Medical Oncology
Questions discussed in this category
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?
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...
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?
Is there data on neoadjuvant chemo-RT or chemo in this setting?
Most patients with PGNMID have no detectable disease in their marrow or blood and urine protein cannot adequately be monitored.
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?
Al-Ibraheem et al., PMID 33731050
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 recently published IMROZ and BENEFIT trials inform maintenance treatment in transplant-in-eligible patients with NDMM?
Assume the patient is young and active.
Are there specific patients where you're more apt to continue versus holding IO while continuing TKI?
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...
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 ...
Are there any subgroups that would still benefit from RNI?
Would the recurrence while already on the checkpoint inhibitor sway you from offering durvalumab?
What is your evaluation approach for RAI response? What cumulative dose do you use in practice for deciding a patient is RAI refractory?
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...
How do you decide between ureteral stent and percutaneous nephrostomy for decompression?
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?
Would you consider omitting local therapy?
How would you counsel the patient given the drug interactions present?
For example, women of southeast Asian descent.
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.
RADICALS-HD trial (ESMO 2022) demonstrated metastasis free survival benefit with 24 months compared to 6 months of ADT.
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?
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...
Should testing for germline mutations -- eg. saliva sample -- occur before or after the completion of chemotherapy - or the timing does not matter?&nb...
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...
Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?
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?
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...
Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...
When, if ever, do you utilize adjuvant RT or chemotherapy?
Would you treat similar to small cell carcinoma? What is the suggested chemotherapy regimen? Will you continue ADT?
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...
With low #s of patients on the durvalumab PACIFIC trial with EGFR mutated disease, and LAURA trial design of osimertinib until progression, should we ...
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 time since radiation, original PSA and grade group/gleason score inform your decision?
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?
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...
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 ...
How would your recommendation change if the patient has H63 homozygous mutation?
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.
In light of the 4/2024 JCO publication by Peng et al., PMID 38215354
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?
Would you still treat with neoadjuvant KEYNOTE-522?
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?
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?
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
Do you offer observation for POLE mutated tumors?
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) ...
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?
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?
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...
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?
If so, what do you typically prescribe?
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...
Role of capivasertib vs SERD? What factors help you decide?
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...
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
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?
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...
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 do you stage and evaluate premenopausal patients with >= cN1 ER+ PR+ HER2- breast cancer prior to surgery to avoid this pitfall?
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...
Would you offer adjuvant Pembrolizumab combined with Capecitabine?
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
Do you find that starting with chemoradiation increases the risk of complete obstruction secondary to transient tumor inflammation, or do you favor st...
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.
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?
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...
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?
Specifically, in the setting of patients that have had a PR or VGPR and are not actively progressing.
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?
How do you advise patients who strongly desire chemotherapy?
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?
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?
PD-L1 CPS of 1, no other actionable mutations except HER2.
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...
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...
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...
If you recommend or use induction chemotherapy, what is your preferred chemotherapy regimen?
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?
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?
Would you consider using endocrine therapy, pembrolizumab, capecitabine, or CDK 4/6 inhibitor?
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...
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...
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?
D-TORCH compared topical diclofenac to placebo
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.
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...
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 next generation sequencing results influence diagnostic and therapeutic decisions for patients with MDS?
Please comment on toxicity profiles and the insufficient evidence regarding overall survival.
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)
Is a placebo-controlled trial anticipated?
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.
GETUG-AFU V05 VESPER TrialDid the ASCO 2023 overall survival data change your practice?
(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...
In the DAISY trial, ORR of 30.6% in T-DXd treated patients (n = 38) with HER2-null breast cancer
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?
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?
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?
And, for additional information, what are the differences in 5 year survival and disease specific survival for stage I NSCCA between lobectomy vs SBRT...
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...
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?
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.
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.