Medical Oncology   

Questions discussed in this category



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...

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...

Since HR low-positive, HER2 neg tumors behave aggressively similar to TNBC, does the degree of HR positivity factor into your decision-making?

ESOPEC compared perioperative FLOT vs neoadjuvant chemoradiation per the CROSS trial, and showed superior OS with perioperative FLOT. What concerns do...

Given that LU002 has failed to meet its progression free survival benefit in results presented at ASCO, will you offer consolidative radiotherapy for ...

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...

S/P neoadjuvant chemotherapy and followed by oncologic surgical resection but with positive margins.

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 ...

Are there specific patients where you're more apt to continue versus holding IO while continuing TKI?

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...

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?

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

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

Would you consider administering Keytruda (pembrolizumab) concurrently with radiation therapy for the treatment of a patient with an ER-negative, PR-n...

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 ...

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

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?

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...

How does the changing landscape of first-line treatment impact your decision making for second line therapy?

Patient has multiple adverse features on pathology, however, PSA just became detectable one year after surgery. SPPORT included patients with PSA>0...

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?

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...

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...

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? 

Burnmeister data from 2012 showed a local control benefit for radiation therapy in selected patients, but that was without immunotherapy. Is adjuvant ...

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...

Given the FDA approvals for PARP inhibitors and combinations in mCRPC, when do you obtain NGS for mCRPC? Do you have a preferred assay?

Current NCCN guidelines do not include adjuvant chemotherapy for patients treated in this fashion; however, in the PROSPECT trial itself, an additiona...

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?

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...

Controlled extracranial disease on trastuzumab+pertuzumab for 2 years. Treatment options include Enhertu or WBRT. Not a candidate for SRS or neurosurg...

Would you consider radiation following surgical resection of an intramedullary benign nerve sheath tumor with a small amount of residual tumor (9 mm) ...

PFS curves appear similar between the AKT-altered vs overall study population in the trial publication. Is there any additional information available ...

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...

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. ...

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?

If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...

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...

Would you wait until bowel symptoms are controlled or ever pursue diversion before starting treatment?

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...

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...

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...

Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...

Which patients specifically benefit from both mpMRI and PET-PSMA?

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

Do you give first-line CDK 4/6 inhibitors with Tamoxifen or Aromatase Inhibitor (+/- GnRH analog)?

Have you changed your practice given BMT-CTN 1506/Morpho results? Would you utilize maintenance therapy in patients who achieve MRD- remission?

In non-FGFR mutated patients, would you use cisplatin/gemcitabine or sacituzimab govitecan at this point?

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...

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...

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...

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...

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).

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?

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...

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).&...

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?

Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...

Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?

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?

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...

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?

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...

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...

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...

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...

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?

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 prefer doxorubicin based chemotherapy or are alternative TKIs useful in this scenario?

Does the anagrelide shortage play a role in your decision-making? Do you avoid anagrelide in general?

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. ...

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? 

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?

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.

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...

Are you concerned about cases where radiation has to be started urgently before leukapheresis?

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 you recommend observation, APBI, whole breast or whole breast with low axilla treatment?

The trial showed an overall survival benefit of 8% at 5 years with induction chemotherapy (80% vs 72%) utilizing at least 5 cycles of carboplatin-pacl...

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...

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?

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?

As SCLC in never smokers is extremely rare, do you consider NGS testing, or do you modify treatment in any way?

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?

Triplet v. Quadruplet? Do you opt for VRd, DaraRD, CyBorD, Dara-RVd or another regimen?  How would this change for a patient with high risk cyt...

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?

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...

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer. 

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...

Are there characteristics which could help identify whether a follicular lymphoma might behave more indolently vs aggressively and inform treatment se...

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...

This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...

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 ...

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...

Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.

Would you recommend using chemotherapy based on RxPonder regardless of Oncotype score in a premenopausal patient? Or would you hold chemotherapy since...

Would non-gastric GISTs, high mitotic rate, large size, and young age of patient affect your decision? Especially knowing that TKIs suppress cell grow...

How do the results affect your recommendations for workup and management?

How do you decide when to “pull the trigger” in these cases where the growth trajectory is slow?

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?

Do you consider "bridging" therapy prior to transplant, and if so, what are your thoughts on the intensity of the chemotherapy?  

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? 

For a node positive, triple negative patient that underwent neoadjuvant chemotherapy followed by breast conservation with a complete pathologic respon...

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?

What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...

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...

Assuming the patient had no prior radiation and has no evidence of metastatic disease, would you start with adjuvant radiotherapy or adjuvant systemic...

Are there any circumstances where use of T-DXd would supercede the use of CDK4/6 inhibitors or other non-chemotherapeutic options (PIK3CA etc?)

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...

Do you utilize rituximab or any other specific management strategies?

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...

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?

Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion? 

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 ...

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...

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.

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 ...

Does the patient's MMR status affect your opinions? What is/are your current preferred second-line regimen(s)? 

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

Do next generation sequencing results influence diagnostic and therapeutic decisions for patients with MDS?

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?

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

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...

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...

Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...

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...

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

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...

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...

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?

Received neoadjuvant ddAC/T followed by adjuvant capecitabine for residual disease and found to have metastatic pulmonary nodules within months of sur...

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...

> 30s, female with metastatic colon cancer. Presented with a headache. Metastatic hemorrhagic mets per MRI 10/2022. Had radiation. Kras mutated, Br...

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...

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?

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?  

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...

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?

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...

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?

Would your recommendation change in a patient having pain from disease and you wanted a quick response?

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

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?

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>...

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...

When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...

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?

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...

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...

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...

Does your choice of agent differ, or are you more or less likely to offer maintenance than if the patient had multiple myeloma alone?

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...

Specifically, would you consider either neoadjuvant or adjuvant immunotherapy in this setting, or only after recurrence?

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 ...

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...

Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...

Given that pembrolizumab/trastuzumab with chemotherapy is new SOC for metastatic disease, how would you approach those with recent fluoropyrimidine + ...

And, for additional information, what are the differences in 5 year survival and disease specific survival for stage I NSCCA between lobectomy vs SBRT...

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

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?

There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?

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...

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...

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...

With studies showing non inferiority to zoledronic acid q 3 months in support of bone metastatic disease, would you consider extrapolating this data a...

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"...

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. 

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...

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...

According to the NCCN guidelines, there is a highly selected group of T4a glottic larynx patients that can undergo observation instead of postoperativ...

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?

If a patient with endometrial stromal sarcoma managed with fulverstrant has a single oligoprogressive lung nodule, is there any contraindication to tr...

How is your approach different from or similar to those who undergo surgical menopause? 

Is there an optimal chemotherapy regimen that optimizes cure rates while minimizing side effects?

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?

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...

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?

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?

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?

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 ...

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

Current NCCN guidelines recommended not combining relugolix with these agents until more data is available.  Any drug interaction concerns or ot...

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?

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...

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...

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...

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?

Would you avoid combination with TKI given possible higher risk of osteonecrosis of the jaw?

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...

Patient is young. Bilirubin normalizes when tucatinib is held, but again increases to grade 2 when it is restarted. Evaluation for hemolysis was negat...

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?

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?

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?

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?

In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...

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?

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?

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...

If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?

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...

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...

Is there evidence that T-DXd crosses the blood-brain barrier?

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...

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-...

Or would you proceed with cabazitaxel or other therapy? Initial chemo-hormonal therapy was ADT + Docetaxel x6 cycles.Docetaxel rechallenge at time of ...

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...

- 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?

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...

Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...

Do you drop or adjust the temozolomide at any point, or rather continue to progression as long as temozolomide is well tolerated?

Did S1800a stratify by prior treatment response? Would you choose different 2L treatment for a patient who progresses rapidlly on pembro + platinum do...

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?

If yes, would you directly add olaparib at progression on abiraterone vs waiting to use abi/olaparib at a later line of therapy?

Would you offer adjuvant radiation? (Dose? Target?) vs Salvage? Would you add ADT? Would you add abiraterone? Would the number of lymph nodes involv...

- 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 would your approach be in a patient with a mid-esophageal squamous cell carcinoma treated with chemoradiation therapy followed by surgery, with P...

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...

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? ...

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?

Which patients would you recommend active surveillance alone, a less morbid procedure such as enucleation, or a Whipple surgery? How does age influenc...

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? ...

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...

Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...

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...

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?

The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TD...

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 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 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...

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?

Is there evidence or experience to support use of targeted therapy for KRAS G12C mutated NSCLC as first line in place of chemotherapy? 

Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?    

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...

Residual GEJ mass and progression in local lymph nodes after carbo+taxol chemoRT without distant metastases.

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...

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 this raise concerns about the efficacy of adjuvant immune checkpoint inhibition? Are any preliminary results from AMBASSADOR (adjuvant pembrolizu...

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...

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...

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&...

Assuming no overlap with prior RT doses, would a history of necrosis cause you to hypofractionate rather than deliver single fraction SRS?

Should these cancers be treated like hormone positive breast cancer or triple negative breast cancer? She is pre menopausal with cT1c grade 2 disease...

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...

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 ...

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...

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

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?

Is dose modification of docetaxel necessary with Gilbert's when giving TCHP?

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...