed therapy 3 years ago.
Preferred options in NCCN guidelines: 5FU+cisplatin, 5FU+oxaliplatin, paclitaxel+carboplatin?
How does your approach differ for patients with stage IIA versus IIB disease? Age?
< 4 lymph nodes involved, initial diagnosis was 11 years ago when she was treated with mastectomy and adjuvant tamoxifen for 5 years.
What steroid-sparing strategies do you use?
For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?
Pleomorphic sarcoma
Would you consider still immunotherapy even if aggressive disease vs single agent chemotherapy?
For instance, patients with ATM mutations
If so, please describe your experience and dosing.
Does the SYSUCC-001 trial presented at ASCO 2020 change your practice?
https://meetinglibrary.asco.org/record/186872/abstract
How do you weigh the negative results from IMvigor 010 of adjuvant atezolizumab vs the results...
If the cancer was also HER2+, would that influence your decision?
If so, would you consider it with monotherapy only or also with combined checkpoint blockade?
I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...
This patient underwent mastectomy and ALND (10/28 positive lymph nodes). Immediately following axillary LN dissection (and prior to radiation) imaging...
Is there a preference for obinutuzumab over rituximab in early relapsed DLBCL, or in primary refractory disease?
Would you consider using PARP Inhibitor in this situation?
An ASCO 2020 poster from the German Testicular Cancer Study Group found that 37% of CSIS seminoma and nonseminoma were miscatagorized resulting in ina...
If offering neoadjuvant chemotherapy, which regimen would you use?
Is there data to support every 3 week dosage v. weekly?
https://ascopost.com/news/march-2022/postoperative-weekly-vs-every-3-week-cisplatin-i...
Are you placing more weight on patient risk factors such as age >65 or co-morbidities?
What dose of radiation, what type of chemo, and what indications?
Data from the SOFT/TEXT trials showed clinical benefit in ovarian suppression + aromatase inhibition for high risk, premenopausal ...
Are there subsets of patients who will not benefit with addition of first line immunotherapy?
What advice do you give regarding dietary practices, feeding tubes / parenteral nutrition, and pharmacotherapy specifically for cachexia?
Would you hold treatment for patients who develop PE/DVT while on BRAF-directed therapy?
Is FOLFOX or 5FU acceptable without XRT if D2 resection?
For a patient not on dialysis? Outside of single agent 5FU, all other standard chemotherapeutic options would be contraindicated for nephrotoxicity.&n...
Would you consider the addition of chemotherapy to proton beam therapy?
Would your approach change based on the type of reaction (eg. Stevens-Johnson syndrome vs DRESS)?
How would you address maintenance (if any) post-tra...
Patients oftentimes have cardiac co-morbidities with requirement for anti-coagulation making TKIs, including Bevacizumab, difficult to dose. Would the...
What is your preferred treatment?
Any strong considerations for infusional vs. bolus doxorubicin?
For instance, would you discontinue when there is resolution of adenopathy and normalization of counts? If so, do you overlap ibrutinib with other the...
Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?
This has been a common practice in the community. Is there a benefit for certain patients?
What if the patient has a history of confirmed COVID-19 but has since recovered?
The NCCN recommends both regimens.
Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.
At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...
Patient previously received neoadjuvant carboplatin, anthracycline and taxane regimen and is BRCA negative.
Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?
When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...
Would you treat with platinum-etoposide alone again, or would you add atezolizumab?
IMpower133
How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation?
Does the availability of first line checkpoint inhibitor therapy affect your treatment decision?
How would this change if the patient had metastatic HR+,HER2- breast cancer and now has symptomatic pancytopenia secondary to BM involvement after TCH...
Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristic...
If so, which patients are the best candidates?
Patient has MSKCC high risk disease. Immunosuppression is with mycophenolate mofetil and tacrolimus.
She has received 4 cycles of AC with no clinical response and is now pending completion with Taxol.
Would you consider single agent IO such as Nivolumab, given data are not strong (Checkmate 459)?
Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?
GI work up negative. NGS cancer type and isochromosome 12p ordered and pending. Pathology at RPLND was negative for cancer.
Would you treated with local therapies (RFA or SRS) and continue pembrolizumab or would you move to second line treatment?
There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.
Do you worry about the ability to collect stem cells (at the time of progression to MM) if someone with SMM has been on prolonged lenalidomide?
Would you consider genomic assays before neoadjuvant chemotherapy? How would you modify your treatment given the COVID-19 pandemic?
Would you use dual agent chemotherapy such as FOLFIRI, combination of chemo with biologic- IRI/Cetux or all 3 drugs simultaneously? How would sidednes...
T1a - 2mm; N1 - 1 ipsilateral lymph node measured 6mm
Oncotype says too small to test and NGS says too few cancer cells to determine status.
Would you continue to trend ctDNA to detect early recurrence?
What chemotherapy regimen would you recommend?
Upfront surgery vs neoadjuvant therapy? And if neoadjuvant therapy, which regimen?
Patient has a good PS.
Brain metastases have undergone resection, SBRT and WBRT
Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...
Would you consider using recently approved agent for symptomatic / unresectable PN, Selumetinib prior to Systemic Chemotherapy in this setting?
A patient with stage 3 melanoma on adjuvant nivolumab needs radioactive iodine for papillary thyroid cancer.
Quite often we encounter cholestatic hyperbilirubinemia, wherein GI and IR do not believe ERCP with stents or PTC will alleviate jaundice. If the pati...
Does this also apply to somatic mutations?
Do you routinely test for this with a re-biopsy?
There are multiple regimens including IGEV and most recently reported results of BEGEV without preference on NCCN guidelines.
Risk of CNS relapse in a reported series is less than 5%.
How does gBRCA status impact your decision?
What are the risks of infection with COVID-19 if using immunotherapy?
If so, are there particular patient/tumor characteristics that influence your decision?
How do you prescribe a steroid taper? If it is grade 2, would you keep them on low dose prednisone while continuing? When do you feel comfortable re-c...
Are there specific mutations or co-mutations were you would consider use of this agent?
Given the rarity of DLBCL with MYC/BCL2/BCL6 rearrangements, do you approach this disease differently than DLBCL with MYC/BCL2 or BCL6 rearrangement, ...
Would your choice vary based on the patient's gender?
Aside from smoking cessation, what interventions have you found useful to manage patients with chronic symptomatic laryngeal edema? Steroids seem to b...
How are you modifying your current sarcoma-directed therapy in the setting of the COVID-19 pandemic?
For example, would you consider switching to an outpatient regimen in lieu of AIM for metastatic soft tissue sarcoma?
Would you treat with typical small cell paradigms such as surgery followed by adjuvant platinum doublet +/- radiation vs definitive chemoradiation? Or...
Such as in patients who are elderly or have borderline performance status
Should staging and treatment decisions be made based on imaging alone?
Patient is a 67yo with a pT1 (2.5mm) pN1a merkel cell of the chest, 1 mm deep, widely clear margins, SLN with 1.5mm met, 11 additional axillary ...
Acknowledging that there is no time for good trials yet in this setting
Would the recommendation differ based on HR+ vs. TNBC vs HER2+ classification?
Would you recommend against immediate breast reconstruction?
Given that majority of benefit is derived from the capecitabine, would this be an acceptable option to decrease patient contact with the healthcare sy...
Would you consider delaying chemotherapy and proceeding only with endocrine for now?
Would you consider regorafenib based on the REGOBONE trial? Or would you consider other agents knowing that we do not have positive survival data with...
How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...
Initially treated with anastrozole, current treatment is with fulvestrant.
Or do you consider addition of this agent in the re-induction setting for refractory disease?
If so, how much systemic therapy would you give before considering surgery?
Personally, my practice is to guide patients directly to surgery or to do neoadjuvant chemotherapy rather than to do neoadjuvant endocrine therapy, bu...
For example, if you had a triple positive breast cancer found on breast biopsy and repeat ER/PR/HER2 testing at the time of surgical resection showed ...
Would you continue pembrolizumab with a re-challenge with carboplatin/taxane or move to second line therapy?
If so, how long is too long to wait?
The phase 2 trial of pembrolizumab in JCO 2019 showed efficacy, and I have patients preferring to avoid chemotherapy.
Would your practice vary based on hormone receptor or Her2 status?
What features are used to distinguish anaplastic multiple myeloma (AMM), and what other conditions should be considered in a differential diagnosis (e...
When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...
Mitigating the spread of COVID-19 is of utmost priority now that containment measures have failed. Social distancing will help "flatten the curve" of ...
Would you incorporate platinum into your treatment or enroll in an adjuvant IO trial?
No adjuvant treatment was given upfront
No primary identified in the contralateral breast. No distant metastasis identified.
Do you send multiple Oncotype testing for each sample in a multifocal or multicentric breast cancer?
Tumor size and grade meet criteria for oncotype testing in all foci.
Would you forego neoadjuvant chemotherapy?
Are you using growth factor support differently?
Any changes to immunotherapy?
Other considerations?
What factors other than the Khorana score influence your decision regarding prophylactic anticoagulation in these patients? If prescribing an agent, w...
IHC: ER 70%; PR 70%
OncotypeDx: ER - Negative; PR - Positive
Patient received anthracycline and paclitaxel for HR+ breast cancer in the past.
Would you monitor or directly offer systemic therapy?
Many commercial testing assays report on EGFR gene amplification in addition to the known sensitizing mutations. Are there any data that this can be u...
Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?
Do you proceed with Paclitaxel or go to surgery instead?
Is there specific workup you perform? Are there preventive measures? Once established, are there non-pharmacological and pharmacological treatments yo...
Would you even consider trabectedin in this case given its cardiotoxicity?
Would presence of features considered high risk in stage II sway your interpretation of the IDEA trial?
Is this also a marker of TKI sensitivity?
ie, not a classic NTRK3-ETV6 fusion.The patient has progressed through CDk4/6 inhibitors and intolerant of alpelisib, and does not want chemotherapy.&...
She has no other site of disease progression and has been on an aromatase inhibitor (progressed in the CNS while on a study with adjuvant abemaciclib)...
Would you proceed with maintenance atezolizumab or switch to second line therapy?
Would you choose to use IO or BRAF directed therapy based on BEACON? Or would you continue to use cytotoxic chemotherapy?
The APT trial reported excellent DFS, OS and RFI for tumors <=3cm but few were smaller T2s (2-3 cm) and few were >70 years old.
Is there data for weekly versus every 3 week cisplatin in this setting?
Residual disease with bulky retroperitoneal masses also present on scans
Stage T1bN1mic
Would you offer adjuvant TKI to patients with locally recurrent multifocal adenoid cystic carcinoma?
For example, for a patient that has been through multiple disfiguring surgeries and radiation and wants to delay time to next resection.
For instance, in a patient with isolated distant nodal involvement who had the lymph node resected but did not have a lymph node dissection?
Tumor 13 cm on back with retiform and kaposiform features; all margins negative except one abuts inked margin; atypical cells with 4 mitosis/HPF.
Add...
With extensive use of NGS testing, it is commonplace to identify mutations that have no validated therapeutic intervention, but strong biologic signal...
Assuming the patient is not a candidate for SRS
Would you offer nodal dissection and/or additional adjuvant immunotherapy in addition to wide local excision?
Package insert indicates discontinuing bevacizumab in PE and there are no guidelines on re-challenging after acute clot is managed.
Do you proceed to resection or palliative chemotherapy?
Assuming patient is not a surgical candidate and wishes to pursue definitive radiotherapy, what duration of ADT would you give?
This patient is interested in conceiving and therefore would like to wait to start the tamoxifen.
Pre-treatment estradiol: <5
Estradiol after 1 yr: 35
Do you ever consider stopping if stable disease and good tolerance?
Patient does not want chemo but is tolerating these well otherwise.
For example, if a patient had testosterone pellets injected, perhaps making endocrine therapy less efficacious, would that sway you to use chemo?
Being that this is a favorable histology would you use Oncotype Dx to help decide on neoadjuvant chemotherapy? Would you recommend neoadjuvant endocri...
https://www.ncbi.nlm.nih.gov/pubmed/31838010
Is dental evaluation indicated for edentulous patients?
Do you start with TKIs or platinums?
Does the KN-522 data change your decision about chemo regimen?
In the absence of side effects, would you be inclined to continue beyond 10 years as chemoprevention? Would you factor an intermediate/high oncotype R...
Would you treat this differently than someone who only presents with axillary nodal disease?
How would you manage symptoms? How would you adjust the adjuvant regimen (dose reduce, omit paclitaxel etc)? What strategies would you consider for pr...
This is a patient with a 1.8cm node negative HER2 positive tumor that is grade 3, high Ki67, and ER positive.
In your experience, what approach has been successful to bridge to surgery?
To me, the recent NEJM study is flawed in that the control arm did not have maintenance treatment while the experimental arm used maintenance Dar...
Would you recommend surgical resection if feasible? Or just monitor every 3-6 months as NCCN guidelines suggest?
Would your management differ based o...
How would a much higher risk cancer affect decision making? How would you treat him?
Does timing of recurrence (early vs late) factor into your decision and would you consider consolidation durvalumab?
Data presented at the 2017 SABCS (abstract GS1-01) of the EBCTCG meta-analysis stating a benefit of dose-dense chemotherapy applies to ER positive and...
Germline genetic testing negative
Would you proceed to autologous transplant, or switch to an alternate regimen (eg. daratumumab-based) first?
Would the type or degree of organ involv...
How do you choose between single-agent or combination chemotherapy versus newer treatment strategies such as palbociclib?
Abstract 5014 at ASCO annual meeting 2019 showed superiority of PSMA-PET imaging over fluciclovine-PET imaging. Are you utilizing these speciali...
How, if any, do you utilize genomic testing to guide systemic therapy?
Would your choice be affected by which high risk features the patient has (eg. double- or triple-hit status vs IPI score of 3-4)?
Keynote 407 recently published data on pembrolizumab +/- chemo for metastatic squamous cell lung cancer. The confidence interval for the group w...
Specifically with reference to rural settings where the logistics of early in the week delivery may be more challenging.
There is a national shortage of vincristine.
Does the degree of PD-L1 expression weigh into your decision?
If so, what is your approach to laboratory and clinical testing?
Are there clinical scenarios in which 5 years of tamoxifen alone remains sufficient?
ex. age, surgical risk, and/or performance status
Do you offer EPO and TPO support? Do you modify your systemic therapy up front or after subsequent cycles?
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...
Would you offer AI + OFS or tamoxifen to a woman with a grade 3 T2N0 tumor and OncoType of 15?
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?
Do you have a similar approach in younger population?
Are there any special considerations with the PNET?
CPS score of 40%. How and when do you incorporate immunotherapy into the treatment of metastatic gastric adenocarcinoma?
Of note, CLASSIC (Noh; Lancet Onc 2014) nor ARTIST (Lee; JCO 2012) evaluated other histologic subtypes, is the approach to treatment any different tha...
Our medical oncology team wants to give a patient Vitamin B12 and Folate 1 week before chemo- do we need to push back the RT start date to start both ...
This question has come up most frequently with respect to the flu vaccine recently. Also, frequently this has been asked about the shingles vaccine an...
In light of the results of the ESPAC-4 trial, is combination gemcitabine plus capecitabine being considered over single agent gemcitabine for adjuvant...
Additionally, would the finding of any mutations, such as ESR1, change your recommendation?
How do you approach pathologic review and genomic testing, if indicated, of a spindle cell neoplasm?
For example, if a biopsy reads: lesion comprised of spindle cells arranged in a fascicular pattern, elongated, hyperchromatic nuclei, focally positive...
Would you recommend it for a mammographically occult primary or if the patient had dense breasts? What if a high risk patient decides not to hav...
History of Multiple Myeloma with renal failure currently on velcade.
For example, is this still your approach in women with small tumors or node negative disease?
Example: Low grade mucinous tumor post bilateral mastectomy
e.g., subungual hemorrhage and onycholysis?
If so, for what platelet count threshold and do you have a preference as to which agent?
Once a tissue biopsy has confirmed light chain amyloid, what additional tests do you perform as part of a standard workup?
In whom should treatment b...
2D Echo - Normal Ejection Fraction
Would you offer adjuvant chemotherapy to a post-menopausal woman with a BRCA2 mutation and a T2N0 ER positive breast cancer with an oncotype of 12?
There are multiple options that carry a category 2B recommendation in the NCCN guidelines. Does germinal B center type vs activated B-cell type play a...
How would you decide on VRd vs DRd for initial management of transplant ineligible multiple myeloma?
Are there specific patient groups where you would choose one over the other?
Are the cost differences significant enough to dissuade you from choosin...
In practice, does starting with chemoradiation followed by chemotherapy result in a significant delay in initiating chemotherapy or a patient's abilit...
How do you approach this given the limited # of patients this applies to? Checkmate 017 and 057 only had 5-7% of patients still on nivolumab at ...
If so, what agent(s) would you consider given the concurrent amplification and mutation?
Would your choice of concurrent chemotherapy be impacted by this histologic finding?
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 SPARTAN trial, median PSA at study entry was ~ 7. Does the MFS benefit extend to patients with low PSA(< 2 or < 1)?
Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...
It is included in favorable histologies on NCCN, but no mention of how to treat based off HER2 status.
Does the extent of the surgery matter?
In patients who have a mixed response or progression and are poor candidates for other systemic agents, would you consider consolidating the chest? Wo...
Would your recommendations change in the neoadjuvant versus adjuvant or metastatic setting?
Would you consider single agent immunotherapy given recent exposure to platinum agent or chemoimmunotherapy?
(ie Deuvelle criteria 1-3) Is it appropriate to discontinue brentuximab like you would with bleomycin?
In the absence of a frontline clinical trial, would you treat with carboplatin+pemetrexed+pembrolizumab or consider IMPOWER 150 or other?
Would the presence of peritoneal carcinomatosis change your treatment strategy? If Ki-67 <50%, would you avoid platinum based cytotoxics?
Patient only had upfront surgery.
Are the other options of chemotherapy that can be used instead of platinum based doublets, including with paclitaxel?
i.e. doxorubicin, ifosfamide + RT. Do you worry about decreased locoregional control or increased toxicities with the use of G-CSF in combination with...
Specifically, do you consider repeating maintenance therapy after second line therapy if a patient had already received 2 years of maintenance rituxim...
How would you specifically treat a grade 1, but HER2 positive lobular?
The German trial included patients with tumors up to 16cm from the anal verge, while the Swedish trial update found no local control benefit for tumor...
Would you consider first line treatment with somatostatin analog or Lu 177 dotatate? Is observation an option for asymptomatic patients?
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...
-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX.
-Given that this is standa...
Would you still proceed to high-dose therapy and autologous SCT?
Would you incorporate radiation pre- or post- transplant? Or offer additional salvag...
Are there any data regarding response to checkpoint inhibitors for these patients?
If the patient has not experienced significant infectious complications? If so, what agent?
Patient has grade 3, pT3N0 disease and is s/p lumpectomy.
Do you re-challenge with nivolumab alone, change from nivo 1/ipi 3 to nivo 3/ipi 1 upon re-challenge, or stop immunotherapy altogether if grade 3?&nbs...
For instance, does isolated CALR mutated MF change your management?
For instance, if the fluclicovine scan shows a few small avid nodes not only in the pelvis but extending to the paraaortic region, would you treat the...
PDL1 status pending; BRCA wild type
Specifically, do you utilize 3 cycles of chemo with ISRT or 6 cycles? Do you use R-EPOCH or R-CHOP in these cases?
Knowing that benefit of contralateral mastectomy is lower in older women who has already manifested BRCA related cancer and 10-20 % mastectomy related...
For instance, do you ever start with dasatinib 50 mg daily? Are there any titration schedules that you follow?
NCCN include active surveillance as an option in specific circumstances based on Rini et al. (Lancet Oncology 2016) however this set is not well defin...
Does the pathology outweigh usual staging and risk factors?
Margins were negative and there was no evidence of LCIS or lobular component in the lumpectomy specimen. Role for possible mastectomy?
Any role to switch to MVAC?
Would you treat with chemoimmunotherapy based on IMvigor130 data presented at ESMO Congress 2019?
What would be the next line of treatment, PRRT, capecitabine and temozolomide or other?
Does the results of the tnAcity trial influence your decision in choosing a 1st line option?
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...
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 suspect progressive disease v. radiation necrosis vs optic neuritis due to immunotherapy. Eyes were within radiation field 8 months ago.&nbs...
Status post nasolacrimal stent with improvement. Would you re-challenge or permanently discontinue docetaxel?
e.g. lymph node metastasis, presence of tumor involving the peritoneal surfaces and/or the abdominal wall. If so, which regimen would you offer?
NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?
Given the PFS benefit seen in the most recent ECOG-ACRIN, and the prior study of Rd showing an OS benefit, is your practice to put any high-risk SMM p...
e.g. mixed indolent/aggressive NHL, mixed NHL/HL? Is there a definitive way to discern composite from transformation? NCCN does not list recommendatio...
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?
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 pilot study has shown activity of this combination in a small patient group.
Are there any biomarkers that would affect your decision for first line PD-1 therapy (including but not limited to STK11)?
1st-line pembrolizumab is supposed to be used AFTER failure of appropriate targeted agents in this setting, but would you consider the reverse sequenc...
if so, are there specific cytogenetic, molecular, clinical, or hematologic factors that you take into consideration?
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...
How would you utilize PD-L1 expression to guide your decision making in this situation?
The NCCN seems to make its recommendation based on extrapolation from colon cancer, but those patients are not treated with pre-op chemoRT.
More generally, do absorption issues effect the efficacy of tamoxifen and/or aromatase inhibitors?
Specifically, how do you explain potential cognitive decline in a way that explains what changes they can expect in their daily lives?
Have you changed your practice based off the FLYER trial presented at ASH 2018?
How would you figure out how to treat someone with a prior localized HR+,HER2- breast cancer treated with adjuvant AC-T (5years ago) and a recent ipsi...
Do you utilize it immediately following chemoRT or wait until disease progression?
How would you handle high risk features (eg double hit) with the limitations of dialysis?
Patient initially was started on cetuximab due to renal insufficiency of unclear chronicity (uncontrolled hypertension) that significantly improved du...
Would you treat until progression or for a defined "adjuvant" course after nephrectomy?
For instance, not chronic autoimmune diseases (eg RA, IBD) that may relapse/remit but events like Guillan Barre syndrome that is not likely to recur b...
Would you consider an aggressive approach with RT and/or surgery to the bone lesion and treat the primary as locally advanced breast cancer?
Do you use anti-hormonal therapy for these patients?
Role of neoadjuvant TC vs. anthracycline based regimen?
Although platinum/5-FU was used in KEYNOTE-048, can an alternative like carbo/paclitaxel be given since it may be better tolerated?
i.e. gross disease on scans that is too diffuse to be removed completely and/or decreasing but not normal markers
Do you pursue close surveillance, s...
Although not approved, for example, are you every using AVD-nivolumab?
Given not surgical candidate and within 1 year of chemoRT (recurrence within RT field), would you repeat chemoRT, RT alone, or systemic therapy alone?...
Would you continue osimertinib after radiation therapy, switch to crizotinib, or consider chemotherapy +/- immunotherapy?
Do you reduce the dose to <400 mg daily or employ dosing schedules?
What is your preferred neoadjuvant chemotherapy course for healthy adult patients with osteosarcoma?
Is there an age limit you use to consider MAP? Would you consider using AIM instead?
How do you choose between local therapy (surgical debulking or ablation) v. 2nd line systemic therapy? Would you consider immunotherapy?
How would you approach a post-menopausal woman who now wishes to start adjuvant endocrine therapy more than 3 years since surgery?
Would you prefer first-line AI/CDK 4/6 inhibitor, or first-line AI followed by 2nd-line fulvestrant/CDK 4/6 inhibitor (either abemaciclib, once availa...
Would presence of TP53 mutation weigh in on the offer of radiation? Would there be any change expected on the chemo regimen?
SOLO1 trial studied stage 3/4 patients.
If finished adjuvantly, what would you do -- continue TC or change chemotherapy?
In this case, Gleason 5+5 in all cores, clinical T4.
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...
Provided the patient can have the solitary met treated definitively with SBRT and is otherwise a good surgical candidate
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...
How about those with metastatic disease eager to maintain quality of life? Do you risk progression of disease if the TNF blocker is re-started?
Particularly if steroids are used for non-immunotherapy toxicities (COPD exacerbation, brain edema, autoimmune diseases to name a few) -- when do you ...
Specifically, would you consider utilizing sodium thiosulfate in adults based on the pediatric data from Brock et al. NEJM 2018?
Would you give 3 cycles of RCHOP followed by consolidative IFRT or 6 cycles of R-mini CHOP? Is there a role for 3 cycles of R-mini CHOP followed by IF...
Assuming the patient has an indication for treatment.
Thrombosis was ruled out and no etiology was found. Would you start ponatinib back at a lower dose, transition to omacetaxine or begin transplan...
If yes, would you still recommend dual HER2 directed therapy?
After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has beco...
How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?
Given the national shortage of etoposide starting in February 2018?
Rationale for adjuvant therapy was high Oncotype score.
What would be a safe dose for ifosfamide and how would you time with HD? Alternatively, would you recommend a different regimen? What about using neoa...
How do you treat if adriamycin is not an option?
Specifically concurrent ifosfamide? Induction AIM?
Given metastatic disease and not a trial candidate, how would you approach this scenario? How does an underlying diagnosis of NF1 affect your decision...
Given that DBA is associated with increased incidence of MDS, AML and other solid tumors, would this modify your treatment recommendations?
For early stage disease in a single breast, would you consider neoadjuvant chemotherapy or upfront surgical staging followed by adjuvant therapy? What...
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...
On occasion, patients with locally advanced gastric cancer are poor candidates for FLOT-like chemotherapy. Should such patients be taken to surgery up...
In a patient with a good performance status, would you consider this?
If so, what is your approach to sequencing and timing of targeted therapy and local therapy?
NCCN suggests either concurrent chemoRT or induction chemotherapy in these patients.
RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.
PDL1 is > 50%. There was no perforation or lymph node involvement.
How long would you continue androgen deprivation after radiation?
How would you approach this situation in the absence of BRCA mutation data?
Should these patients be managed using small cell lung regimens?
I have seen anywhere from 4-6 months utilized. Is there any data to guide your strategy?
Do you tailor treatment to a goal response? Do you refer to data illustrating improved prognosis if the patient develops a CR or PR?
Does your approach differ by EBV status?
Provided the sternal lesion was low volume and treated with curative intent and patient has been on tamoxifen for < 5 years, would you switch to AI...
ie renal dysfunction, hearing loss, neuropathy
UpToDate indicates that VIP is an alternative to BEP for men who are not candidates for bleomycin, and that one criteria for not being such a candidat...
Has the utility of BRAF in CRC expanded beyond guiding prognosis? Is there a role in non-metastatic CRC?
Could carboplatin be considered here? Or any evidence for a PARP inhibitor?
Patient characteristics would unarguably be a deciding factor, but outside of these how would you approach the situation?
Liquid biopsy also showed AR amplification.
If so, after how many cycles of chemotherapy would you switch?
Patient has small cell carcinoma of the bladder with extensive hepatic metastases. Would you extrapolate the approach from IMpower133?
PIK3CA and ESR1 mutations on NGS without other targets and who has progressed on CDK 4/6 & AI and several single agent chemotherapies. Aside...
Does hormone receptor status impact your decision?
Would you recommend surgery, definitive chemoRT, or chemotherapy alone?
Retrospective data show very low response rate of immunotherapy in FGFR mutated patients.
NCCN suggests to consider continuation of imatinib from some single/multi institution non-randomized trials for ~2 years, but does not suggest what fa...
Would PDL-1 status impact your decision?
With the recent finding of benefit of pembrolizumab and SBRT (PMID: 31294749), would you consider "adjuvant" pembrolizumab for PDL1 positive patients?...
Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?
There is some data on TMZ and 5FU based regimens, but convincing evidence is lacking. How would you approach this situation?
What would you use either in adjuvant setting or in metastatic setting?
Should cystectomy remain standard of care?
(Recently debated in JAMA Oncology:
http://jamanetwork.com/journals/jamaoncology/article-abstract/2520055...
Tamoxifen prophylaxis has not been studied in women <35 years old, but it would be reasonable to assume they would benefit.
In a patient with a prior response to ADT and progression on taxane and platinum chemotherapy, would you consider AR directed therapy?
Assuming there are no other indications at the moment.
I have seen some advocate for this in the community, although a Cochrane metanalysis did not find an advantage to giving the taxane earlier.
Some specific questions:
Would you recommend repeat biopsy to confirm residual disease?
How would your recommendations vary if the patient had pre...
I understand the perioperative trials are not based on tumor regression in cancer cells.
In a patient with who had undergone neoadjuvant TCH-P, lumpectomy, and RT and is currently on AI, pertuzumab, and trastuzumab, how do you think about ...
Would you reserve TKI for after standard of care chemotherapy and immunotherapy or consider earlier line of treatment?
Would this affect your decision regardless of the stage and symptoms?
If so do you favor repeat tumor biopsy or cfDNA?
Would you forego anthracycline?
Do you await molecular and cytogenetic results prior to initiating therapy, or does age and function status primarily drive your choice?
NCCN does not list any preferences for the TKIs in their guidelines.
Aggressive histology with tall cell variant papillary thyroid carcinoma that's progressed 2 months after RAI and while on TSH suppression, without tra...
What if only site of progression was in the brain/CNS?
Neratinib was studied following adjuvant trastuzumab. Do you extrapolate that data to give neratinib to patients who have received adjuvant T-DM1 inst...
The ABC trials (Blum, JCO, 2017) used six cycles of TC. Is it because of the superiority seen with TC x four cycles versus standard AC x four cycles (...
I.e., Can day 2 Rituximab (RCHOP) or day 6 Rituximab (DA-EPOCH, Hyper CVAD) be given? Or should only Day 1 Rituximab be used with chemoimmunotherapy i...
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 be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...
Since some prior studies (eg. Eskelund et al. Blood 2017 130:1903-10.) have shown intensive chemoimmunotherapy does not overcome the ad...
Often patients are referred to medical oncology for adjuvant therapy for early stage breast cancer after BCS and just before starting radiation.
Per the ALSYMPCA study, they excluded patients with > 3cm lymphadenopathy. Patient is currently on enzalutamide and leuprolide and refuses docetaxe...
For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?
Would this approach be different for a patient treated with tri-modality therapy (ie neoadjuvant chemoradiation followed by resection)?
Given the prior results of Keynote 189, how do you plan to utilize the data from Keynote 042 with pembrolizumab monotherapy?
Or do you reserve in case of oligo-progression or progressive/symptomatic disease?
Would the presence of high-titer antiphospholipid antibodies (for example) in the absence of a clot history alter your decision?
Do you see a role for adjuvant radiation therapy?
Would you give chemotherapy concurrently with radiation? Would you change your radiation dose?
CT or PET? If so, how often?
Does the STAMPEDE trial, showing a survival benefit with the addition of docetaxel to standard treatment, change the standard of care for high risk, n...
These patients were excluded from the SOLAR-1 trial.
Tumor measured 3 mm.
There is increased stroke risk after 65 years of age with bevacizumab. Does that stop you from using it?
Would you offer definitive management with radiation and ADT? Or systemic therapy alone such as with ADT+abiraterone?
She developed biopsy proven skin nodules while on paclitaxel. PDL-1 positive and BRCA negative. Would you consider atezolizumab with a different agent...
What are the major factors that impact your decision? If you opt for surgery, what factors impact your decision to offer RT preoperatively vs. postope...
Mixed opinions about efficacy of IO therapy in this subtype.
KEYNOTE-062 showed deep durable responses are possible with upfront pembro, specifically in the CPS >10 subset, with OS advantage when compare...
ENZAMET and TITAN trials published at ASCO 2019 show benefit to both 2nd generation AR antagonists when compared to placebo but wondering how this wil...
What factors do you consider to aid in this decision making? The TIGER trial is a prospective randomized trial comparing these approaches.
She is otherwise asymptomatic and no LFT abnormalities. Would you switch to chemotherapy or offer different endocrine therapy?
Rate of pneumonitis was low in the PACIFIC trial but does it mirror the real world setting? We are seeing increased pneumonitis in our practice.
https://www.nejm.org/doi/full/10.1056/NEJMoa1813181
Is IO related pneumonitis in the radiation field or more diffuse?
For example - Would you offer tandem transplantation in a young, fit patient in a CR after first transplant, but with MRD detectable?
Some ENTs advocate for a neck dissection as a way to avoid chemotherapy if there is a high chance there is no ECE. This is without removing the primar...
Patient has hot flashes.
Would you proceed with induction chemotherapy (eg TPF or cis/gem) to downstage or neoadjuvant chemoRT? Would your approach be different if there is or...
SELECT trial
Do you feel it is important to start durvalumab within 14 days of completing cCRT? What real life challenges do you face in doing so and wh...
Pathology is clear this is not a concurrent DLBCL and is indeed transformed CLL
Have you seen RAI or lenvatinib be efficacious for locally advanced disease — allowing for better surgical outcomes? Do you utilize EBRT?
FDA package insert lists posaconazole as strong cyp3A4 inhibitor and states to consider other therapies.
http://abstracts.asco.org/239/AbstView_239_262655.html
For those that do receive adjuvant therapy with stage II disease, we know magnitude of benefit to be lower. If the decision is made to administe...
Medical inoperability is clearly defined, anatomical resectability is also pretty much clear (invasion of trachea/carina/esophagus, etc). But what abo...
Would you treat to the GEJ regardless of whether the positive node was identified in the upper portion of station 8? Do surgeons routinely dissect to ...
NCCN guidelines recommend adjuvant chemotherapy for patients with stage 2 or 3 R0 resected NSCLC including 4 cycles of platinum based chemotherapy, bu...
Can it be added after 2 or 3 cycles of HMA?
Do you follow invasive or DCIS guidelines? Would you consider re-excision in a patient with multifocal microinvasive carcinoma of the breast arising i...
Is there any data as to whether TKI or immunotherapy is more effective in this population?
Do you offer perioperative chemo with metastectomy with an isolated liver metastasis? The RENAISSANCE/AIO-FLOT5 trial (PMID:30448343) is seeking to an...
If so, would you combine them vs monotherapy? Patient ECOG is 1
Why do the NCCN guidelines suggest using neoadjuvant therapy only for patients with T2 or greater tumors?
Is pembrolizumab considered standard of care in the 2nd line treatment of recurrent cervical cancer?
Does the phase II KN-158 provide sufficient evidence to change management?
Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?
If so, would you treat as node + BC with anthracycline and taxane regimen or non-anthracycline regimen (i.e docetaxel and cyc...
With increasing utility of immunotherapy across cancer types, patients with history of solid organ transplants may face need for cancer IO. How do you...
She developed isolated paraspinal recurrence that is not amenable for local therapies including RT.
Patient defers chemotherapy. She is currently on anastrozole/Herceptin and perjeta with a response but it is suboptimal. I would like to add a CDK 4/6...
The patient received THP and now is on maintenance HP when she developed CNS disease.
She had a ipsilateral chest wall recurrence after mastectomy ~5 wks after surgery that was known TNBC. Residual disease remained in known breast and a...
Initially stage 1 disease with high risk Mammaprint recurrence risk completed adjuvant chemo 15 months ago.
Does presenting total white blood cell count affect your decision? Does myeloid subtype affect your decision?
No actionable mutations were identified on next generation genomic sequencing.
How would you treat metastatic, unresectable, solitary fibrous tumor in a patient with mild hemophilia A? Each anti-VEGF medication comes with a warni...
Do you consider specific pre-medications, an alternate checkpoint inhibitor, or abandon ICI altogether?
If so, how would you modify this regimen?
Data was presented at ASCO in 2017 that abemaciclib has brain activity in HR positive breast cancer.
Retrospective studies (PMID: 29935305, PMID: 30125216) have shown a correlation between poorer outcome and baseline steroid use in patients treat...
If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?
She had not received any systemic therapy previously.
Most guidelines recommended adjuvant chemotherapy if tumor size was >3cm at the time of TAILOR Rx and patients with tumors >5cm were not include...
greatest measuring 1.0cm.
How do you interpret results when IHC is < 1% but CPS > 1?
Or would you proceed with standard-of-care adjuvant approach for high risk patients?
How might your decision change if the patient had a suitable 10/10 donor? How about if the patient had a targetable molecular mutation such as IDH2?
If neck dissection was done, do you offer adjuvant chemo and/or XRT?
The use of neoadjuvant CDK 4/6 inhibitors is not standard of care, but there are clinical trials looking at this question and patients who are chemoth...
AI+ CK4/6 inhibitor? Fulvestrant + CK4/6 inhibitor? AI + fulvestrant? AI + fulvestrant + CK4/6 inhibitor?
I.e. according to Mammaprint test?
Would it make a difference in terms of OS if the patient received AC?
Are there any patient and/or pathologic features that would lend you to considering IL-2 over other approved I/O or TKI therapies?
Would you proceed with modified radical mastectomy followed by systemic therapy, or would you consider neoadjuvant therapy? Would biomarker status mat...
Does the presence of N1 disease push you towards offering chemotherapy or would you continue endocrine therapy based on the PR?
Retrospective data suggest clinically significant disease flare after tyrosine kinase inhibitor discontinuation in patients with EGFR-mutant lung canc...
Do you use crizotinib for first-line therapy?
Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on sa...
First line pembrolizumab is only approved after progression on TKI - but would you ever offer chemo-immunotherapy prior to target therapy?
Is the timing of progression (in relation to chemoradiation) a factor, and is there any role for repeat PD-L1 testing at the time of progression?
In addition to gabapentin and Lyrica, what else can you do for chemotherapy induced neuropathy?
Arterial events have clear instructions to permanently discontinue on the FDA label. Especially in HCC without many other treatment options, giv...
Favored approach: AC-T +\- carboplatin, +\- gCSF
Is there one drug that carries the least risk of pneumonitis?
Do you use chemotherapy or radiation?
The FDA has approved the new dosing schedule of Nivolumab 480 mg every 4 weeks for multiple disease sites (melanoma, RCC, urothelial carcinoma, SCC of...
The patient has been off her AI for two years.
How does grade or performance status affect your treatment decisions?
She has hepatorenal failure due to metastatic disease.
Does anatomic location (eg retroperitoneal or thoracic) affect your treatment decision?
Do you have a time threshold for re-challenge with platinum? Of note, Checkmate 141 defined platinum refractory as relapse within 6 months of pl...
For the first treatment day (during combined chemo/XRT courses), is it ok to give XRT first then send the patient for chemo or should the chemo be giv...
When 5FU is a backbone to so many regimens, when (if ever) do you consider re-challenging so as not to abandon an entire line of therapy?
Have you used anti-androgen therapy? Do you enroll patients on a trial or treat off label?
No viable cell was present.
Is there a role for attempting to continue EGFR inhibition in addition to chemotherapy for small cell lung cancer?
The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...
NCCN lists multiple preferred options.
What factors influence your decision?
Would you consider adding atezolizumab to a cisplatin/irinotecan regimen, or cisplatin instead of carboplatin?
Which patients should receive TDM-1, Trastuzumab+Pertuzumab or Trastuzumab alone?
In obese patients, would it make sense to switch from a GnRH agonist to an antagonist based on the data from the recent JCO study of dagrelix vs. trip...
Is there a role for SBRT with or without the addition of systemic therapy?
This is specifically in regards to metastatic colon cancer with good disease control of disease on FOLFOX and preserved hepatic function.
NCCN recommendations seem to mention these patients as not candidates for preoperative systemic therapy if the invasive carcinoma extension cannot be ...
Patient did not receive neoadjuvant therapy.
I have received inquiry from a patient's gastroenterologist regarding use of Entyvio or Stelara in such a situation.
What would be the optimal sequence of surgery, radiation, and chemotherapy for this patient? This patient has an excellent performance status and...
Clinical T1c patients were included in the KATHERINE trial that often are treated with adjuvant paclitaxel and trastuzumab
If it is still within the 12 month period and no disease recurrence?
Is there a point at which there may be no benefit? More than 3 months from breast surgery? 6 months? 1 year?
Would you maintain dose density of chemotherapy and use peg-filgrastim prior to delivery of the baby? Would you defer taxane and anti-HER2 therapy unt...
If so, what would be the regimen that you would consider and what factors would sway you for or against chemotherapy for such patients?
The ABC trials show a DFS advantage of anthracycline-based regimens. Would age alone procure you from using it in a patient?
Any factors that would impact this decision (how far along adjuvant trastuzumab, disease characteristics, etc)?
The patient had minimal to no response to neoadjuvant therapy.
This patient is a young lady with stage IV ER/PR positive, Her2 negative with oligometastatic breast cancer undergoing a planned bilateral oophe...
Would you give adjuvant chemotherapy or start osimertinib?
The CALOR trial included patients that could receive HER2-targeted therapy.
Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...
Given the recent results presented from the Griffin trial, would you choose a daratumumab-based regimen (eg. D-VRd) over other salvage options (V...
Only a small subset (22-24%) of patients in Katherine trial received a non-anthracycline containing regimen.
Can repeating Oncotype on a locoregional recurrence show a change in the biologic behavior of the cancer over time and guide treatment decisions?
In light of the data from ERA223 showing increased deaths and fractures with the combination of radium-223 and abiraterone compared to abiraterone alo...
The recurrence was 2 years after treatment with ddAC + T. If you elect for systemic therapy after local therapy, what chemotherapy would you use...
The patient completed AC-T three years prior.
IHC has been repeated and confirms triple negative disease.
What features would make you more likely to recommend radiation therapy with chemotherapy?
Does the presence of BRAF mutation affect your decision?
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.
Assuming there was an initial period of response to the mCRPC treatment.
Should this be the new standard of care based on the results from the recently published SOLO-1 trial?
Two new phase 2 studies this year with apatinib/oral etoposide (AEROC) and sorafenib/topotecan (TRIAS) were released, and NCCN also lists many single ...
Would you consider neo-adjuvant chemotherapy or treat with endocrine therapy?
One such patient progressed through trastuzumab/pertuzumab/letrozole and TDM1 alone. How would you combine ER+ approaches (eg CDK 4/6 inhibitor ...
What patient and disease factors may influence your decision?
Do your recommendations differ if patients are pre or postmenopausal given the data?
There is no primary and no distant disease seen on restaging PET. RTOG 0236 shows significant regional failure rate. Some have reported salv...
Do you ever start radiation +/- 24-48 hrs from C1D1 for chemotherapy due to logistical barriers?
Do you prefer chemotherapy to start at beginning of ...
Do you routinely perform molecular testing?
Would you add atezolizumab to carboplatin + etoposide for small cell/neuroendocrine prostate cancer?
Treatment for small cell/neuroendocrine prostate is extrapolated from data on small cell lung cancer. It now appears that Carboplatin + Etoposide + At...
Would you offer immunotherapy combination (nivo/ipi) in patients who have failed nivolumab mono-therapy?
For instance, in stage III, would you use chemotherapy in neoadjuvant or adjuvant setting? What regimen would you use?
Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?
Are you directed by symptoms, PSA changes or do you have a standard schedule regardless of those factors?
For example, in a patient > 70 years old?
Have the results from IMpassion130 changed the standard of care?
She otherwise does not have any BRCA mutations nor any underlying cardiac disease.
Late relapse, previously treated with BEP 30 years ago.
Would the site of disease relapse play a role in your decision (i.e. isolated lymph node recurrence versus failure at primary site of disease)?
Which appetite stimulants are the most effective? How do you respond to patients who request medical marijuana?
And how long? According to the ABCSG-16 Trial there was no difference in extending AI beyond 2 years after an initial 5 years.
Will you incorporate the results from KATHERINE into clinical practice now?
At what point (ie 8, 10, 12 weeks or more) would you no longer offer consolidation durvalumab?
Has the recent data presented at ASH affected your choice of regimen?
Would your choice differ between transplant-eligible and transplant-ineligible ...
The CREATE-X trial did not include HER-2 positive patients but the ER-negative population benefited from capecitabine. Would you consider capecitabine...
Shanafelt et al. recently presented results from the phase III E1912 study at ASH 2018. Will you still utilize FCR as first-line or now use Ritux...
Hormonal therapy would not be tamoxifen.
Since the randomized phase II data from Gomez et al presented at ASTRO 2018 showed a survival benefit, is there concern about randomizing patients to ...
Would you consider treatment based upon imaging alone or would you wait for tissue confirmation of metastatic disease?
Does the answer vary based on whether it is neo/adjuvant or metastatic setting?
How applicable is the SOFT/TEXT data in this setting ?
Would MRD assessments affect your clinical decision making for MM patients outside of a clinical trial?
Do you use etoposide-based regimens such as R-CEPP? How about substitution with liposomal doxorubicin?
Is concurrent chemotherapy necessary for these patients?
Analyses have showed questionable benefit with chemotherapy
One example is the original breast cancer ER high 90%, PR mod to high 40%, Her2 negative. A liver metastasis diagnosed 2 years later showed ER l...
Do you test for COX-2 and PIK3CA mutations?
Would you offer chemotherapy alone per data from BILCAP or is there any role of radiation?
Does the lack of D2 dissection automatically necessitate adjuvant chemoradiation therapy (ie <5 LN obtained)? Would the presence of high risk facto...
What are your thoughts with the new KEYNOTE-522 regimen? Would you just use carbo/paclitaxel/pembro part of the regimen or give as much doxorubicin as...
Does your practice differ based on limited or extensive stage disease?
Does the Child Pugh score factor in your treatment decision, i.e. Child Pugh score C?
I have seen favorable clinical trial reports on dasatinib for metastatic disease, but no data on possible adjuvant use. NCCN guidelines suggest ...
Does papillary histology influence your decisions regarding surgery, chemo, radiation dose or nodal coverage?
For a patient with cT3-4N0 rectal cancer, does the dose of the previous RT affect your decision making (for example, 45 Gy to the pelvis with boo...
If there is no other evidence of metastatic disease, would you offer thoracic radiation? Either upfront with chemo or after initial system therapy if ...
OS benefit was limited to patients with endocrine sensitivity, defined as either a documented clinical benefit (CR, PR, or SD for ≥24 weeks) f...
Abstract LBA5_PR ‘Radiotherapy (RT) to the primary tumour for men with newly-diagnosed metastatic prostate cancer (PCA): survival results from S...
Routinely? Only with oropharyngeal cancer etc.? Given that low expression of EGFR subset did better, do you believe there is a true benefit in cetuxim...
The NCCN guidelines suggest surgery can be considered for up to T3N2 NSCLC after a period of induction chemotherapy/chemo-radiation without progressio...
Specifically, what regimen would you choose in a patient with new renal failure but not requiring dialysis?
Would you consider radiation and/or chemotherapy?
What is the ideal timing for monitoring and what laboratory tests should be used?
Initial pathology additionally yields low Ki-67 and is HER2 negative.
Is this recommended in a certain subset of patients (EGFR positive or 1 metastasis only)? Or should we await maturation of the MD Anderson/Colorado/On...
How common is hyperprogresion, and are there any strategies to mitigate it?
What if the patient has thymoma-associated myasthenia gravis?
What factors influence your decision (patient/disease characteristics, additional agents added to induction chemotherapy, CR1 or later, etc)?
Currently, nivolumab is approved as a second line systemic therapy for patients with metastatic HCC with Child-Pugh (CP) A-B7 based on results fr...
How do you approach a decision to retry a previously failed therapy if patient does not wish to pursue a clinical trial? Does sidedness (left or right...
Does an age over 70 years, size, histology and hormone receptor status affect this decision?
If a patient obtains a PR or less to front line cladribine, what factors help you chose between a second course of cladribine, an alternative pur...
Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?
The patient is relatively asymptomatic.
Patients with T3aN1a( stage IIIA per AJCC7) were excluded from nivolumab adjuvant trial. Would you consider nivolumab in these patients?
Do you offer chemotherapy upfront in all patients or only if borderline resectable/unresectable? If you treat, what regimen do you use and how l...
Prospective International Randomized Phase II Study of Low-Dose Abiteraterone with Food versus Standard Dose Abiraterone In Castration-Resistant Prost...
The patient only had disease involving the right breast and axillary, cervical, and supraclavicular lymph nodes. She had complete response to with ddA...
Would you offer locoregional control alone, locoregional with adjuvant therapy, or active surveillance?
What would you consider in the first and second line settings with intact MMR/MSI?
Prior to the PACIFIC trial, patients were treated with definitive chemo/rads. With local recurrence <1yr after chemorads and definitive treatment f...
Has the publication of IMpower133 changed standard of care?
All tumors in this case were <2cm in size.
Or do you wait for platinum resistance?
Would starting with chemotherapy be preferred in this situation and consider concurrent radiation, then switch over to Pembrolizumab once some control...
Checkpoint inhibitors have demonstrated durable responses in clinical trials, which was never seen with cytotoxic chemotherapy in the past. What are t...
Essentially, is there any role for "COMET trial" type therapy for a low risk elderly patient?
If so how would you select patients (ie. PS, histology, PD-L1 expression level)?
How about if disease is found in the CSF?
Is TC or CMF adequate or is only ddAC -> T recommended?
When is it warranted to utilize targeted therapies for known mutations (eg. midostaurin or an alternative TKI for FLT3 mutations, ivosidenib for ...
Does the choice of initial induction regimen affect your decision for when to employ lenalidomide maintenance?
Are there situations where you would c...
Are you routinely using letermovir as CMV prophylaxis in high-risk patients?
Any special considerations with its use versus other antiviral agents?
...
(HER2/CEP17 ratio <2.0, copy number >4.0 and <6.0 signals/cell)
There is a gray area in clinical decision making where the practice seems to be different for borderline size tumors such as a 7 mm T1b lesion with no...
If yes, what dosage and do you use it continuously or intermittently? Regarding provera, many patients with ER/PR (+) breast cancer worry about taking...
In a patient s/p orchiectomy and with pelvic lymphadenopathy, would you consider lymph node biopsy to confirm involvement by non-seminomatous germ cel...
Would you consider switching regimens?
Do you test for pregnancy prior to each cycle?
Most of the studies have excluded non clear cell histologies. If you use a similar approach to clear cell, have you seen similar responses?
Should it be started at the initial diagnosis of bone mets?
For which patients would you consider addition of apalutamide or enzalutamide? How do you decide between the 2 drugs?
The recent SPARTAN trial showed a remarkable improvement in metastasis free survival and many other secondary endpoints except the lack of significant...
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?
How would being MSI-H/dMMR influence your choice of adjuvant treatment?
NCCN guidelines recommend both single agent Pembro and/or Ipi/Nivo as first line options. How would you choose between the two? In case of the latter,...
NCCN recommends to change therapy or maintain current therapy in this setting without further clarification. What thresholds would cause a change in t...
Not to decrease recurrence risk, but for chemoprevention of new ER-positive DCIS or invasive disease based on the Gail Model. If so, is there data to ...
Would you treat differently for de novo disease vs disease arising from large cell transformation of an indolent NHL?
Given the rarity of this in MF, is it still predictive of response to lenalidomide therapy?
For example, would a + vascular margin, extranodal extension of N1 disease, translobar disease, or high risk histologies (large cell neuroendocrine, s...
Does their candidacy for autologous HSCT affect your decision to use maintenance lenalidomide?
Would you repeat PET or is it adequate to change to CT surveillance? Although surveillance PET/CT is not recommended by NCCN guidelines, these are oft...
Would you treat with localized therapy with chemoradiation or SBRT or consider ROS-1 directed therapies?
The FDA recently approved Braftovi (encorafenib) and Mektovi (binimetinib) in combination for unresectable or metastatic melanoma. When would they be ...
Is there any role for orchiectomy in this setting?
Would you use the same schedule as early stage NSCLC primary?
The current NCCN guidelines reserves radiation for patients who are not resectable after induction chemotherapy. Does it make sense to offer concurren...
How does the timing of recurrence play into your decision?
What are the special considerations in the non-metastatic setting vs metastatic setting?
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 ...
For example, would you consider this in a patient that would otherwise be eligible for adjuvant treatment (stage III or stage IV with oligometastatic ...
The patient is a pre-menopausal woman with low-grade, stage I IDC who initially could only tolerate 10 mg of tamoxifen for her first year of trea...
Young woman with Her2 positive disease involving her right breast, regional lymph nodes, and liver had a CR on PET after therapy with THP and now plan...
Would you offer adjuvant therapy post resection?
Would you switch chemotherapy regimens (i.e if the patient received FOLFOX/Avastin, change to FOLFIRI/Avastin)? Would you treat wuth immunotherapy per...
The NEJM 2015 paper by Tolaney et al only included 1.5% of patients with micrometastases.
Would your choice of treatment change if the same patient was T790M negative and osimertinib was given as a first-line therapy?
If a patient has ER/PR+ and Her2 positive disease in the primary tumor while axillary lymph node core biopsy is ER/PR+ Her-2 negative, do you man...
If so, what is the ideal imaging?
Do you prefer carboplatin-paclitaxel-bevacizumab, carboplatin-pemetrexed-pembrolizumab, or chemotherapy alone?
Is there a role for immunotherapy outside of trial setting?
Would this be any different for whole brain radiotherapy?
Pt is healthy and tolerating Tamoxifen well.
In a patient treated over 10 years ago with mastectomy and chemo now with recurrence in the ipislateral axilla, would you offer additional with chemot...
Which of the systemic options would you give concurrently with radiation therapy in the adjuvant setting? According to NCCN guidelines, high dose...
Would you consider repeating neoadjuvant chemo/RT? Does this, occurring in the context of Lynch Syndrome, change the treatment approach?
Can these patients be re-challenged with Herceptin?
Does the more recent NEJ026 trial describing benefit from Bevacizumab plus Erlotinib over Erlotinib alone in patients with EGFR driver mutations ...
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 sequence radiation?
Specifically, this patient had a new left lacrimal gland metastatic lesion that developed four years from her initial diagnosis and is currently under...
Would you change to an alternative triplet therapy, or switch to maintenance therapy?
Are there variations in depth of response short of CR that woul...
Testicular ultrasound, CT, and tumor markers are without abnormalities outside of the mass.
There are now five PD-1/PDL-1 inhibitors approved for metastatic bladder CA, one (Atezolizumab) as first-line therapy in cisplatin-ineligible patients...
does it matter whether it is given frontline vs later?
If there are 3 negative scans, do you continue annual screening?
Does the more recent data regarding the continued utility of brentuximab vedotin and the utility of PD-1 inhibitors factor in to your reasoning at all...
A recent phase III trial published in JCO describes the NVALT-11/DLCRG-02 study, evaluating PCI vs observation in patients with stage III NSCLC s/p co...
Is there any data to suggest delayed initiation of adjuvant treatment would be beneficial? Or would close surveillance be reasonable? Patient is asymp...
Would you do this for ER+ patients?
According to the PERSEPHONE trial presented on ASCO 2018, in HER2+, non-metastatic breast cancer, 6 months Hercep...
Specifically, would carbo-taxol-bev-atezo (IMpower 150) be an attractive option given the activity of bev-atezo in sarcomatoid PDL1+ metastatic RCC (I...
Do you have experience administering these agents in the outpatient setting?
What systemic therapy do you use? Do you incorporate any multi-modality therapies?
I have a patient who will be climbing to the base camp of Mount Everest. Does a climb to 15,000 feet increase her risk? Should she wear a compression ...
Could one make a case for addition of Rituxinab frontline to increase the chances of a complete remission and even maybe achieve MRD-negative status ?
Does it differ from the treatment of other relapsed peripheral T-cell lymphomas?
Are there any clinical trials or case series focused on SPTCL?
Is t...
What factors if any would influence your decision and what would your approach be?
Does presence of intraperitoneal spread and solitary extraperitoneal visceral metastasis affect management?
Do we continue the hypomethylating agent indefinitely?
If yes, what factors push you to test for AR-V7 or would you test all patients in this clinical scenario?
Would you give neoadjuvant chemotherapy in a patient with T1 N1 M0 ER/HER-2 positive cancer if they are candidates for upfront lumpectomy?
If there is no response to neoadjuvant AC -->T, would you offer additional adjuvant chemotherapy?
Is there any data for the benefit for systemic chemo in such situation?
Is there any evidence to use trastuzumab and pertuzumab without doxorubicin?
High enough risk to justify anthracycline+taxane chemotherapy followed by ovarian suppression + aromatase inhibition.
Is it reasonable to use single agent carboplatin for elderly patients?
Would you initiate abiraterone or enzalutamide for the rising PSA or wait until the patient is symptomatic or has a new site of metastasis?
For the Impower 150 trial, is there data reported on PFS and OS for ABCP vs ACP (atezolizumab/bevacizumab/carboplatin/paclitaxel vs atezolizumab/carbo...
Or would you wait to start coincident with the start of cycle 2? If a shorter time from the start of any therapy to the end of radiation (SER) is sign...
Many times we encounter patients who do not have a tissue sample readily available or in whom obtaining such a sample would be hard. On a more molecul...
How do you interpret the results of Checkmate 227 in light of Keynote 189 and Keynote 407?
Are these patients better candidates for preop chemotherapy alone?
Can you comment based on the results of PRODIGE 24 from ASCO 2018?
http://abstracts.asco.org/214/AbstView_214_218335.html
Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?
If so, after what duration?
Patient currently has bone and lung metastasis.
In the context of the new staging systems and possible differences of HPV mediated vs smoking mediated oropharynx SCC, would you ever not recommend co...
Does the recent FDA approval based on PFS and response rate in KEYNOTE-021 warrant it's use?
Technically, you can have up to 55% of larger cells circulating and still be called CLL.
Can you extrapolate the data on Durable Complete Response After Discontinuation of Pembrolizumab in Patients With Metastatic Melanoma to patients on a...
Would you use this combination in frontline vs later lines of therapy ?
The PERSEPHONE trial to be presented at ASCO suggests 6 months of Herceptin is non-inferior to 12 months in early Her2 postive disease.
Would you observe until progression or would you place the patient on maintenance?
Patient does not have BRAF mutation.
If so, how frequently?
Has the new data with the Natera assay from Reinert T et al in JAMA Oncology May 2019 changed your practice?
In this study, doses of 2mg/kg Q3wks, 10mg/kg Q3wks and 10mg/kg Q2wks were used. What did the majority of these patients in CR receive?
By the definition this would be M1 disease, but would definitive treatment be appropriate? Is there clear data that a single pleural nodule has no cha...
Do you start with 1250 mg/m2 BID and then dose reduce based on toxicities? Many studies across varied types of malignancies have shown good tolerabili...
Would you consider "aggressive" concurrent chemoradiation followed by SRS to the CNS lesion and possible consolidative immunotherpay (the PACIFIC...
How do you treat these patients if they progress after immune checkpoint inhibitors?
First episode was 10 years ago and patient did not receive XRT. Would you give XRT now?
Current NCCN guidelines seem to support a variety of approaches.
The patient is cisplatin ineligible due to renal dysfunction.
Would you consider MS an absolute contraindication to this treatment?
What is the optimal regimen for a pre-menopausal female with progression of ER+,PR+ and Her2 neu negative breast cancer while on tamoxifen for six mon...
Do you consider it only in lymph-node negative or up to three lymph nodes?
Once you decide to begin treatment, any special precautions you would use for protein levels starting that high.
Pt previously treated with radical prostatectomy and adjuvant radiotherapy.
If recommending therapy, what is the role of concurrent abiraterone + AD...
Would your recommendation change at all depending on time to relapse or original stage of melanoma?
Given the results of Keynote 189, is there any benefit of chemotherapy+pembrolizumab in specific subsets of patients in the first line setting?
The patient initially had a great response to THP for four months, but now with quite a bit of lung, pleural, and nodal involvement.
If the patient has large, bulky nodes would you consider starting after chemotherapy for cytoreduction? Or otherwise consider replanning mid-treatment...
Based on new FDA approval of nivolumab plus ipilimumab in the first-line setting for intermediate- and poor-risk disease, would you give the combinati...
Do you offer additional adjuvant chemotherapy, proceed to adjuvant endocrine therapy, or search for a suitable clinical trial?
Could observation and serial cystoscopy be a reasonable option or is surgery necessary? If recommending surgery, can a procedure less than a nephroure...
Intramammary lymph node involvement has been shown to have a poorer prognosis (Hogan, Surg Onc, 2010). Would Oncotype be useful in these patients...
Assuming that the involved area is too widespread for RT. Would you try single agent rituximab first? Or obinutuzumab? What if rituximab alone gave on...
Would you consider capecitabine in addition to paclitaxel?
CIC-DUX4 fusion sarcoma is a rare entity, the aggressiveness of which is comparable to Ewing's sarcoma. A major dilemma is whether to treat these pati...
Provided patient is tolerating treatment well.
Is there any data to support this?
No prior chemotherapy.
The recent NEJM phase II trial http://www.nejm.org/doi/full/10.1056/NEJMoa1715519?query=featured_home looked at a small cohort of 24 patients and show...
Knowing that the analysis now is more detailed than it was 10 years ago.
What about non-Ashkenazi Jewish breast cancer patients with suspic...
How do you choose between 3 and 4?
While we await the results of TailorX, what has been the experience in your practice? If the decision for adjuvant chemotherapy is made, do you f...
If staged so due to satellite lesion and negative nodes? How do you decide between adjuvant PD-1 inhibitor or BRAF/MEK inhibition in BRAF-mutated pati...
Assuming SRS to the resection cavity is advised, would you recommend early immunotherapy to improve outcomes/enhance a possible abscopal eff...
Do ER/PR and HER2 markers have any role?
Would you use oncotype to guide your decision?
In the absence of clinical trial, is there are role for dose-escalating alectinib, or would you consider brigatinib or chemotherapy?
Would you consider an aggressive approach such as hepatic resection if the patient is young and has good PS?
Patient does not qualify for breast cancer screening by annual MRI per criteria (IBIS lifetime risk<20%, no known genetic predisposition,...
What adjuvant options would you consider? chemotherapy? radiation?
the MZL was untreated in the past prior to transformation.
Do these patients have a higher risk of recurrence post CR as opposed to patients with de ...
Is it commonly used if no clinical trials are available?
How does it vary for patients with a history of hypertension, diabetes, CHF, and coronary artery disease?
Originally received anthracycline and taxane based regimen.
Would you use carbo/paclitaxel or capecitabine or a different approach?
Do you follow treatment guidelines for indolent lymphoma or CLL? How do you get 17p testing on someone with only lymphadenopathy?
When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?
5FU/mitomycin C or 5FU/cisplatin? Is there any benefit of cisplatin in terms of skin toxicity?
Specifically, in patients that had progression or developed toxicity on ibrutinib? Idelalisib is very toxic and venetoclax a labor-intensive drug to g...
Even though Venetoclax is not FDA-approved yet, assuming you can get it off label?
1. Gemtuzumab: What dose/schedule and which HMA?
2. Venetoclax: W...
Is there any data on safety of radiaiton with pertuzumab?
Would you consider chemotherapy either before or after the lung resection?
Would you consider referring the patient for HIPEC at some point in their treatment, possibly after giving adjuvant chemotherapy, especially if patien...
Is re-challenge with 5-FU safe? Do you consider Capecitabine?
These patients have been largely excluded from these trials. What if the infection is well controlled?
In a patient who underwent laparoscopy for endometriosis and was found to have a 1mm focus of neuroendocrine tumor, would you recommend further surger...
Would you consider resection? Or maybe anti-CD20 monoclonal antibody?
My practice had always been to transfuse for plts < 10, but the recent ASCO guideline change suggests that in the post-autoSCT setting it is ...
In the absence of any other classic CLL indications for treatment.
Is there a difference among all the commercial genetic testing labs? Is there anything beyond CLIA- and CAP-certification that we should look for...
After mastectomy for the locally recurrent disease, would you consider "pseudo-adjuvant" chemotherapy for local recurrence per the CALOR trial? If so,...
What factors dictate choice of observation versus 6 months of adjuvant peri-operative chemoradiation plus chemotherapy especially if patient did not r...
Can you apply the ACOSOG Z0011 study to women who have HER2 positive disease?
Assuming it is clinically indicated, would a checkpoint inhibitor be efficacious in a patient who has a concurrent autoimmune illness (PMR/TA) and is ...
If filgrastim, how many days would you give? Pegfilgrastim is often not covered by payers if given less than 14 days before chemotherapy.
Would you ever considering re-starting immunotherapy before completing the taper?
According to the new guildelines on managing immunotherapy related ...
Do you refer all patients who are felt to be at high risk to a genetic counselor for testing or are you comfortable performing a MyRisk panel in your ...
The patient has no medical problems and no history of leukemia/MDS. Biopsy of the filum terminale and arachnoid confirmed a myeloid sarcoma and MRI sh...
Recent NEJM study showed an increased breast cancer relative risk in longer durations of hormonal contraceptive use that could last up to 5 years. Pre...
An article (BRCA mutation and outcome in BC. Ellen Copson, et al. Lancet Oncol. 2018) showed G3, BRCA+ breast cancer had poorer prognos...
If you treat pre-chemotherapy volumes, is there a benefit to induction chemotherapy even in bulky disease. If so, how do you define disease that ...
If so, what would be the regimen?
Pt has progressed on AI and Faslodex. Goal is radiation to axilla as a palliative intent and Capecitabine to control systemic disease.
Data reported by Motzer et al Lancet 2015 demonstrated a statistically superior PFS benefit of lenvatinib monotherapy over everolimus alone. In partic...
What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?
Subq has been shown to have lower risk of neuropathy. Is there any reason to use weekly IV still?
Are you using post-neoadjuvant Xeloda based on preliminary data from the CREATE-X trial? Does BRCA mutation influence your decision?
Obviously the details matter a lot, but are there guiding tenets one should follow beyond expressing condolences to the family?
Would it change your management if patient if IgVH mutated?
If so, when? Are there certain ERBB2 mutations that would predict response to trastuzumab and/or neratinib?
Following the dosage guidelines based on absolute neutrophil count may cause the patient to end up receiving lower doses.
Would you consider using CKD inhibitors upfront in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Hercepti...
Is the use of immunotherapy being considered, and if so, is the data extrapolated from treatment of mNSCLC and head and neck SCC?
Does resection have an impact on survival?
This is in regards to the risk of secondary cancers after radiation therapy or cytotoxic chemotherapy (such as anthracyclines) in an immunosuppre...
Would you recommend radiation and/or systemic therapy? If you would irradiate, what would your fields/volumes look like?
Taking into account the overlap between treatment regimens for esophageal and gastric cancers, in what clinical context might you feel comfortable tre...
In a patient with multiple poor risk features including TP53 mutation, 1q amplification, stage III, and circulating plasma cells, would you consider a...
For a lesion that appears radiographically consistent with a high grade glioma, would you treat empirically if there is hesitancy to perform a high ri...
Using an AI if a woman is taking an estrogen supplement seems counterproductive.
Assuming the patient was initially treated with surgical resection and adjuvant chemotherapy followed by radiation and appropriate endocrine therapy.
What do you do with low grade (grade 1/3) tumors? In other words, does high grade pathology over rules?
NCCN lists CRT as category 1 but also lists chemotherapy alone as an option. Is this decision based on discussion between surgeon and oncologist...
She has metastatic disease beyond the pelvis (lungs).
Specifically, rising levels noted while on somatostatin analogue.
If so, what regimen would you consider?
In light of two phase III randomized trials showing duloxetine (S1202) and acupuncture (S1200) both improve AIMSS, which would you try first? Wou...
As in removing the 5-FU bolus from the start of therapy and not because of toxicity?
Would the exact Oncotype score guide your decision (ie closer 25-30 v. >30-35)? NCCN recommends Oncotype only for tumor size < 5mm but this case...
Recent evidence has been mixed, with no DFS or OS benefit in 1 trial (ASSURE, Haas et al, Lancet 2016) and DFS benefit in another (S-TRAC, Ravaud et a...
When will you prescribe 3 v. 6 months of FOLFOX or XELOX for the adjuvant treatment of colon cancer?
The abstract of the pooled meta-analysis is not definitive (JCO 35, 2017: suppl; abstr LBA1), and of the phase III trials (SCOT, TOSCA, Alliance/SWOG ...
Do you send Oncotype in patients with ER/PR+ breast cancer and micrometastasis in one sentinel node?
If Oncotype is high risk, what regimen of adjuvant chemotherapy would you recommend?
Would you use a regimen with lower incidence of neurotoxicity such as CMF or a taxane-based regimen with a low threshold to dose-reduce?
Would you consider second line immunotherapy before considering chemotherapy?
Is there a treatment that you prefer for such patients?
What regimen do you prefer?
Would you consider using ckd inhibitors in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Herceptin? NCCN ...
How do you approach treating ER/PR positive/HER-2 positive metastatic breast cancer? Do you combine hormonal therapy / chemotherapy and HER-2 directed...
If a patient with stage II or III colon adenocarcinoma who presents to your clinic 12-16 weeks after surgical resection do you give adjuvant chemother...
Does HER2 or PD1/PDL1 positivity change first line treatment (i.e. preferential enrollment on clinical trials) or do such patients still receiving sta...
We often treat elderly women with lumpectomy and adjuvant hormonal therapy without radiation. I am concerned about how to proceed after the 5 year poi...
For example, how significant does the M protein have to increase for you to begin a conversation about new therapy?
Many women are distressed when asked to discontinue hormone replacement therapy or use intravaginal estrogen suppositories.
If so, which agent(s) do you prefer?
Can T790M mutation develop within this early time frame, or are these perhaps patients who may benefit from switch to chemotherapy?
Some patients request chemotherapy scheduling adjustments to avoid feeling ill on major holidays. Delaying chemotherapy by a few days isn't of particu...
Example case: Patient given neoadjuvant docetaxel + cyclophophamide achieves a partial response after 3 cycles of Taxotere + cyclophosphamide but is u...
Are results of BCIRG-006 trial applicable for patients with triple positive breast cancer or only for those with HER2+?
Given the apparently stronger results from KEYNOTE 052 (pembrolizumab) compared to IMvigor 211 (atezolizumab), would you consider pembrolizumab for pa...
Or do you recommend treatment with systemic therapy alone, as this represents Stage IV disease?
Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?
The GTX (gemcitabine, docetaxel, capecitabine) regimen is listed as a category 2B recommendation in the NCCN guidelines- when would this be ...
How often will you monitor it? In the setting that patient is morbidly obese, does your strategy change?
Specifically, to you lean towards elotuzumab or a daratumumab-based regimen?
How does this approach change with mediastinal lymph node involvement? What are the indications for definitive or adjuvant radiotherapy +/- chemothera...
The current treatment for bladder adenoCA is surgery. However in non-surgical candidates, RT is an option. Would you consider adding chemo ? Also woul...
Since immune check point inhibitors have been approved for GEJ and gastric cancer, would a distal esophogeal adenocarcinoma be considered GEJ or does ...
What is the best evidence for what dose to use? When would you give it in relation to the checkpoint inhibitors? Which metastatic sites do you choose ...
Would you consider subtotal gastrectomy vs medical therapy?
Tamoxifen prophylaxis is FDA-approved, but would you extrapolate from adjuvant/metatastic data for hormone receptor positive breast cancer in post-men...
If so, what chemotherapy regimen would you use? If not, what management options would you generally recommend?
In the absence of data demonstrating a clinical benefit for one strategy versus the other, what do you do in practice?
Most oncologists are comfortable offering FOLFOX for 1st line metastatic adenocarcinoma. Would you be comfortable offering FOLFOX to met. squamous eso...
If a patient will receive a total of 4 cycles ABVD and has a CR by PET/CT after cycle 2, can RT be omitted to non-bulky sites to avoid toxicity?
Is there a change in approach over the past few years? Would there be a role for the 12-gene recurrence score?
How do you select between the available treatment options (gemcitabine, docetaxel, paclitaxel, nab-paclitaxel) in combination with platinum?
Up...
Is there data for switching from nivolumab/ipilimumab to pembrolizumab if a patient develops significant pneumonitis but also had a significant radiog...
NCCN puts "preferred" regimens but only category 1 is cisplatin and fluoropyrimidine. When would you use that regimen over FOLFOX?
If so, how do you manage counseling for someone with low health literacy?
Based on 2-3% MSH2 mutation and 1% MLH1 mutation rates in metastatic disease regardless of castration sensitivity, should we be looking for this earli...
If choosing systemic therapy, do you prefer bevacizumab with or without irinotecan? Have you used anti-PD1 agents (e.g. nivolumab) off label?
When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...
Has the recent FDA approval of dabrafenib/trametinib changed your practice?
Being that there is limited data on CNS penetration with either regimen, what would you prefer in a patient who already received whole brain RT?
If current systemic treatment is otherwise controlling the disease and is well-tolerated, is there value to locally aggressive therapy in an attempt t...
The FDA recently approved neratinib based on data from the ExteNET trial; however, benefit appears modest and the risk of toxicity is not low.
For patients receiving adjuvant gemcitabine alone, would you now switch to adjuvant capecitabine alone?
If so, what regimen?
Do you offer neoadjuvant RT with resection and node dissection vs. definitive radiation? How extensive does the nodal disease have to be for you...
Do you have a cutoff in terms of tumor size, number of LN, Oncotype score, etc that makes you choose lower vs higher intensity chemo?
In a patient who developed oligometastatic disease before completing adjuvant XELOX, what treatment(s) and duration of treatment would you recommend?
I have a few patients with kras braf mutation negative metastatic colon cancer treated with upfront FOLFOX- bev followed by 5FU-bev who had regression...
There is limited data that suggests steroidal AI exemestane could be of some benefit after nonsteroidal AI failure (Lonning PE et al. J Clin Oncol 200...
Specifically I am thinking if a PET scan shows complete response, would it be reasonable to stop bleomycin and continue AVD?
For example, would you order a PET/CT to evaluate for lymphatic or distant metastatic disease?
When PDL1 expression is negative, but IHC for mismatch repair expression is consistent with mismatch repair deficiency (MLH2, MSH2, and MSH6 expressed...
Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)?
What adjuva...
Does your institution do this routinely?
In patients with new bone pain and without any evidence of bone metastases receiving GnRH agonists, how do you manage pain symptoms?
What dose and volumes would you use?
Pending head-to-head comparisons, do you believe there are any subgroups who might benefit more from one or the other?
I.e. either for treatment of high-risk disease or intolerance/contraindication to tamoxifen. Will you continue it for the full 5 year course?
Do you prefer doing this through a "neoadjuvant" approach vs. post-operatively?
CALOR trial
Stenting is not possible/not able to bring down the bilirubin level.
Are the results of the STAMPEDE trial presented at ASCO 2017 practice changing?
How does the modest results of the APHINITY trial impact your practice?
Drug information indicates a patient may need 3-4 months off TKI. This seems like a long time off drug. Would a MMR of a certain duration make it less...
In a patient with isolated leptomeningeal disease (no systemic disease), would you still recommend systemic therapy?
Regorafenib has been approved for patients with advanced HCC post-sorafenib, but the benefits are slight and toxicity substantial. Nivolumab has...
Would you ever give another IMiD?
Specifically when given as a single agent. Any role for G-CSF?
PET/CT/bone marrow biopsy negative for evidence of distant disease. Following 4 cycles of combination chemotherapy with no evidence of progressive dis...
Have the results of LUX-Lung 7 changed your routine practice? Are there promising up-front clinical trials that these patients may benefit from?
With the advent of many new agents, any thought to initial therapy different from CHOP or CHOEP?
What about T3N0 disease? Would you use a recurrence score to help inform decisions?
Assume good compliance with oral therapy, equivalent access to either agent, no contraindictions to either therapy, and absence of any visceral crisis...
Do you reserve this approach for only women with triple negative breast cancer or all-comers?
Given the poorer prognosis of these patients, do you approach their treatment any differently than a unilateral cancer?
Is this in addition to or mutually exclusive from oncotype/mammaprint?
Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...
Patient has hormone-refracatory disease, had high visceral burden (pulmonary mets, bone, lymph). Progressed on taxane, xeloda, gemcitabine. Now ...
Can immune check point inhibitor be restarted if grade 4 hyperglycemia (with acidosis and insulin drip requirement) has resolved?
Given recent FDA accelerated approval of pembrolizumab for MSI-H tumors regardless of site of origin, does it make sense to apply MSI testing, in...
If biopsy of the lesion is consistent with GI origin adenocarcinoma and there are no other sites of disease, would wedge resection followed by adjuvan...
In IB-IIIA cases?
Is there any role for a trageted agent with CNS penetration (such as second generation ALK inhibitors) after completion of postoperative brain radiati...
If not, what is your thyroid hormone withdrawal protocol? If so, would you still treat a patient with possibly metastatic disease?
Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?
Given the non-specific nature of AFP and its elevation in various benign conditions, is there an AFP cutoff level or change over time for which you wo...
In a patient who already received 13 courses of radiation (with complete response), is there any other effective treatment?
Which patients do you consider to be chemotherapy-ineligible for the sake of this treatment decision? How strong does the contraindication need to be?
Or would you try to wait and get the steroids off first?
Should we be routinely sequencing ALK to select an ALK inhibitor with the appropriate efficacy, matched to resistance patterns?
Tumor involves stomach, liver, and lymph nodes. Pathology is suspicious for sarcomatoid carcinoma, possibly sarcomatoid cholangiocarcinoma.
What would you choose if there is no response to neoadjuvant AC-T? Taxol, THP, TCHP?
Do you prefer neoadjuvant chemotherapy or proceeding directly to surgery, followed by adjuvant therapy?
What clinical considerations factor into your decision to choose leuprolide vs goserelin vs triptorelin vs degarelix, etc?
Assuming cytotoxic chemotherapy is given, would you still then proceed with adjuvant endocrine therapy? Would you switch agents or classes of en...
In LAP07's second randomization (capecitabine+54 Gy vs maintenance gemcitabine +/- erlotinib), 60% of unresectable pancreatic cancer patients who did ...
NCCN guidelines offer suggested schedules for interval imaging and laboratory studies, but also make it clear that the quality of evidence for these r...
What, if any, is the role of immunotherapy in this situation ?
The pathology shows both adenocarcinoma and neuroendocrine features.
What determines which you select first? How do concerns about cross-resistance factor in after progression on one of these agents?
To what extent do you worry about overlapping myelosuppression? Is there any advantage to overlapping therapy?
Is there a role for salvage LN dissection or salvage RT to the node? And is there a role for systemic therapy (ADT or chemotherapy) in addition? If yo...
What factors influence your decisions to offer neoadjuvant chemotherapy?
Is there any role for either the addition of bevaciziumab or for maintanance pemetrexed?
Do you prefer this approach based on the FALCON trial showing improved PFS with frontline fulvestrant?
Do you extrapolate the results of OPTIMIZE-2 and CALGB 70604 showing that an every 12 week dosing of zolendronic acid is noninferior to ever...
Two retrospective studies from Stanford showed that patients who received ADT had an increased risk of dementia and Alzheimer's. Is this finding ...
If a patient developed locoregional recurrence after initial chemoradiation, would resection of known disease followed by observation be preferred?
Do you use a PSA threshold, PSA doubling time, or only evidence of metastatic disease to trigger ADT? For those without rapid doubling time, do you ev...
And how should we compare checkpoint inhibitors? Given the FDA approval of atezolizumab and nivolumab as second-line agents for metastatic urothe...
For instance with isolated progression at one metastatic site, with all other disease stable and clinically doing well.
How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?
How do the different assays compare when choosing a specific immunotherapy, and does this change for first vs second (or beyond) line of therapy?
Is there a select patient population that you use it for? Is it also being used in cancers other than breast cancer?
At what point is the neuropathy a contraindication to further bortezomib therapy?
Although bendamustine + rituximab is a standard option for advanced follicular lymphoma when treatment is required, does the regimen rituximab + lenal...
There are many options to choose from, including large gene panels with up to 80 genes at the same cost as BRCA 1/2 testing, while others offer j...
Would you use 5-FU and radiation alone? Would your management be different for loco-regional (curative) vs metastatic situations?
Is there a role for routine use of additional or alternative imaging modalities for these patients, such as tomosynthesis, MRI, or ultrasound? I...
Is there data related to types of metastases (tumor histology, anatomic distribution, hemorrhagic, diffuse, size, edema etc.) and risk for seizure?&nb...
Would your recommendations change if it was a partial vs complete radiographic response?
Are there differences between palbociclib and ribociclib? What would make you choose one over the other?
Specifically, can you rechallenge after the effusion has resolved (e.g. therapeutic thoracentesis)? If so, how long do you wait to rechallenge (especi...
Would you add chemotherapy if there was gross residual disease, pN+ and/or ECE?
How long do you typically wait before starting consolidation chemotherapy, and do you routinely perform re-staging scans prior to consolidation?
Imatinib, or a second-generation TKI? Are there specific factors that make you choose one over the other?
When would you use surveillance versus repeat excision or adjuvant systemic or local therapy?
If so, how would HIV/Hepatitis status affect you decision?
If so, do you use antivirals and/or antibiotics? Does it matter if the patient has mantle cell lymphoma, CLL, or Waldenstrom's macroglobulinemia?
Can the classic indications for post-hysterectomy radiation (eg. "Sedlis" and "Peter's" criteria) be applied? Does the histology change radiation dose...
The CABOSUN trial showed a benefit in PFS and ORR, with unchanged OS, over sunitinib.
In the setting of recent craniotomy and a plan for SRS to the surgical cavity, which systemic therapy would you choose and when would you start it?
Example patient: 50 year old pre-menopausal woman with a familiy history of pre-menopausal BRCA1 and BRCA2 wild-type breast cancers in sister and...
For example, if a post-menopausal patient is treated in the first line setting with docetaxel, herceptin, and perjeta, would you add an aromatase...
The immediate response by patients in this situation seems almost universally to be, "But I'll starve to death!" Referencing literature about lack of ...
For a patient with a history of non-muscle invasive disease in the bladder, presenting with a prostatic urethra only recurrence, do you approach this ...
What immunosuppressive agents are used and in what order? Does your approach differ depending on the organ involved, e.g. colitis vs. pneumoniti...
In addition to addresing the brain met (surgery vs. SBRT), would you proceed with systemic "adjuvant" chemotherapy, or would you treat the patient as ...
Is there any data to support this approach? If not, are there trials you are aware of looking at "rescuing" these patients with a different chec...
Are there clinic trials that look promising for patients with leiomyosarcoma?
At what point do you send these test, and in what instances do the results influence your treatment recommendations?
If so, how do you counsel patients who are node positive with low or intermediate risk scores? How do you interpret the existing data? NCCN and ASCO g...
Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision? What about whe...
How do you approach management of locally-advanced, unresectable, but non-metastatic bladder cancer?
When do you offer trimodality bladder-sparing approaches? Is there any role for starting standard neoadjuvant therapy in an attempt to convert to rese...
Or in patients with metastatic disease on ADT who have not had primary therapy? In what situations do you consider palliative prostatectomy?
In a patient who underwent lumpectomy for presumed DCIS and was found to have a focus of invasive triple negative disease, would you offer chemotherap...
After confirming castration levels of testosterone, is the next best step to add docetaxel (as in CHAARTED and STAMPEDE, although not explicitly for G...
Is a monthly schedule x 1 year, followed by q3 months, now the the standard of care, as per the recently published OPTIMIZE-2 trial?
When are you concerned for a false positive? FDA guidelines include a suggestion to try another assay in case heterophile antibodies are causing a fal...
How do you weigh the recently presented/published data from the NETTER-1 and RADIANT-4 trials in your decision making?
Is it more/less helpful if CA 15-3 is negative?
Is salvage liver resection considered the next step in treatment for patients who may have resectable tumors after TACE? If so, do specific tumo...
Radium-223 has an overall survival benefit and lower hematologic toxicity, but at a significantly increased cost. Does the cost-effectiveness fa...
This is rarely done, but recently came up in a tumor board discussion. Which chemotherapy would you consider using, and when?
Specifically, do you just wait for count recovery? Do you check for morphologic or molecular remission at all during this time?
If so, at what point? McDermott et al. demonstrated some lasting responses after discontinuation of therapy (JCO 2015), but these responses are s...
Reference: https://www.ncbi.nlm.nih.gov/pubmed/23578724
How might a recent (within 6 months) myocardial infarction affect your recommendations?
In particular, would you offer memantine to those with WHO II or III gliomas and a good performance status but larger treatment volume?
Does the risk of severe inflammation of the liver lead you to choose other therapies in in this population? What about in patients with mild liv...
Does the site of progression or response matter? What if there is progression in the lungs but response in lymphadenopathy, for example?
Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...
Specifically, is there still a role for dd RCHOP followed by ICE, or do you recommend DA-R-EPOCH for all patients?
Does the presence of a sarcomatoid component influence this decision?
If these are presumed to be immune-mediated (e.g. immune neutropenia or immune thrombocytopenia), do you treat with steroids?
For patients who developed oligometastases while off systemic treatment, do you start systemic therapy following local therapy or return to active sur...
Do you typically use 5-FU/cisplatin/cetuximab, or do you prefer other options?
Does the site of palliative radiation therapy matter (i.e. femur, abdomen, pelvis vs base of skull)? How long should you wait to give palliative ...
Based on JO25567 and the phase Ib trial of afatinib and cetuximab, for patients otherwise tolerating therapy would you consider adding these agents or...
The Phase III J-ALEX study and two phase II studies seem to suggest favorable intracranial response rates for alectinib.
Are there circumstances when you would choose IL-2 over checkpoint inhibitor trials or TKIs for fit patients? How should IL-2 be sequenced with these ...
Would you send the patient to a surgeon for consideration of a mastectomy? Would you then consider post mastectomy radiation when the risk of re...
What about patients who are still on steroids for radiation pneumonitis?
NCCN guidelines suggest XRT as standard of care for this stage of disease. However, occasionally patients have their tumors completely excised when un...
What re-induction regimen without cytarabine or an anthracycline is likely to be most effective?
The CALOR study showed a benefit of adjuvant chemotherapy for local recurrence but the regimens given were "physicians choice".
If PET/CT is unrevealing for a primary source, would you treat such a patient with platinum-etoposide or monitor closely until further disease progres...
In your practice, has tumor molecular profiling in pancreatic cancer led to the identification of any actionable targets for which a patient was put o...
Does the location of the pancreatic mass respective to the major vessels alter initial management (surgery, chemotherapy, radiation, or some com...
Do you have a preference for Regorafenib or Lonsurf or do you refer to clinical trials immediately given the known low response rates to these drugs?&...
Would you consider HER-2 directed therapy (lapatinib-trastuzumab)? Does being KRAS-mutated affect your decision?
Would taking the drug at a specific time point prior to their radiation appointment time to maximize blood levels of the drug be clinically beneficial...
How do you counsel them on risk in the curative setting? Do you approach treatment in the metastatic setting any different than patients with &g...
What do you consider when making this decision (concurrent chemotherapy, amount of bone marrow in field, whether patient is already on antibiotics, et...
Does recent data from the OAK study showing a survival benefit for atezolizumab over docetaxel even in non-smokers affect your decision making?
Does switching AIs help? If so, is there a role for switching from a steroidal AI to a non-steroidal AI or vice versa? Are there other adj...
In which circumstances should high-dose chemotherapy with autologous stem cell transplant be considered, versus second-line chemotherapy regimens or c...
Based on the abstract from IMvigor 210 presented at ASCO this year, are you offering atezo to patients who otherwise may not tolerate platinum-based c...
Based on results from PALOMA1 and recently reported MONALEESA2, do you use a CDK4/6 inhibitor as initial therapy? In what circumstances would yo...
Based on a recent single-arm phase II trial, is there a role for paclitaxel, ifosfamide, and cisplatin (TIP) as a first-line regimen instead of BEP?
Would you consider giving the therapy with concominant steroids, or with a dose reduction?
Do you add bevacizumab regardless of whether you are using paclitaxel or pemetrexed with the platinum agent?
Also, are you testing for PD-L1 routinely prior to initiation of first-line systemic therapy?
For fit patients, what regimen do you prefer outside of a clinical trial?
Does your recommendation change depending on the agents they received?
Do other factors (i.e. Gleason score, pretreatment PSA, or pT stage) affect your decision?
The results of the 70 gene panel Mammaprint in combination with Adjuvant! Online were published in NEJM recently. How will you incorporate this data i...
Do you ever consider de-escalating or stopping therapy in this situation? What is your approach to this conversation?
The MA17R trial only included "postmenopausal women" so how do you make a decision for men and pre-menopausal women.
What if the patient has a BRCA1/2 mutation?
If so, when? Although anemia is associated with worse local control in HN cancer, I don't know of any data that shows that blood transfusions can help...
I ask this question recognizing there is no great data here, and that "pseudo-progression" is rare, but I am looking for any guidance with regard to h...
The patient has refused termination of pregnancy.
Given recent advancements in the understanding of biological differences in prostate cancer patients of African vs. other ancestry, does your manageme...
Do you have a preference for specific steroids? Some practices may switch to prednisone during this time.
Patients with gliomas are often on d...
How has CARMENA changed your practice?
For patients who remain fit and interested in treatment, but for whom a clinical trial is not an option, what systemic therapy do you reach for in thi...
What about patients with bone-only metastases?
Do you use cytotoxic chemotherapy as first line or hormonally-targeted therapy such as letrozole + palbociclib?
Do HPV and/or PD-L1 status influence your decision making?
Based on recently published data from CheckMate 032, do you now offer nivolumab to small cell patients who have progressed after first-line chemothera...
Do you treat with standard of care therapy for microsatellite stable (MSS) colorectal cancers or pursue further work-up? Does this differ between adju...
Based on the CALOR trial (http://www.ncbi.nlm.nih.gov/pubmed/24439313), adjuvant chemotherapy should be considered, but what regimen is preferred?&nbs...
What about specifically in never-smokers?
Are there specific subsets for whom these results should change management?
If so, how do you sequence this with other therapies? In addition, in the absence of an effect on radiographic PFS or serum PSA, how do you asse...
In situations where there is a significant risk of either local or nodal persistence/recurrence post prostatectomy with a rising PSA, or nodal involve...
4cm has historically been used as the cutpoint for determining benefit from adjuvant chemotherapy in this population (Strauss et al, JCO 2008; Bu...
In a patient who recently completed NAC, TM/LND and PMRT for a hormone positive locally advanced breast cancer and is then found to have a contralater...
In the IMvigor 210 trial, increased PD-L1 expression in patients’ tumors was associated with response to atezolizumab, but some patients whose t...
Since some prior subset analyses have suggested that oxaliplatin may not improve outcomes of older patients with colon cancer in the adjuvant settin...
The recently published MA.17R trial showed a DFS benefit for extending AI therapy to 10 years in post-menopausal women.
Assuming the patient is a candidate for either of these treatments?
A recent publication of the TEXT and SOFT trials http://www.ncbi.nlm.nih.gov/pubmed/27044936 showed an improvement in breast cancer-fre...
Does the recent Hopkins trial of pembrolizumab change your management of these patients?
A recent systematic review suggested that disease progression owing to a testosterone "flare" may not be a real phenomenon: http://www.ncbi.nlm.nih.go...
Although PD-1 inhibitors are now standard of care for second-line therapy of advanced NSCLC, there remains the question of which therapy is best to us...
If so, what is your preferred regimen?
We have a great palliative care clinic and I like to refer many patients with metastatic disease, even if I feel that they will live a year or two lon...
Is there any consensus regarding the optimal RT dose, fractionation, and timing to the best abscopal response? What is the optimal metastatic site to ...
The role of adjuvant docetaxel with ADT following RT for high risk disease has been previously elucidated by RTOG 0521. Following prostatectomy,...
If the systemic agent is going to be held, how many days prior to starting radiation therapy should the agent be held and when can it be restarted aft...
If a patient had a recurrence that was pathologically proven despite negative idodine scans, what imaging scans would you follow up with for surveilla...
At the ASCO 2016 annual meeting, results of the PRINCE trial were reported. A strategy of intermittent docetaxel was found to be non-inferior to conti...
What is the utility of repeating FISH studies to evaluate for clonal evolution if FISH studies were done at diagnosis?
Would you offer adjuvant TKI following ADAURA data? Or proceed with durvalumab based on PACIFIC data?
In a patient with node positive disease, treated definitively with radiation, should continuous or intermittent ADT be administered? If a patien...
Typically radium-223 is reserved for men with symptomatic bone disease after failure of multiple other therapies. Is there a population of men w...
Is any amount of teratoma or PNET an indication for surgery?
As it is suggested for larger tumors treated with surgery, based on post hoc CALGB analysis?
The NCCN guidelines discourage the use of PET/CT surveillance but the recent analysis of RTOG 0235 found post-CRT PET uptake to be associated with wor...
Based on the European data published in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961085-0/abstract), are you s...
Do you routinely do Oncotype DX testing in these patients?
Should oxaliplatin/capecitabine alone be the standard of care?
What are the targets (tumor bed, positive margin, nodes etc.)?
What dose do you recommend?
I know that some would argue that healthy patients with an excellent performance status may not need an early palliative care referral, but wouldn't i...
Decrease the dose? Treatment break? Steroids?
For example, should nivolumab be considered standard second-line therapy for adenocarcinoma patients? Can it be considered for first-line thera...
In a patient with an R0 resection, would you routinely recommend postop chemoradiation, since these patients were included in the MacDo...
Are there any clinical or pathologic factors that lean you towards or away from giving trastuzumab?
Our Radiation Safety officer reports a higher radiation dose to the patient from the two scans vs the PET.
Do you favor a short palliative regimen, or a full course definitive treatment to 64.8Gy? How does your management change if the patient has a good pe...
What factors should be considered with offering SBRT to oligometastatic bone disease in prostate cancer patients? Should this been done off of a proto...
I am aware that chemotherapy can obviate the need for RT in patients with SVC syndrome, but I'm not sure if this can be extrapolated to spinal cord co...
If so, what would you include in the target and what dose?
Assuming a patient who could tolerate either, which is preferred? Does this depend on the choice for concurrent chemotherapy (5FU+mitomycin vs ci...
Should mutations other then EGFR and ALK be routinely tested for? Should next generation sequencing be routinely done?
If a patient with stage I, low grade follicular lymphoma achieves a complete response after rituxan and treanda is there any role for consolidative ra...
With novel therapies quickly evolving, it's becoming more difficult to discern the proper sequence of therapies and the point at which a clinical tria...
Would you stop the Tarceva at this point?
Are there any open clinical trials testing this?
Are all bisphosphonates equal in its efficacy? What dose?
Our ENT surgeons often tell patients with evidence of matted nodes on imaging that their swallowing function will be much worse after 70Gy as compared...
Do you really feel the failure was because people crossed over to bev at progression, or is it simply that bev does not affect overall survival?
I've read about patients who were treated with concurrent bevacizumab-RT who developed lethal tracheoesophageal fistulas. How long would you have to w...
Definitive chemoradiation vs. surgery followed by adjuvant radiation/chemoradiation?
Even though we do not have the best data on the use of induction chemotherapy, what are current practices?
Is your practice different between HPV+ an...
Is there a consensus on the MAGIC v. MacDonald debate?
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