Medical Oncology   

Questions discussed in this category



What type of adjuvant chemotherapy would you offer? Would clinically positive lymph nodes or residual disease at time of surgery change your decision...

Would you consider gem+Abraxane to avoid FOLFIRINOX toxicity in a small, node-negative tumor?

Would you consider definitive local therapy (surgery, radiation?) if she achieved a good response to initial systemic therapy?

Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?

Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2...

Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.

If radiation, what type? EBRT or brachytherapy? Any other techniques you would recommend, such as rectal balloon? 

What if Medical Oncology wants to give more systemic therapy and further delay XRT start date?What should we be telling the Breast/Plastic surgeon/Med...

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

Given OlympiA trial with olaparib benefit for gBRCA+ patients?What are barriers that you foresee? In your practice who performs mutation testing and w...

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

In light of CheckMate 816 and IMpower010 and FDA approval for neoadjuvant chemo-nivolumab and adjuvant chemo-atezolizumab, how do you decide which sys...

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...

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

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

The Intergroup 0162 trial did not demonstrate noninferiority, although OS difference only 5.1 vs. 5.8 yrs.  Would pattern of spread affect your d...

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...

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

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

NGS without any actionable mutations and PD-L1 TPS 15%. Would you offer chemotherapy, radiation, or immunotherapy and, if so, in what order?

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

What would you offer a premenopausal woman with clinical T2N1 ER positive breast cancer for adjuvant therapy after she achieves a pathologic complete ...

What do you do if LFTs are elevated after one dose of neoadjuvant TCHP (highest ALT >13 times upper limit of normal, normal bilirubin) with prior n...

I have a patient in her 60s with CHEK2 mutation, diagnosed with bilateral breast cancer. Lumpectomy showed b/l tumors <10mm both ER/PR+, HER2-, but...

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

Is it necessary to test CPS given the FDA approvals are not contingent on CPS %?  If you do test, do you check 28-8 (nivolumab), 22C3 (pembroliz...

If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.

Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...

Weekly (20 mg/m2 D1, D2) and q 3 wks (70 mg/m2 x 3c or 100 mg/m2 x 3c) regimens have all been listed as acceptable.  For reference, RTOG 97&...

Would you give neoadjuvant chemo or hormonal therapy or go with surgery first? What chemotherapy would you use? 

Is this an artifact of what agent prior clinical trials used or something to do with mechanism of action (ie less mineralocorticoid effect of dex)?

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

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

The forest plot from CheckMate 274 did not show a benefit for such patients? How would you select between adjuvant chemotherapy and adjuvant nivoluma...

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked. 

If said patient was known to be gBRCA mutated, would you use neoadjuvant chemotherapy to enable adjuvant olaparib for those that did not have a pCR? &...

Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outco...

Do you go by FDA approval alone, or incorporate other data into your treatment decisions?  How do you view updated recent presentation of CM-649 ...

Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full do...

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

Would you consider boosting the nodes?  What dose?  Would this change your recommendation for length of ADT?  

Would you consider chemotherapy, androgen blockade or triple therapy (chemo and AR targeting)?

How much of the benefit of adjuvant chemotherapy do you expect to be due to ovarian function suppression due to the chemotherapy?

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

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

Do you routinely offer post-operative adjuvant radiation in addition to chemotherapy?  Are the results of the recently published negative phase ...

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

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP?  What ...

Patient is young and reoccurrence is one year after initial diagnosis of T1cN0 ER/PR positive, HER2-negative breast cancer treated with mastectomy, bu...

With conflicting data from the EORTC RCT and the Sarcoma meta-analysis collaboration, what factors determine when you would offer adjuvant chemotherap...

In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...

Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis. 

What combination of fluoropyrimidine, PD-1 inhibitor, or trastuzumab do you use?

Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave 150 and HIMALAYA? When do you i...

In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...

Would you restart hormonal therapy in a patient with a new diagnosis of LCIS 2 years after they have completed 5 yrs of AI for stage 1A IDC in the oth...

Patient underwent mastectomy for DCIS in the setting of previous lumpectomy and adjuvant radiation for the invasive breast cancer. 

How would you modify therapy for a younger, fit patient versus an older, frail patient? Lesions in stomach, small intestine, colon resulting in bleed...

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Do you think adjuvant nivolumab should be the new standard of care based on current CM274 DFS data? If OS turns out to be no different, will you still...

NCCN lists PCV as category 1 (and now with analysis in Abstract 2002 from ASCO 2019 showing benefit in IDH mutated), and temozolomide as 2B, yet temoz...

HCG 850, AFP normal, LDH ~500 pre-orchiectomy.  If tumor thrombus, would you favor 4c of BEP? Would you try biopsy it? How common is IVC thrombu...

Are you more inclined to use non cytotoxic regimens such as R2 or PI3K inhibitors?

Are there contraindications to drugs like oxaliplatin or abraxane? Does chronicity or severity of the patient's underlying symptoms play a role in yo...

E.g. One NSCLC with N2 disease, and additional ipsilateral small nodule that is a biopsy-proven second primary. When do you consider SBRT to a nodule ...

(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 ...

Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...

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

KEYNOTE 811 showed improved response rate with the addition of pembrolizumab, but very few patients in this study had low PDL1.

Are there specific clinical factors, efficacy, or treatment tolerability issues that lead you to favor one agent over another?How do you compare or co...

Given multidisciplinary discussion has occurred and SBRT has been agreed upon as local therapy, how do you approach the presence of moderate/significa...

Would you always offer an FGFR inhibitor as second line therapy in these patients instead of a second line chemotherapy regimen?

Should this be sent on initial biopsy or on surgical pathology? What if an initially high risk patient has good risk findings post-operatively?What ha...

Are you offering patients beta-emitters (Samarium-153 lexidronam, strontium-89) to any patients?

How does prior chemotherapy, site of disease, and pathological staging inform your decision? How about molecular markers (PD-L1, ctDNA)?

Is a 3 month delay too long in someone who had postoperative complications?

i.e. treatment-refractory PV, prior to progression to PMF or AML

Are there clinical features (post-op PSA, Decipher score, pN+, pT3, etc) that would inform your decision?

Assume normal cardiac function and no obvious co-morbidities. No anthracycline previously due to age alone. The patient’s BRCA status is unknown...

If an older patient is only fit enough for single agent fluoropyrimidine therapy, would you prefer to give this neoadjuvantly or adjuvantly?

Would you ever consider adjuvant chemotherapy rather than adjuvant immunotherapy after the publication of the CM-577 results? If so, in which pop...

For instance, the foci found were pN1mi (0.5 mm) deposit in 1st SNL (1/13 LN) and mpT1mi (8 foci). Would you consider single or dual anti-HER2 blockad...

Do you worry about false negatives on PET, CT, MRI if ADT is started before the scan? Scheduling scans can sometimes book 2-4 weeks out. 

Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?

Do you allow pre-RT treatment with the CDK 4/6i and hold during RT, vs. allow concurrent with breast/chest wall RT, vs. delay starting CDK 4/6i until ...

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

If a patient is asymptomatic at presentation, how do you incorporate local treatment options (RT/surgery) and when?

Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?

Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...

IMPower110 data add further support to use of checkpoint monotherapy; however guidelines continue to support either I/O monotherapy vs chemo-immunothe...

How does cirrhosis and/or underlying thrombophilia affect your decision?

Patient has already received neo/adjuvant treatment with AC, paclitaxel, capecitabine, docetaxel, and carboplatin.

Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...

Do you consider size > 2cm, visceral pleural invasion or vascular invasion as indications for cisplatin-based chemotherapy? 

Patient previously received neoadjuvant ddAC-T with residual disease at surgery, followed by adjuvant capecitabine which was completed 2 months prior ...

Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient ha...

For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...

In high-risk, node-positive HR+ Her-2 neg breast cancer patients who received neoadjuvant chemotherapy with residual disease, would you give capecitab...

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 ...

How do you manage low libido in women with breast cancer on endocrine therapy? Other than managing vaginal dryness/dyspareunia, if just a desire/libid...

Resected small bilateral tonsil SCC & base of tongue SCC. The patient received 6 cycles of BEP 30 years ago for testicular cancer, and suffers fr...

Conversion tables suggest starting the new drug with the next dose but do not seem to answer this question (i.e. if switching from rivaroxaban 20 mg d...

G1 neuropathy and G3 neutropenia were observed with cycle 12 FOLFOX + bev. Would you reintroduce oxali at a lower dose or switch to irinotecan+EGFRi ...

Has your practice changed based on the randomized, phase 3 study showing prophylactic gabapentin is not effective? Please share your thoughts and exp...

NCCN recommends perioperative FLOT or FOLFOX vs. neoadjuvant chemoRT with Carboplatin/Paclitaxel or FOLFOX.Does CM-577 and the approval of nivolumab p...

For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.

Will degree of PD-L1 status impact your decision? Would you ever offer to stage IB patients as per study enrollment?  Do AJCC v8 staging guideli...

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

How would you manage endocrine therapy 7 years after the original ER+/PR+/HER2- IDC, while on adjuvant tamoxifen/OFS develops a contralateral ER+/PR+/...

If you had a patient with otherwise average risk stage 2 colon cancer but had signet ring or mucinous components to their pathology, would this sway y...

Of note - the tumor tissue biopsy NGS did not show KRAS or BRAF mutations. Microsatellite stable. Patient received first line FOLFOXIRI + Avastin .

Can you use 50mg BID if intolerant to 150mg and 100mg dosing?  Any tips for side effect management to help patients stay on full duration?

Majority of patients on MonarchE received neoadjuvant/adjuvant chemo.  Does the availability of abemaciclib impact your decision to offer chemo ...

For patients who have already undergone trimodality treatment, what time frame do you consider for adjuvant IO?

MonarchE shows statistically significant improvement in IDFS and DRFS, but the magnitude of absolute benefit is modest (3-year IDFS and DRFS rates = 5...

Do you observe, offer adjuvant pembrolizumab, or give a first-line metastatic regimen (IO/IO or IO/TKI)? Does your recommendation vary based on risk c...

Is there a certain time interval where you would feel comfortable to rechallenge with immunotherapy at recurrence (6m vs 1y vs 2y?) Does degree of PDL...

Are the experts convinced by DFS when the OS is immature?  How many in BSC arm went on to receive immunotherapy and was that adequate?

What would you do for a patient with a non-EGFR actionable mutation?IMpower010 included EGFR and ALK mutated NSCLC. Is there any concern in the use of...

In elderly patients (>70-75) with a good performance status, does the risk of neurocognitive decline outweigh the benefit of PCI?

CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

Original question: Would you offer neoadjuvant chemo + keytruda for metaplastic breast adenosquamous low grade?

Do you initially start with systemic therapy alone or do you proceed directly to chemo-radiation? 

In which scenarios would you consider a parp inhibitor as the first line treatment of choice? 

Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as ca...

This involves the primary site responding but progression with new bone marrow involvement with resulting cytopenias.

In light of updated monarchE trial data, it seems a SLNB would help delineate adjuvant treatment options in this population. However, Choosing Wisely ...

Grade 2 DCIS, post mastectomy with negative margins, sentinel nodes negative

This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...

If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...

PSA rose from 25 to 30 ng/mL over 6 months on darolutamide for M0 CRPC, prompting scans which showed oligometastatic disease to bone, not amenable to ...

For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...

How do you weigh the various efficacy endpoints in the trials of novel combinations in ccRCC?  Are there specific clinical populations that you ...

Many of the patients on ASCENT trial were heavily pre-treated and require growth factors. With the day 1,8 treatment cycle, is there a way to minimize...

Would you use it for initial staging or at time of biochemical recurrence?

Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?

What is your approach to a patient who underwent surgery for what was thought to be a thymoma, but ended up being a pure seminoma? No disease elsewher...

After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...

For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...

What clinical criteria would make you prefer TORS as the initial treatment approach?  

Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...

BRCA mutant, ER/PR positive and HER2 positive T2N0M0 breast cancer diagnosed 5 years ago, treated with bilateral mastectomy, BSO, 1 year of adjuvant a...

CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.  

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk? 

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

How do you stage? Like nasopharynx or p16+ oropharynx? Do you treat it like npx ca with chemo xrt + adj chemo or like opx p16+ with definitive chemo ...

Please also discuss the type and duration of anticoagulation.

For patients with hormone negative breast cancer and HER2 positive only by copy number, do you give TDM1 for residual disease or capecitabine?

How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...

Would you think differently about chemotherapy based on %teratoma or size of lymph nodes vs number of lymph nodes (eg. multiple small LN vs single 2-5...

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

Do you add on additional cycles of 5-FU/capecitabine to go beyond 3 months of treatment? Or would you stop at 3 months of therapy, dropping the oxalip...

What is your general rationale for selecting from available options?

If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?

Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? ...

Are there specific patient cohorts in whom you will more preferentially use sacituzumab govitecan? Can data from ASCENT be applied to patients with C...

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

Based on the SCORAD III trial, will you now be treating patients with spinal cord compression with single-fraction radiotherapy? Is there anyone ...

Or with other available IO/TKI combinations should this be strictly reserved for intermediate/high risk patients only?  If selecting IO/TKI, do ...

Would you use immunosuppression in patients several years after curative treatment for melanoma?

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

If any clinical benefit (ie. CR, PR or SD) would you consider switch maintenance avelumab, surveillance until progression, or an alternate regimen?

Molecular profiling revealed no targetable alterations, however tumor mutational burden was >10 mut/Mb.

Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...

Do you select treatment based on toxicity profile since efficacy of regimens will likely never be directly compared? Are there QOL indices that can ...

Do you try to keep Hb> 10 or 12? Or somewhere in between? 

Patient has progression of liver metastases while on pembrolzumab/axitinib. ECOG PS 1 and limited comorbidities.

The patient previously received endocrine therapy alone and in combination with CDK 4/6 inhibitor. She does not have any targetable mutations on NGS. ...

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

To what degree do you factor in patient preference when choosing among available treatments? Are there features of each regimen that you emphasize in ...

What would be your radiation volumes/dose and choice of chemotherapy?

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

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...

For example, does a higher recurrence score influence your choice of TC versus AC-T?  Or your choice to add ovarian suppression to a premenopausa...

 If blood counts are sustained, do you continue or delay?

Do you treat with radiation therapy and what dose do you use? What dose do you accept to the duodenum?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

TNBC diagnosed in 2nd trimester. Neoadjuvant rx not given due to complicated pregnancy and went straight to surgery due to HR+ biopsy. Surgical pathol...

Lymph node is 4.5cm with no reported ECE. Does the size of the LN or presence or absence of ECE affect your decision?

Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...

Do you routinely recommend any dietary changes or is the evidence not convincing?

Should patients with moderate penetrance pathogenic variants be managed similar to BRCA patients and consider risk reducing contralateral mastectomy?&...

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...

What about a higher penetrance PV such as PALB2? See JCO OGR 8/2021 by @Mark E. Robson discussing management of non-BRCA pathogenic va...

Would you prioritize the head and neck cancer or treat the lung cancer first with SBRT to take care of it first? How about if there is mediastinal inv...

GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease.  Prostate MRI pending. 

In a scenario where patient's other clinical/familial risk does not sufficiently qualify them? See JCO OGR 8/2021 by @Mark E. Robson discussing manag...

The recommended concurrent chemotherapy regimens (cisplatin/paclitaxel and cisplatin/FU) in NCCN are based on BID fractionation of radiation as in RTO...

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases). 

How much weight do you give to a hgb/hct threshold versus symptoms?

The patient initially received definitive therapy with AC-T and RT to the breast as well as RT to a solitary bone lesion. She has been on AI for the l...

Does this data change your preferred first line treatment regimens when considering other options such as mAb combos, cytotoxic chemotherapy?

Is the non-inferiority margin of 1.429 sufficient, how was this selected? Is the open label (rather than blinded) study design of any concern? Is th...

Can experts comment on fungal pneumonia risk with individual BTK inhibitors as seen in ELEVATE-RR and whether this impacts their management decisions?

Do you feel comfortable with BTK inhibitors in these patients? In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...

Can the ipsilateral supraclavicular field and bilateral hilar nodes still be limited stage? 

How would non-regional adenopathy change management? What about poor surgical candidacy?

Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?

Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?

Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?

Would you recommend surgery first or neoadjuvant therapy such as concurrent cisplatin/RT or another regimen?

The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting. 

In the case of subtle single lineage dysplasia with normal cytogenetics, do you routinely perform NGS testing for CHIP-type clonal mutations? Do you ...

How do you balance the risk of an EGFR flare while holding osimertinib vs the risk of pneumonitis when continuing?

Did you change your practice given the SRE results in the control arm of EORTC 1333 at ASCO 2021? When using bisphosphonates or denosumab, what dosin...

Patient had estradiol level checked by her gynecologist due to recent irregular bleeding. Estradiol level was markedly elevated on initial testing (90...

Would radical prostatectomy and PLND suffice or would a cystectomy be warranted (even in the absence of bladder involvement) as well? 

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.

If no direct invasion into prostate from bladder or urethra, is there any role for systemic therapy?

Do your recommendations differ between those who receive ABVD and escalated BEACOPP? Do you recommend consultation with fertility specialists for all...

Is there any role for denosumab? How do you counsel patients regarding the benefit of bisphosphonates on breast cancer outcomes?

Patient had an initial tumor response to TCHP, but still had significant residual disease present, including positive lymph nodes and residual breast ...

How do you decide between entrectinib or crizotinib? Since no head-to-head comparison, can real world datasets (such as Doebele et al) be used to comp...

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

Does patient age effect your approach? Would you consider RPLND for any patients in light of the phase II SEMS trial presented at the 2021 ASCO GU Ca...

What determines duration of therapy in patients who achieve stable disease or no evidence of disease on imaging? Is there any role for radiation in t...

This question arises from a case of a patient with multifocal nodular melanoma with circumferential involvement of the perianal region.

The patient was started on chemoimmunotherapy 3 years ago. Recent scans show small treated brain metastases (s/p RT several years ago) and no disease ...

Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?  

Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?

Patient with T2N1 disease and isolated liver metastases. Axilla and liver completely responded to chemo + IO, but limited residual breast enhancement ...

Would there be any benefit to surgery in a healthy/good PS patient? There is so little data on pulmonary atypical carcinoid and radiation respons...

E.g. for a 7cm central NSCLC, would you offer 8 fx SBRT or ChemoRT? Patient is not a surgical candidate.

One example of this scenario would be a patient receiving consolidative durvalumab after chemoRT for stage III NSCLC who develops a new peripheral lun...

Would your treatment approach be similar for a patient with suboptimal performance status?

If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?

Is this a reason to start hydrea? Would you give oral iron after adequate control on hydrea?

Do you consider the small, but statistically significant, improvement in OS to outweigh the side effects of treatment?

Does the answer change on proximity/distance from breast (i.e. what if pelvis or lower extremity?)

While there are many factors involving:- type (DVT vs PE, unprovoked vs provoked) and severity of venous thromboembolism (VTE) size- duration of antic...

Do prior treatments for mHSPC change your thinking on whether or not to use sipuleucel-T?

Although a small subset, do you generally move these patients directly on to chemotherapy +/- immunotherapy or does it depend on the specific mutation...

If all work-up including peripheral flow, bone marrow biopsy, PET-CT returns negative, what additional management (if any) would be recommended?

Are there any chemotherapy regimens that can be used in elderly patients with poor PS who are not candidate for BEP?

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?

Given that risk definitions are based on size, mitotic activity, location and not necessarily genetics/biology, would an otherwise low-risk GIST, who ...

What is the role for adjuvant versus neoadjuvant chemotherapy?

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...

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

If a patient has a large femoral metastasis that cannot be resected, but is to be stabilized with ORIF which will push tumor into the distal end of th...

In reviewing the data, LDH does not upstage to intermediate risk but those patients tend to do worse. Would one treat this patient as intermediate ri...

Ampullary carcinoma is not in the NCCN guidelines. Please address not only the role for therapy but the optimal regimen (i.e. Gem based, vs mFOLFIRINO...

Given that olaparib was given within 12 weeks of completion of standard adjuvant therapy on the trial, will you still offer it to patients outside tha...

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Patient has been treated with carbo/etop/atezo, WBRT, and maintenance atezo. Currently on high-dose steroids. Would you consider hospice or trial chem...

Results of AHOD1331 are not yet known, but adults have started using Brentuximab upfront for high risk patients  

Patient with hepC and advanced cirrhosis with multiple liver mets, but may be able to tolerate oral TKI or PARP. Would you offer this or focus on hosp...

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How does age play a role in this decision?  If you do intensify therapy, how do you explain the negative results of CALGB/Alliance 50303?

If starting with entrectinib would you still try crizotinib, or move to lorlatinib or another novel TKI? Or change entirely to chemotherapy, immunothe...

How often do you monitor ADAMTS-13 levels off therapy?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

Is there any role of radiation therapy for these patient for symptomatic relief? 

Performance status is excellent. Second surgical opinion has also confirmed need for amputation, as the recurrence is now breaching intra and extra ar...

Osteosarcoma conventional type of the distal right femur. cT1N0M0 G3 Stage IIA on MAP protocol completed NACT followed by surgery on radical resection...

The patient was diagnosed with Ewing’s Sarcoma at the age of 10 and completed 6 cycles of vincristine, ifosfamide, etoposide, adriamycin 75mg/m2...

How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...

How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features? Do you still consider CyBorD or R...

Is DFS benefit in KN-564 in ASCO2021 sufficient evidence to change practice?

History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis. Vaginal tumor completely resp...

In patients who have completed all adjuvant therapy. Similar test to what is available for stage 2 and 3 colon cancer patients by Natera.

Do you opt for VRd, DaraRD, CyBorD or another regimen?  How would this change for a patient with high risk cytogenetics?

In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?

Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...

Post-treatment PET/CT and MRI Pelvis at 3 months showed near resolution of iliac and inguinal lymphadenopathy but new avid retroperitoneal lymph nodes...

Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear. 

How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring? What is your experience of subse...

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

Patient is on fulvestrant+CDK 4/6 inhibitor and with NED for 5 years. In which cases would you consider stopping CDK 4/6 inhibitor? 

Given long term data from Keynote 052 for pembrolizumab presented at ASCO 2021. What factors impact your treatment decisions? For cis-ineligible PD-...

Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.

Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

NCCN guideline V4.2021 DLBCL page BCEL-3 states stage I-II, bulky >= 7.5cm should be treated with 6 cycles of RCHOP, but most bone lymphoma studies...

This patient had resection of the primary, requiring multiple resections to obtain an R0 resection, followed by adjuvant radiation to the primary. The...

Given recent data in Blood (Moik et al, 2021), and the potentially overlapping risks with other clinical factors associated with NSCLC. Will you alte...

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

There are many delivery methods of cannabis, including smoking, ingesting it through food, or inhaling it. Is one method more effective than another?

The ALTA and ALEX trials showed better PFS with brigatinib v. crizotinib and alectinib v. crizotinib. How do you choose your first...

Would you test for resistance mutations in this setting, using blood-based sample if no progression outside CNS?

<40y/o female w/ initial biopsy showing G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 copies/nucleus.)...

Would you radiate? Surgery? Chemo? Follow with short interval scans? How would size of adenopathy (e.g. <2cm vs larger) and time of recurrence (wi...

Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...

Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...

Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

Would you consider induction: TPF vs cis/gem or would you proceed with chemoradiation with cis/RT and consider adjuvant cis/5FU?

If so, how do you sequence it? Would you consider before adjuvant radiation vs concurrent with adjuvant (chemo)radiation vs after adjuvant radiation? ...

What is the current data regarding acquired resistance mutations for ALK?  Should newer agents such as lorlatinib be reserved for later lines a...

If so, would you recommend adjuvant chemotherapy and PCI after?

Does having a concurrent consumptive process e.g. DIC change your management? 

Would you change your radiation therapy treatment dose or volume if you needed to treat a chloroma? If a patient had a separate cancer (e.g. skin canc...

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

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

Are you routinely performing molecular sequencing? Would you modify your treatment approach in first or later lines based on PDL1 status?

Since desmoid tumors are associated with high estrogen states, is there an optimal contraception approach? Is there an optimal time for pregnancy? How...

When would you consider utilizing autologous SCT in those with a PR or SD? Is there a potential role for BCMA-directed CAR-T or bispecific therapy in...

Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative. PET confirmed isolated recurrence

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

Is there an age cutoff below which you would offer adjuvant chemotherapy regardless of Oncotype results? (Example: A 35 y/o woman with T2N0, ER+, sen...

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...

This patient had a Ki67 of 27%. However, the inclusion criteria for the NETTER-1 Trial was Ki67<20%. Would Lutathera be an option if labs are withi...

Does it differ in the curative vs palliative setting? Specifically thinking about adjuvant CAPOX in a patient with a BSA of 3. ~400 mg of oxaliplatin ...

Presuming that imaging does not show distant metastatic disease, what would you offer? What about if the patient were PD-L1 negative?

What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...

Would you use ALK inhibitors such as crizotinib based on recent phase II data? Are there any research efforts to combine ALK inhibitors with current ...

How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?   Review of literature suggests that most of these pa...

What clinicopathological features would need to be present for you to recommend adjuvant chemotherapy? Would you treat pT3 disease? Any specific histo...

Specifically, would you offer salvage radiation to a patient who underwent a prostatectomy with PLND and had a post-op PSA of 12 with pathology reveal...

Are there any subsets of patients that you're more inclined to offer maintenance?

Benefit of oxaliplatin in patients >70 years of age is not proven and only 5FU/capecitabine in a MSI-H tumor is of questionable efficacy. What woul...

What would your treatment approach be- surgery or chemoRT? What is your preferred chemo regimen? Is there a % threshold other than 100% (e.g. 95%) th...

Would you use a small cell regimen over a more traditional FOLFOX-esque approach?

Would you offer this patient chemotherapy? What are your thoughts about OFS plus AI and avoiding chemotherapy?

Do you aim to give a total of 26 doses or do you stop at one year from first dose no matter how many were given?

What regimens would you consider combining it with? Any specific combinations to avoid or special considerations?

Would you choose to incorporate HER2-targeting agents, chemotherapy, endocrine therapy, or a mix of these?

Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction ...

The GeparSixto, CALGB 40603, and more recently Prospero support doing it; however, it is not currently endorsed by NCCN and the latter Prospero s...

What is your preferred risk stratification model?  There does not appear to be a consensus among experts as to what cutoff in recurrence risk ju...

How do you decide between supportive care v. chemoimmunotherapy? Is there a threshold of disease burden that would push you towards recommending hospi...

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

Assuming the patient is a candidate for all anticoagulation options (no mechanical valve, antiphospholipid syndrome, patient-specific contraindication...

Is Ommaya placement with CNS-directed therapy preferred to intrathecal or cranial irradiation? How do you interweave this therapy with systemic therap...

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

Given nationwide shortage in vinblastine, several of my patients under active therapy are facing delays in their therapies. Is it appropriate to subst...

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses? 

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

 Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients  th...

In the post-op setting, would you delay 1 week even if it took them out of the 6 weeks post-op window? Meaning the loading dose of erbitux was given d...

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...

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?

There was an abstract in European J of Cancer (Srinivasan R, 2014:50: S6, P8) showing a good response rate with Bevacizumab and Erlotinib. Would you u...

Would you use R-CHOP or a more intensive chemotherapy regimen?  Would you consolidate with radiation therapy after 3 cycles or use systemic thera...

While the CKD population is at high thrombotic and bleeding risk, would you consider anticoagulating a patient prophylactically if they had a history ...

Conversely: In a patient with N2 EGFR+ NSCLC receiving radiation, would you still consider use of osimertinib?

What tumor or patient characteristics lead you to consider the use of neoadjuvant hormonal therapy without chemotherapy?

Would you recommend the patient stop testosterone upon this new diagnosis? If the patient is not amenable to stopping, would you incorporate an AI in ...

Are there particular patient characteristics (e.g. age, ER%, Ki67, grade) that make you more likely to choose neoadjuvant endocrine therapy?

Is the short time to recurrence a reason to not consider definitive management with surgery/radiation? Should systemic therapy be added if pursuing d...

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

Based on available results from the IMMUNED trial, which evaluated the role of adjuvant nivolumab/ipilimumab or nivolumab monotherapy vs placebo in re...

Do features such as nodal involvement, Ki-67, degree of ER positivity, etc. change your management? Would you use any gene expression assays to help y...

Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

How many cycles do you prefer before and after? How long do you tend to wait before starting radiation after initial chemo and after radiation to resu...

How would you approach additional systemic therapy? Would the clinical stage of the cancer affect your management?

Specifically, for cT2N0M0 small cell bladder cancer without response to neoadjuvant cisplatin and etoposide on imaging, would you proceed with cystect...

Post-auricular cutaneous angiosarcoma, pT1 (19 mm) with negative margins. Unclear if there is any indication for systemic therapy, given early stage a...

Would you differentiate between patients with measurable disease vs NED?  Are there specific data to guide us?

What was the magnitude of benefit for patients with EGFRm NSCLC by stage?  Are you still considering adjuvant osimertinib for patients with earl...

Would you consider high-dose dexamethasone (deliberating adverse effects of antenatal steroids) or move to next-line therapies?

If so, how long do you wait after surgery prior to imaging to avoid post-operative findings?

Is adjuvant radiation and/or adjuvant chemotherapy indicated? 

The current NCCN guideline version 2.2021 is a little confusing. On page HODG-2,  the clinical staging/risk classification did not include ESR, b...

Ref: EINSTEIN-CHOICE and AMPLIFY-EXT Would you approach this differently in patients with inherited thrombophilias?

If advanced stage do you follow same guidelines as Scc? Do you use same Cth regimen? Role of total laryngectomy ? 

How do you assess the risk of complications from including bevacizumab vs the known benefits of including it with chemotherapy?

Are there scenarios in which you would proceed with checkpoint inhibitor for PDL1+ disease before having full molecular testing results?

For patients who have progressed on first line checkpoint inhibitor (e.g. Nivo/Ipi) and second line TKI (e.g. Cabozantinib) 

Does your recommendation differ between autologous and allogeneic transplants? Does your recommendation differ in allogeneic transplant recipients wh...

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

Are you performing repeat molecular sequencing after progression on targeted therapy? If so, are you obtaining tissue biopsy vs liquid platform?

Is data available regarding the percentages of patients in each arm who underwent staging PET or the breakdown of CNS imaging modalities?

If patients do recur, do you perform these tests on the initial surgical specimen or on tissue from a fresh biopsy (or both?)

Would you offer refractory doses (40-50 Gy) to the RPnodes and send for splenectomy? Or would you offer refractory doses to both RP nodes and spleen?&...

What systemic therapy options are available for ESRD patients?

Would you consider an Oncotype or Mammaprint? Would your management change if the patient had 1-3 positive LNs on SLNBx (as opposed to ALND)?

The woman was on on a GnRH agonist + AI due to her premenopausal status at diagnosis and now wants to know if she continues to need the GnRH agonist.&...

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

Are the rates of adjuvant chemotherapy used in ADAURA consistent with real-world practice?

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

Does your management change based on the type of end-organ involvement at the time of diagnosis? Are there any reports of CNS involvement with non-se...

I know many centers are exercising extra precautions in light of the new concerns with coronavirus. How are people explaining things to their patients...

For example, gastric GIST, < 5 mitoses/hpf and size > 5 cm but < 10 cm is intermediate by NIH criteria but low by NCCN/CAP criteria.  Th...

In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

If post-op with clear margins would you prefer adjuvant RT or close observation with surgery for optimal reduction of local recurrence? This particula...

For patients with low risk, early stage, hormone receptor positive, HER2 negative breast cancer who initiated endocrine therapy in order to delay thei...

Do you use specific tools or take into account certain factors when considering treatment options for older adults?

Assuming no clinical trial, no actionable mutation, and PD-L1 < 50%, do you consider the patient to be primary refractory to platinum and move to s...

This includes handling saliva, vomit, sweat, vaginal secretions, semen, urine, and stool. Are there recommendations for intimacy, sex, laundry, and&nb...

I know that many advocate using vaginal estrogen in this situation.  Most of the studies of vaginal estrogen in this situation have been small an...

Are there particular mutations (eg SF3B1) or syndromes (eg MDS/MPN overlaps such as MDS/MPN-RS-T) where you are more apt to using lenalidomide?

Would chemotherapy alone suffice? Repeat biopsy and EUS were negative for residual disease.

In a patient who is not a surgical candidate, do you offer concurrent carbo/taxol rather than 5FU/oxaliplatin? 

If so, what is your time threshold for when you'll start PCP prophylaxis--when you anticipate steroid courses greater than 1 week? 1 month? 3 months?&...

A recent NCBD analysis (Rusthoven et al, JCO 2016) suggests that the addition of prostate RT significantly improves survival compared to ADT alon...

Knowing the differential effect seen with menopausal status in RxPONDER, would you avoid chemotherapy or still offer chemotherapy, given that only 15....

Would you recommend re-excision or proceed to adjuvant therapy if the tissue margin is negative? Pathologist states that tumor foci at margin was only...

Patient had a clinical T2N0 cancer at diagnosis, completed 6 cycles TCHP, and had 0.2mm residual disease with 80% cellularity, negative sentinel node.

Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...

Do you have any experience with intra-pericardial chemotherapy administration, and if so, in what cases?

Patient is 34yo and G0 referred from surgical oncology. Laparoscopic specimens of myoma and what appeared to be adhesions were significant for maligna...

An otherwise healthy patient with spleen only diffuse large B cell lymphoma with mild spleenomegaly, Spleenectomy plus Rchop or Rchop plus RT? 

Referring to a high risk patient with cT3N1 disease and ypT2N0 disease following neoadjuvant chemotherapy.

For example, will you recommend a certain vaccination timing in relationship to their treatment? Any concerns for reduced immune response or risks of ...

Or the converse:  changing to IV formulation after starting on subcutaneous pertuzumab/trastuzumab?

Conversely, is there any situation where you would prefer the IV over the subcutaneous formulation?

ASCO 2016 guidelines specified that SLNB was not recommended for T3/T4 N0 patients but uptodate allows it.

For example, a patient on cytoreductive therapy and aspirin BID, but suffers an arterial event, or a patient who is already on therapeutic anticoagula...

Is there a distinction between these tumors and patients with breast cancer with neuroendocrine features?

Does tumor size impact your recommendation? High grade? Young patient age?

Would it affect your decision whether original primary tumor and treatment was hormone positive or negative?

Does the advent of more effective therapies like peptide receptor radioligand therapy (PRRT) and capecitabine and temozolomide (CAPTEM) dampen enthusi...

In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...

Would gross ENE or R1 resection trigger you to consider adding chemo? If so, do you use weekly cisplatin or cisplatin/etoposide?

2 populations of cells with 95% negative by FISH (ratio 1.07) and 5% positive by FISH (ratio 10)

What is the lowest level you have seen with uncomplicated or complicated crises?

Do you consider placing an Ommaya for IT chemo with methotrexate or cytarabine? Knowing that leptomeningeal carcinomatosis carries such...

Can results from emerging AML data be extrapolated to high risk MDS populations? Is there data to guide the choice of continuing the HMA in combinati...

Based on MINDACT update from 2020, a 5% difference in DMFS for patients 50 years or younger was noted, favoring treatment with chemotherapy (93.6%; 95...

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

What clinical scenario(s) do you find results to be the most beneficial?

Is there a role for neoadjuvant cisplatin-based chemotherapy? Do patients with sarcomatoid histology respond to checkpoint inhibitors?

Do you use the same high risk factors as adenocarcinoma when deciding on adjuvant treatment for early stage disease?

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

Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?

Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

Does the recent CROWN trial affect your first line treatment decision? 

Options: 1) ddAC-T- surgery- adjuvant capecitabine if residual disease 2) weekly taxol/carbo x 12 followed by dd AC x 4 3) Keynote 522- pembro/taxo...

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

Do you prescribe creams (e.g., urea) to prevent HFS, or is their use generally more reactive? 

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy. 

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?

NCCN recommends either ISRT with rituximab/chemotherapy or ISRT alone in this scenario.  What factors help your decision making?

How would your treatment change given pCR rates are reportedly much lower in triple positive patients?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

No primary thoracic mass identified. Knowing these often following an aggressive clinical course, would you consider concurrent chemo/RT, incorporate ...

No actionable mutation on NGS testing. What approved therapy do you prefer? Are there specific investigational agents currently in clinical trial...

Many patients have had prior chemotherapy exposure with newly diagnosed AML that may not have classic therapy-related cytogenetics.  How do you a...

Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?

Initial treatment with Taxane-Trastuzumab-Pertuzumab with then maintenance with the two anti-HER2 agents and and an aromatase inhibitor. Would you bio...

Following chemoradiation, would you consider maintenance durvaluamb as for NSCLC even given the SCLC component? 

Is there any data justifying the use of systemic therapy over localized therapy (e.g. radiation or surgery) in this situation prior to a progression e...

The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...

This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...

If no testicular mass on exam or ultrasound - is there a role for orchiectomy? What chemotherapy regimen would you use and how many cycles?

Rituximab has entered the treatment algorithm in the first-line setting for the initial treatment of TTP. However, in remission, the role of adjuvant ...

In patients with symptomatic disease that observation would not be appropriate, what is your preferred treatment?

Which Radiation modality, if any, would be preferred? Typical chemotherapy does not work for SFT. In which circumstance would you use VEGF ( Temozolo...

Or would you consider IO agent be given only after progression on platinum + fluoropyrimidine?

For example, is there any data to suggest a benefit to starting with immunotherapy prior to TKI or the alternative?

Are you employing more or less primary chemoRT v. surgery for some cancers? Are you dose de-escalating? What are issues radiation oncologists should b...

Assuming patient received appropriate local therapy for brain metastases, which agent would you use?

Do you only give intrathecal chemotherapy or systemic therapy?

Other than when there are obvious contraindications to anthracycline, such as cardiac dysfunction, when do you use a non-anthracycline containing regi...

Would you consider it for a patient with good PS but with limited metastatic disease? What dose fractionation would you prefer?

Is there any specific precautions or concerns to consider with TKI initiation if the patient has vasogenic edema?

What are the scenarios in which a rebiopsy is warranted for follicular lymphoma?

Would you modify the radiation dose or field in this setting? Would you pre-emptively dose reduce chemotherapy, or modify the dosing of ruxolitinib?

I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?

The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease.   Both ARTIST and Inte...

(assuming that the patient is int-poor risk, has measurable disease outside of the CNS, warrants treatment with appropriate PS)

Would you offer SBRT to both sites, SBRT to the primary and standard fractionation to the node due to proximity to the main bronchus/proximal lobar br...

Pre-menopausal women make progesterone and their menses are typically lighter on tamoxifen because it's a mild endometrial ER stimulant blocking their...

How has your practice been impacted by the ECOG 2108 (Khan et al. ASCO 2020 Abst LBA2)? Are there sites or distribution of disease that prompt you to ...

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

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

Does the absence of an OS benefit in the AG221-AML-005 presented at ASCO 2020 deter you from this strategy?

How do you decide on other chemo regimen? (Dosing, frequency, carboplatin based, non-platinum based etc.) Would you use Cetuximab? Altered fractiona...

What is the time window in which you would consider adding AR targeted therapy? Is there a time frame in which you would NOT consider introducing sin...

Given the changing landscape of treatment, some patients may have already received capecitabine previously.  Would this impact your treatment rec...

Does the reported positive endpoint in OS for Checkmate 743 change your practice?

Would you consider use of immunotherapy with checking PDL1? What chemotherapy agents would you consider along with mastectomy/radiation?

What do you do/say when a discussion of evidence-based information doesn't convince a patient that this is her best chance of cure? Some patients even...

The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...

Would you consider an anthracycline based substitution vs changing to nab-paclitaxel or a combination with platinum agent?

In patients who are intolerant to hydroxyurea, anagrelide and interferon

Has anyone omitted post path fracture radiation of pelvis/long bone in favor of starting endocrine treatment first? Or would one omit RT and start a C...

Data suggest patients with D842V-mutated or KIT/PDGFRA WT GIST do not respond to imatinib, but NCCN guidelines does not take into consideration mutati...

Do you prefer surgery vs radiation? For surgical patients, do you offer neoadjuvant chemotherapy? If so what regimen? 

Is there an optimal strategy to minimize unnecesary steroid use?For example, pre-treatment dexamethasone or 3 day dexamethasone? Prednisone only conti...

Would it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

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

Topotecan, nivolumab/ipilimumab and others are listed within NCCN guidelines, and lurbinectedin was recently approved in this space. How do you decide...

For a patient with high risk disease and a severe enough reaction that additional taxane-based therapy is contraindicated, do you consider alternate c...

Is there data and FDA approval for this indication? What about for nodal failure after radiation? 

The upfront plan is to use a definitive radiation dose of 66 Gy. My reading supports the use of 5FU + cisplatin but another doctor is recommending FOL...

She had had 4 prior biopsies. Would the fact that she received 2 months of neoadjuvant tamoxifen due to COVID change your approach?

Would you consider this refractory disease and go on to salvage regimen and auto-SCT, or is there a role for definitive XRT to the site of residual di...

The recent NELSON trial evaluates screening in a slightly different population than the USPSTF/NLST criteria. Which will you follow?

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

Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...

While the KATHERINE trial for HER2+ used path staging, CREATE-X for TNBC with capecitabine used the Japanese Breast Cancer Society response criteria. ...

How do you balance risk of chemo after surgery with risk of progression of disease while waiting for healing after surgery before starting chemo?

Given the recent reclassification of gain(1q21) as a high risk cytogenetic abnormality, has this changed your practice in managing newly diagnosed pat...

Is there any evidence for sacituzumab govitecan (IMMU-132) in this situation with progressive systemic disease after prior anthracycline and taxane?

TROG 99.03 showed nearly 20% improved PFS at 10 years with chemoimmunotherapy despite 31/75 patients assigned R-CVP vs 44/75 assigned CVP without ritu...

How would the sidedness of the tumor, BRAF, RAS,HER2 or MSI status affect your decision?

Is there evidence for daratumumab-based doublet regimens? Would your choice differ based on the patient's transplant eligibility?

< 4 lymph nodes involved, initial diagnosis was 11 years ago when she was treated with mastectomy and adjuvant tamoxifen for 5 years.

For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?

Would you consider still immunotherapy even if aggressive disease vs single agent chemotherapy?

Does the SYSUCC-001 trial presented at ASCO 2020 change your practice?

I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...

This patient underwent mastectomy and ALND (10/28 positive lymph nodes). Immediately following axillary LN dissection (and prior to radiation) imaging...

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

Is there a preference for obinutuzumab over rituximab in early relapsed DLBCL, or in primary refractory disease?

An ASCO 2020 poster from the German Testicular Cancer Study Group found that 37% of CSIS seminoma and nonseminoma were miscatagorized resulting in ina...

Data from the SOFT/TEXT trials showed clinical benefit in ovarian suppression + aromatase inhibition for high risk, premenopausal ...

What advice do you give regarding dietary practices, feeding tubes / parenteral nutrition, and pharmacotherapy specifically for cachexia?

For a patient not on dialysis? Outside of single agent 5FU, all other standard chemotherapeutic options would be contraindicated for nephrotoxicity.&n...

Would your approach change based on the type of reaction (eg. Stevens-Johnson syndrome vs DRESS)? How would you address maintenance (if any) post-tra...

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

For instance, would you discontinue when there is resolution of adenopathy and normalization of counts? If so, do you overlap ibrutinib with other the...

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

This has been a common practice in the community. Is there a benefit for certain patients?

What if the patient has a history of confirmed COVID-19 but has since recovered?

Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Patient previously received neoadjuvant carboplatin, anthracycline and taxane regimen and is BRCA negative.

Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?

When using short course RT, the NCCN guidelines currently recommend short course RT followed by chemotherapy, followed by surgery. Many surgeons are h...

Guidelines do not provide strong guidance on who will benefit from temozolomide vs PCV or when to consider re-challenging with temozolomide.

Does the availability of first line checkpoint inhibitor therapy affect your treatment decision? 

How would this change if the patient had metastatic HR+,HER2- breast cancer and now has symptomatic pancytopenia secondary to BM involvement after TCH...

Do different modalities of imaging (PET vs MRI vs CT) help you to distinguish one etiology versus the others? What about other clinical characteristic...

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