Medical Oncology
Questions discussed in this category
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 ...
PD-L1 CPS of 1, no other actionable mutations except HER2.
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?
Especially as the study was done before the adoption of total neoadjuvant therapy
The ICI adjuvant data we have so far doesn't clearly separate MSI-H disease from all comers.
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?
How do the results affect your recommendations for workup and management?
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?
If so, when and to what extent?
Do you proceed with sequential, concurrent, or sandwich treatment?
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?
Do you consider "bridging" therapy prior to transplant, and if so, what are your thoughts on the intensity of the chemotherapy?
Since there is no overlap between chemo regimens for these cancers, how would you sequence treatment?
Such as in a patient with essential thrombocythemia with a CALR mutation, younger than age 60, no history of thrombosis, no bleeding or vasomotor symp...
How frequently and what type of testing/sample are you performing MRD assessment?
Does your approach differ between transplant-eligible and transplan...
My understanding is that if someone isn’t medically operable, the default is to offer systemic therapy palliatively because breast cancer is tho...
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?
For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?
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
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...
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...
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...
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 considering bridging with chemotherapy, and if so for how long?
Would you only give three cycles with radiation, or are you adding two more cycles of FOLFOX afterwards?
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.
Both sets of CT scans pre and post- chemoimmunotherapy show no evidence of distant mets.
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
Imaging of breast and systemic imaging is all negative.
Would you give adjuvant radiation and Her2 based therapy like any other Her2 + breast cancer?
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?
There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?
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?
Based on the KEYNOTE-716 study and Dec 2021 FDA approval
Will you use it rather than a carboplatin-containing regimen?
Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone
When would you consider a bone marrow biopsy?
If so, in what situations?
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...
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...
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?
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...
> 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?
How would it change your risk group or management? Does Decipher help further inform treatment?
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?
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...
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 with similar progression free survival.
Does the patient's young age affect your decision when applying data from the IDEA collaboration?
In light of the recently published GY-018 and RUBY trial, how would you treat an advanced stage/recurrent uterine cancer?
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?
Is there benefit to radiation on top of systemic therapy?
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?
Would portal hypertensive gastropathy or colopathy sway you away from using it?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...
Are you more worried about QT prolongation in this subset of patients?
This would “combine” approaches from both CheckMate 816 and IMpower010.
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...
There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (Cousino et al., PMID 23071225).
Is radiation effective in this case and if so, what dose would you use? Is there potential for perforation?
What data may support routine escalation of endocrine therapy? Should HER2 therapy be prioritized instead?
How does data from PADA1 and EMERALD trials impact your decision making?
And if so, would you offer FOLFOX or Immunotherapy?
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...
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?
How does margin positive influence your decision?
How do you stage and evaluate premenopausal patients with >= cN1 ER+ PR+ HER2- breast cancer prior to surgery to avoid this pitfall?
For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...
How does this change for patients with elevated bilirubin?
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
Is there a preferred duration of ADT? Do you give abiraterone/prednisone or other novel hormone therapy?
If doing radiation, would you just do SBRT t...
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...
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?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
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?
Or would you sequence a different BTKi?
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)...
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...
Given the recent update from the NAPOLI-3 trial presented at GI ASCO 2023, the two regimens appear to have similar OS.
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...
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 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...
If so, how long do you continue medication and when do you discontinue?
Does treatment with surgical resection versus radiation alone change your man...
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?
Add OFS with endocrine therapy plus Taxane-HP combo? What taxane is preferred?
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?
The patient had a prior right-sided ER+ HER2-ve breast cancer, treated with neoadjuvant chemotherapy, MRM with ALND, and PMRT
They recently developed...
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?
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...
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?
Current NCCN guidelines recommended not combining relugolix with these agents until more data is available.
Any drug interaction concerns or ot...
What contraindications or concerns do you have in this scenario beyond assessing the Child Pugh Score?
What VAF burden would be considered significant prognostically or for treatment decisions?
If a patient previously received taxane-based chemotherapy for the initial cancer, is additional chemotherapy recommended or can HER2-directed and hor...
Is the marginal advantage of AC/T in 1-3 node positive outweighed by toxicity such as risk of cardiotoxicity and leukemia, regardless of RS?
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 50mg BID if intolerant to 150mg and 100mg 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...
Are there factors which would make you more likely to use atezo/bev vs durva/treme vs TKI?
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?
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...
Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...
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?
Patient is BRCA 1/2 wild type; completed four cycles of carboplatin/paclitaxel and two cycles of AC with pembrolizumab in the neoadjuvant setting.
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?
Are there specific patient factors for which you would more preferentially use this regimen?
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...
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?
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.&...
How does the changing landscape of first-line treatment impact your decision making for second line therapy?
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...
- 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).
I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...
What would your approach be in a patient with a mid-esophageal squamous cell carcinoma treated with chemoradiation therapy followed by surgery, with P...
Would you consider switching to a different regimen?
Secondary MF such as post-PV, for example.
Do you apply the same prognostic scoring systems?
My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...
Endocrine therapy is usually not indicated for DCIS s/p bilateral mastectomy, but would the fact that residual tissue (nipple-sparing) alter your deci...
How often are you scanning the brain and what is your trigger to treat?
We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to ach...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...
Would you consider the BEACON regimen (i.e., encorafenib/binimetinib + cetuximab) in this setting?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
Is prior Ra-223 a contraindication for treatment?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice...
Patient has ED unresponsive to cialis/viagra; would you recommend testosterone replacement therapy?
No evidence of palpable splenomegaly, normal hematocrit and platelet count
If you do recommend adjuvant therapy, what regimen would you use?
Do the results change your clinical practice?
Which patients would you recommend active surveillance alone, a less morbid procedure such as enucleation, or a Whipple surgery? How does age influenc...
If so, what would you consider ordering?
The said patient has been on Imatinib for 2.5 years and is In MMR. Last rt-PCR was 0.04.
Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT
How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...
In patients with prior perioperative immunotherapy with early relapse, would re-introduction of immunotherapy be reasonable with high TMB?
Is there role for IVIG? Would you alter the dose or time course of steroid therapy?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling?
Given POLE mutation status can currently o...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
At initial diagnosis she had T1cN0 disease treated with lumpectomy and SLNB followed by 12 weeks of paclitaxel with 1 year of trastuzumab.
I recently saw a patient who had been treated with concurrent pembrolizumab-RT elsewhere. Is this an acceptable practice outside the setting of a clin...
How do you operationalize finding biomarker information in EHRs/testing portals, either for your own patients or if they have changed providers?
If a...
Do you have a preference for bicalutamide? Can abiraterone be used instead?
Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...
Presuming strong indication for ASA - eg history of NSTEMI
Do you perceive a difference between somatic vs germline BRCA mutations?
What if Medical Oncology wants to give more systemic therapy and further delay XRT start date?What should we be telling the Breast/Plastic surgeon/Med...
If you do not use prophylaxis, what skin care strategy do you employ?
At what PSA would you become suspicious for biochemical recurrence and pursue restaging? Is there a threshold value?
What imaging modality would you ...
NCCN states to consider adjuvant chemotherapy similar to muscle invasive bladder cancer in this scenario, but one would avert adjuvant chemotherapy in...
Would you give trastuzumab every 2 or 3 weeks, pembrolizumab every 3 or 6 weeks?
Would you use it for initial staging or at time of biochemical recurrence?
The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TD...
In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...
Would you debulk with neoadjuvant therapy to achieve resectability?
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 include a CDK4/6 inhibitor knowing the patient doesn't meet criteria of monarchE trial but still is Stage IV?
Would you ever consider using these in sequence?
Would you consider omitting treatment if small tumor and early stage? Or would you use tamoxifen?
Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2...
eg. eGFR < 30 ml
Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.
If radiation, what type? EBRT or brachytherapy? Any other techniques you would recommend, such as rectal balloon?
In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?
Assuming minimal toxicities except fatigue from long, recurrent infusions.
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?
OlympiA trial did not include her2+ breast cancer.
Do you use specific PDL-1 assays for each approach?
Any data to support this combination for non-clear cell RCC?
Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?
The Intergroup 0162 trial did not demonstrate noninferiority, although OS difference only 5.1 vs. 5.8 yrs. Would pattern of spread affect your d...
The OncotypeDx score was 51 in this scenario.
Residual GEJ mass and progression in local lymph nodes after carbo+taxol chemoRT without distant metastases.
Stage is cT4N2M0.
If not, what instructions do you give to patients regarding checking temperature at home/return precautions?
ER low being 1-9% (<10%), PR 20%
If so, would you adjust 5-FU dosing?
Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.
If so, what regimen do you utilize?
Would you proceed with KEYNOTE 522 regimen and add anti-HER2 targeted therapy adjuvantly?
What would you offer a premenopausal woman with clinical T2N1 ER positive breast cancer for adjuvant therapy after she achieves a pathologic complete ...
What do you do if LFTs are elevated after one dose of neoadjuvant TCHP (highest ALT >13 times upper limit of normal, normal bilirubin) with prior n...
Would T or N group change your recommendation?
Would your thinking change if the patient continues to be NED after an unplanned chemo break, e.g. for insurance issues?
Would you consider the discontinuation of either anti-HER2 agent or both?
I have a patient in her 60s with CHEK2 mutation, diagnosed with bilateral breast cancer. Lumpectomy showed b/l tumors <10mm both ER/PR+, HER2-, but...
Does measuring serum free-light chains make a 24-hour UPEP unnecessary?
Does this raise concerns about the efficacy of adjuvant immune checkpoint inhibition? Are any preliminary results from AMBASSADOR (adjuvant pembrolizu...
Is it necessary to test CPS given the FDA approvals are not contingent on CPS %?
If you do test, do you check 28-8 (nivolumab), 22C3 (pembroliz...
Although grade 3 toxicity rates were low, ~10.5% experience some degree of ILD, are there strategies to reduce risk before treatment starts?
Are ther...
Would you treat with adjuvant chemotherapy or immunotherapy?
Are there data for using checkpoint inhibitors in this setting?
Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...
Weekly (20 mg/m2 D1, D2) and q 3 wks (70 mg/m2 x 3c or 100 mg/m2 x 3c) regimens have all been listed as acceptable. For reference, RTOG 97&...
Would you give neoadjuvant chemo or hormonal therapy or go with surgery first? What chemotherapy would you use?
The trial inclusion criteria was essentially "docetaxel candidate per the treating oncologist"
If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology?
Would you attempt targeted therapy or would you choose chemo-immunotherapy?
What agents would have sufficient efficacy overlap to treat both?
Would the timing of the relapse (eg within 6 months) impact your decision making?
Assuming no overlap with prior RT doses, would a history of necrosis cause you to hypofractionate rather than deliver single fraction SRS?
ET is JAK2+
Is there a concern regarding rarer side effect emergence (cardiac, bone, muscle, cognitive) of long term exposure to "maximal" androgen deprivation? I...
Should these cancers be treated like hormone positive breast cancer or triple negative breast cancer?
She is pre menopausal with cT1c grade 2 disease...
What scenarios would you do second neoadjuvant treatment vs surgery?
Do you stop therapy at 2 years or continue until progression of disease?
Is it reasonable to dose de-escalate since survival will likely depend on the metastatic lung cancer?
Would you give R-CHOP without knowing if there was use of prior anthracycline?
Pathology did not meet criteria for a well-differentiated nor dedifferentiated liposarcoma, nor a spindle cell sarcoma.
The forest plot from CheckMate 274 did not show a benefit for such patients?
How would you select between adjuvant chemotherapy and adjuvant nivoluma...
How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...
How would you approach treatment of a patient with metastatic NSCLC with PD-L1>1% and HER2-mutation?
Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...
VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked.
If said patient was known to be gBRCA mutated, would you use neoadjuvant chemotherapy to enable adjuvant olaparib for those that did not have a pCR? &...
Do you view CPS < 1% or 1-4% separately? Do you view the incremental benefit of adding immunotherapy still advantageous given relatively poor outco...
Do you go by FDA approval alone, or incorporate other data into your treatment decisions? How do you view updated recent presentation of CM-649 ...
Are there meaningful differences in the CHECKMATE 649 and KEYNOTE 590 studies to guide this decision?
Would you use reduced dose chemoimmunotherapy, single agent chemotherapy, or single agent immunotherapy if the patient is unlikely to tolerate full do...
Would you consider boosting the nodes? What dose? Would this change your recommendation for length of ADT?
Would you consider chemotherapy, androgen blockade or triple therapy (chemo and AR targeting)?
Do you have a preferred sequence of therapies for diffuse skin limited MF?
What would you consider as contra-indications to Cladribine?
Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation.
Would you consider re-challenging with a different TKI?
How much of the benefit of adjuvant chemotherapy do you expect to be due to ovarian function suppression due to the chemotherapy?
What is the impact among patients and providers?
Has your documentation been adjusted now that patients can readily review?
Previously untreated
Is dose modification of docetaxel necessary with Gilbert's when giving TCHP?
Which agents would you select and for how long would you treat them?
NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP?
What ...
Patient is young and reoccurrence is one year after initial diagnosis of T1cN0 ER/PR positive, HER2-negative breast cancer treated with mastectomy, bu...
With conflicting data from the EORTC RCT and the Sarcoma meta-analysis collaboration, what factors determine when you would offer adjuvant chemotherap...
In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...
When chemotherapy is indicated in early stage soft tissue sarcoma, would you prefer to use AD or AI?
AD: doxorubicin + dacarbazine
AI: doxorubicin + ifosfamide
ER 95%
Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis.
Would you avoid imid's given reported association with transplant rejection?
For pts w/ eGFR between 30-60
What combination of fluoropyrimidine, PD-1 inhibitor, or trastuzumab do you use?
Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?
HR+ = ER 34%, PR 0%
RCB2 = no nodal involvement
In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...
Would you restart hormonal therapy in a patient with a new diagnosis of LCIS 2 years after they have completed 5 yrs of AI for stage 1A IDC in the oth...
Would pegylated interferon be preferred?
Does the degree of resectability affect your management?
Patient underwent mastectomy for DCIS in the setting of previous lumpectomy and adjuvant radiation for the invasive breast cancer.
How would you modify therapy for a younger, fit patient versus an older, frail patient?
Lesions in stomach, small intestine, colon resulting in bleed...
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
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 there contraindications to drugs like oxaliplatin or abraxane?
Does chronicity or severity of the patient's underlying symptoms play a role in yo...
What factors may favor RET inhibition versus observation?
E.g. One NSCLC with N2 disease, and additional ipsilateral small nodule that is a biopsy-proven second primary. When do you consider SBRT to a nodule ...
Can atezo be used even if patient has completed chemotherapy preoperatively?
The patient is intolerant to trastuzumab deruxtecan. In which clinical settings would you consider reintroduction of TDM1?
Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...
Based on the results of the phase 2GORTEC study reference; Sun et al., PMID 32758455.
How would you proceed given that cT1c didn't meet the study criteria?
Currently on C2 of doxorubicin/cylophosphomide/pembro. Would you expedite surgery?
KEYNOTE 811 showed improved response rate with the addition of pembrolizumab, but very few patients in this study had low PDL1.
Would the results of PEACE-1 trial justify this?
Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence?
Given multidisciplinary discussion has occurred and SBRT has been agreed upon as local therapy, how do you approach the presence of moderate/significa...
Would you always offer an FGFR inhibitor as second line therapy in these patients instead of a second line chemotherapy regimen?
Should this be sent on initial biopsy or on surgical pathology? What if an initially high risk patient has good risk findings post-operatively?What ha...
Are you offering patients beta-emitters (Samarium-153 lexidronam, strontium-89) to any patients?
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?
40 yo adult patient with a~6cm mass with concern for skull base bony involvement (group III and stage III, no nodal involvement )
Would you ever consider adjuvant chemotherapy rather than adjuvant immunotherapy after the publication of the CM-577 results? If so, in which pop...
For instance, the foci found were pN1mi (0.5 mm) deposit in 1st SNL (1/13 LN) and mpT1mi (8 foci). Would you consider single or dual anti-HER2 blockad...
Is there any utility in monitoring serum tamoxifen levels?
Do you worry about false negatives on PET, CT, MRI if ADT is started before the scan? Scheduling scans can sometimes book 2-4 weeks out.
Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?
For instance, ER/PR >1% but <10% and Ki67 >50%
Do you allow pre-RT treatment with the CDK 4/6i and hold during RT, vs. allow concurrent with breast/chest wall RT, vs. delay starting CDK 4/6i until ...
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
If a patient is asymptomatic at presentation, how do you incorporate local treatment options (RT/surgery) and when?
If multi-agent systemic therapy, i.e. FOLFIRINOX, is also planned, is there a preferred sequence of therapies?
Does the 2020 approval of Nivolumab and Ipilimumab for mNSCLC with PDL1 >1% impact your decision?
e.g. DITP from eptifibatide after a cardiac intervention
Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...
How does cirrhosis and/or underlying thrombophilia affect your decision?
IVIG, TPO, or other agents?
Would you treat with PARP inhibitor or Check-Point Inhibitor?
Patient is ypT2N1
Would you recommend 6 months of FOLFOX or just surveillance?
Patient has already received neo/adjuvant treatment with AC, paclitaxel, capecitabine, docetaxel, and carboplatin.
Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...
Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?
Do you consider size > 2cm, visceral pleural invasion or vascular invasion as indications for cisplatin-based chemotherapy?
Patient previously received neoadjuvant ddAC-T with residual disease at surgery, followed by adjuvant capecitabine which was completed 2 months prior ...
Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient ha...
Does not meet Olympia trial indication
For medical oncologists, would you offer a PD-1/L1 inhibitor? For other subspecialties, how would you counsel the oncologist regarding the risk of usi...
In high-risk, node-positive HR+ Her-2 neg breast cancer patients who received neoadjuvant chemotherapy with residual disease, would you give capecitab...
Received optimal pre-op denosumab; only option is now amputation
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...
Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?
Is Crohn's diagnosis an absolute contraindication for immunotherapy?
Conversion tables suggest starting the new drug with the next dose but do not seem to answer this question (i.e. if switching from rivaroxaban 20 mg d...
G1 neuropathy and G3 neutropenia were observed with cycle 12 FOLFOX + bev.
Would you reintroduce oxali at a lower dose or switch to irinotecan+EGFRi ...
Has your practice changed based on the randomized, phase 3 study showing prophylactic gabapentin is not effective?
Please share your thoughts and exp...
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.
What about for a patient with complete radiographic response who declines surgical management?
How do you decide how long to continue?
Will degree of PD-L1 status impact your decision?
Would you ever offer to stage IB patients as per study enrollment? Do AJCC v8 staging guideli...
Would you consider second line nivo-ipi for patients with a specific histology or tumor PD-L1 expression?
How would you manage endocrine therapy 7 years after the original ER+/PR+/HER2- IDC, while on adjuvant tamoxifen/OFS develops a contralateral ER+/PR+/...
If you had a patient with otherwise average risk stage 2 colon cancer but had signet ring or mucinous components to their pathology, would this sway y...
How do you maintain a trusting relationship with your patients when this relapse occurs?
What about changing standard regimens for TCL with HLH?
Does PDL1 status impact your decision?
For patients who were not neoadjuvantly on pembrolizumab, is it safe to initiate it concurrently with radiation?
Are there factors to explain why MonarchE was a positive study and PALLAS was not?
Of note - the tumor tissue biopsy NGS did not show KRAS or BRAF mutations. Microsatellite stable. Patient received first line FOLFOXIRI + Avastin .
Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.
Does severity of dementia play a factor in recommending ADT?
For patients who have already undergone trimodality treatment, what time frame do you consider for adjuvant IO?
Oncotype score in this case was 14.
NGS of TURBT specimen had high TMB (18 Muts/Mb).
Do you observe, offer adjuvant pembrolizumab, or give a first-line metastatic regimen (IO/IO or IO/TKI)? Does your recommendation vary based on risk c...
How do HPV-positive patients respond to ICI compared to HPV-negative in your experience?
e.g. IS < 0.002% by qPCR
Is there a certain time interval where you would feel comfortable to rechallenge with immunotherapy at recurrence (6m vs 1y vs 2y?) Does degree of PDL...
Are the experts convinced by DFS when the OS is immature?
How many in BSC arm went on to receive immunotherapy and was that adequate?
What would you do for a patient with a non-EGFR actionable mutation?IMpower010 included EGFR and ALK mutated NSCLC. Is there any concern in the use of...
How does your treatment approach vary depending on the underlying predisposition?
In elderly patients (>70-75) with a good performance status, does the risk of neurocognitive decline outweigh the benefit of PCI?
High-risk criteria meaning >4 positive nodes and Ki67 >20%
CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?
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...
Is a repeatedly abnormal serum immunofixation all it takes for MGUS?
In a patient with a history of VTE (now off anticoagulants), is it safe to administer fulvestrant?
Do you initially start with systemic therapy alone or do you proceed directly to chemo-radiation?
Given arguments exist between the FDA and ASCO, where do you stand?
Does VAF <1% make you want to do a BM biopsy for confirmation?
Is there a role of EBRT to the prostate with extended fields to cover the retroperitoneal nodes plus ADT (definitive therapy) or would you treat as ca...
Would you stop all treatment after 4 cycles, or proceed with pembrolizumab alone, and would PD-L1 expression factor into your decision?
Would you do consolidation radiation or active surveillance?
Would presence of variant histology change your recommendation?
This involves the primary site responding but progression with new bone marrow involvement with resulting cytopenias.
Given sacituzumab is an antibody drug conjugate of the active metabolite of irinotecan
In light of updated monarchE trial data, it seems a SLNB would help delineate adjuvant treatment options in this population. However, Choosing Wisely ...
Grade 2 DCIS, post mastectomy with negative margins, sentinel nodes negative
This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...
Is there any role for radiation therapy alone?
How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?
If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...
PSA rose from 25 to 30 ng/mL over 6 months on darolutamide for M0 CRPC, prompting scans which showed oligometastatic disease to bone, not amenable to ...
If yes, how many cycles?
For stroke-like migraine attacks after radiation therapy (SMART syndrome), does your management of these patient's change with recurrent episodes? How...
How do you weigh the various efficacy endpoints in the trials of novel combinations in ccRCC?
Are there specific clinical populations that you ...
How and when do you plan to perform HER2 testing in patients with NSCLC?
Many of the patients on ASCENT trial were heavily pre-treated and require growth factors. With the day 1,8 treatment cycle, is there a way to minimize...
Can intrathecal methotrexate be continued with close neurologic observation vs switch in treatment now due to findings?
If so, when do you consider this?
Do you worry about fluoropyrimidine resistance with concurrent chemoRT? Is there any role for neoadjuvant immunotherapy?
Do you give adjuvant chemotherapy to a patient with a completely resected mediastinal pure seminoma?
What is your approach to a patient who underwent surgery for what was thought to be a thymoma, but ended up being a pure seminoma? No disease elsewher...
How would need for anticoagulation change your consideration?
Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?
After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...
For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...
How do you decide if it may be safe to continue immunotherapy?
What would be the treatment duration if using oral TKI?
How does trastuzumab deruxtecan compare to other HER2 targeted strategies?
What clinical criteria would make you prefer TORS as the initial treatment approach?
What factors would influence your approach?
Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...
BRCA mutant, ER/PR positive and HER2 positive T2N0M0 breast cancer diagnosed 5 years ago, treated with bilateral mastectomy, BSO, 1 year of adjuvant a...
Does disease response (CR vs PR vs SD) or IO-TKI combination factor into your consideration?
Would a PET avid pelvic lymph node without distant metastatic disease change your management?
CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.
Ki67 = 90% with multiple small nodes on PET scan and normal CBC
Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?
Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...
Patient received full dose concurrent cis + RT previously.
How do you stage? Like nasopharynx or p16+ oropharynx?
Do you treat it like npx ca with chemo xrt + adj chemo or like opx p16+ with definitive chemo ...
Please also discuss the type and duration of anticoagulation.
For patients with hormone negative breast cancer and HER2 positive only by copy number, do you give TDM1 for residual disease or capecitabine?
No oncotype was sent on the original breast cancer.
How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...
Would you think differently about chemotherapy based on %teratoma or size of lymph nodes vs number of lymph nodes (eg. multiple small LN vs single 2-5...
Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?
Do you feel the dosing used in...
If not carboplatin, would you recommend nivolumab instead?
When is the optimal time (if ever) for cytoreductive nephrectomy?
Do you add on additional cycles of 5-FU/capecitabine to go beyond 3 months of treatment? Or would you stop at 3 months of therapy, dropping the oxalip...
What is your general rationale for selecting from available options?
If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?
Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? ...
Are there specific patient cohorts in whom you will more preferentially use sacituzumab govitecan?
Can data from ASCENT be applied to patients with C...
Would the etiology of HCC affect your decision, e.g. non-viral hepatitis since less benefit was shown for this group in IMbrave150?
Would you offer topotecan, lurbinectedin, or another agent given the CNS progression as well?
This situation can feel uncomfortable. Would this feel safer if patient is s/p mastectomy and had TNBC?
How do you interpret the comparative efficacy in squamous cell subsets among the CM vs KN vs EMPOWER studies?
Do you choose Lorlatinib or brigatinib? Or do you try to add chemotherapy to alectinib?
Based on the SCORAD III trial, will you now be treating patients with spinal cord compression with single-fraction radiotherapy? Is there anyone ...
Or with other available IO/TKI combinations should this be strictly reserved for intermediate/high risk patients only?
If selecting IO/TKI, do ...
Or what is your preferred regimen for stage IV ccRCC following progression on IO/IO?
Has anyone tried this approach with success?
Would you use immunosuppression in patients several years after curative treatment for melanoma?
Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...
If you do recommend resuming carfilzomib, what dose and frequency would you use?
If any clinical benefit (ie. CR, PR or SD) would you consider switch maintenance avelumab, surveillance until progression, or an alternate regimen?
Molecular profiling revealed no targetable alterations, however tumor mutational burden was >10 mut/Mb.
Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...
Largest invasive focus is 0.4mm
What about multiple anaplastic plasmacytoma without bone marrow involvement?
Do you select treatment based on toxicity profile since efficacy of regimens will likely never be directly compared?
Are there QOL indices that can ...
Do you try to keep Hb> 10 or 12? Or somewhere in between?
Patient has progression of liver metastases while on pembrolzumab/axitinib. ECOG PS 1 and limited comorbidities.
Are there differences in outcome among the BRCA mutated subgroup, or others?
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?
Or would you restrict such treatment to patients with known pathogenic germline BRCA mutations?
Given ductal histology, is docetaxel preferred over NHT?
Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...
For example, does a higher recurrence score influence your choice of TC versus AC-T? Or your choice to add ovarian suppression to a premenopausa...
E.g. disease burden causing airway or vascular compression.
Ki-67 > 95%, PET-CT negative for any additional disease.
Are there other high or very high risk features that would also contribute to your decision making?
CNS recurrence occurred within two years of prior neoadjuvant therapy
If blood counts are sustained, do you continue or delay?
Do you treat with radiation therapy and what dose do you use? What dose do you accept to the duodenum?
Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...
In which situations would you consider this a reasonable treatment option?
NSABP B51 and B52 specifically prohibit this.
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?
Would you offer adjuvant RT or chemotherapy? If so, what chemotherapy would you prefer?
Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...
Do you routinely recommend any dietary changes or is the evidence not convincing?
Are there other supportive care interventions that would otherwise be covered by hospice?
Should patients with moderate penetrance pathogenic variants be managed similar to BRCA patients and consider risk reducing contralateral mastectomy?&...
Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...
Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...
What about a higher penetrance PV such as PALB2?
See JCO OGR 8/2021 by @Mark E. Robson discussing management of non-BRCA pathogenic va...
Would you prioritize the head and neck cancer or treat the lung cancer first with SBRT to take care of it first? How about if there is mediastinal inv...
GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease. Prostate MRI pending.
Would your decision be influenced by whether a pathologic complete response was attained?
Would you elect for concurrent chemoRT or RT alone?
In a scenario where patient's other clinical/familial risk does not sufficiently qualify them?
See JCO OGR 8/2021 by @Mark E. Robson discussing manag...
The recommended concurrent chemotherapy regimens (cisplatin/paclitaxel and cisplatin/FU) in NCCN are based on BID fractionation of radiation as in RTO...
Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?
Specifically do we know by how much each intervention reduces the risk of developing MBC or increase breast cancer specific as well as overall surviva...
The patient is treatment naïve and asymptomatic. She also has disease in the body (bone and liver metastases).
Insurance won't pay for harvesting if the transplant is not done within a year.
The patient initially received definitive therapy with AC-T and RT to the breast as well as RT to a solitary bone lesion. She has been on AI for the l...
Does this data change your preferred first line treatment regimens when considering other options such as mAb combos, cytotoxic chemotherapy?
Is the non-inferiority margin of 1.429 sufficient, how was this selected?
Is the open label (rather than blinded) study design of any concern?
Is th...
Can experts comment on fungal pneumonia risk with individual BTK inhibitors as seen in ELEVATE-RR and whether this impacts their management decisions?
Do you feel comfortable with BTK inhibitors in these patients?
In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...
Such as patients with specific underlying cardiovascular risk factors or other medical comorbidities?
Would you use MRD status to guide your decision making?
Can the ipsilateral supraclavicular field and bilateral hilar nodes still be limited stage?
Patient previously had prostatectomy and salvage RT
How would non-regional adenopathy change management? What about poor surgical candidacy?
Is leukocytosis and thrombocytosis alone an indication for treatment?
If so, venetoclax/dexamethasone by itself or do you include a PI?
Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?
The patient was started on a beta blocker, as this is standard in the area.
Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?
Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?
Would you consider using infigratinib after progression on pemigatinib?
Would you recommend surgery first or neoadjuvant therapy such as concurrent cisplatin/RT or another regimen?
The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting.
In the case of subtle single lineage dysplasia with normal cytogenetics, do you routinely perform NGS testing for CHIP-type clonal mutations?
Do you ...
Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).
How do you balance the risk of an EGFR flare while holding osimertinib vs the risk of pneumonitis when continuing?
The patient has an intact uterus and has failed all available AI therapies due to multiple intolerances.
Did you change your practice given the SRE results in the control arm of EORTC 1333 at ASCO 2021?
When using bisphosphonates or denosumab, what dosin...
What if the patient is no longer responding to steroids?
Do you allow patients with breast cancer on tamoxifen to use black cohosh?
Would radical prostatectomy and PLND suffice or would a cystectomy be warranted (even in the absence of bladder involvement) as well?
Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...
Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.
If no direct invasion into prostate from bladder or urethra, is there any role for systemic therapy?
Any role for surgical extirpation vs systemic treatment?
Is there data that it actually helps?
Do your recommendations differ between those who receive ABVD and escalated BEACOPP?
Do you recommend consultation with fertility specialists for all...
When do you use mitotane?
Is there any role for denosumab? How do you counsel patients regarding the benefit of bisphosphonates on breast cancer outcomes?
Especially with the current drug shortage of nelarabine.
ER <1%; PR 45%, Her2 negative by IHC and FISH. Grade 3, Ki67: 80%.
Patient was on tamoxifen when progression occurred; unable to tolerate adjuvant AI.
How would this affect adjuvant radiation plan in breast conservation therapy patients and mastectomy patients?
Will you incorporate carboplatin into the backbone as it was done in the KEYNOTE trial?
Patient had an initial tumor response to TCHP, but still had significant residual disease present, including positive lymph nodes and residual breast ...
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...
What therapy would you offer if the patient had a baseline grade 2 neuropathy?
While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...
In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...
Is it safe to challenge with other CD20 monoclonal antibodies such as obinutuzumab?
Does patient age effect your approach?
Would you consider RPLND for any patients in light of the phase II SEMS trial presented at the 2021 ASCO GU Ca...
What determines duration of therapy in patients who achieve stable disease or no evidence of disease on imaging?
Is there any role for radiation in t...
This question arises from a case of a patient with multifocal nodular melanoma with circumferential involvement of the perianal region.
Or would you recommend upfront resection as long as borderline resectable?
Do you have a specific age cutoff?
The patient was started on chemoimmunotherapy 3 years ago. Recent scans show small treated brain metastases (s/p RT several years ago) and no disease ...
Presuming that work-up for cardioembolic sources is negative, how would you proceed?
Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?
Do you prefer WBRT, IT chemo or targeted systemic therapy and what is your preference on the sequence of therapies?
Would appreciate expert opinion on when to reimage and when to restart anticoagulation depending on findings.
Patient is <60 years old
Patient with T2N1 disease and isolated liver metastases. Axilla and liver completely responded to chemo + IO, but limited residual breast enhancement ...
Would there be any benefit to surgery in a healthy/good PS patient? There is so little data on pulmonary atypical carcinoid and radiation respons...
E.g. for a 7cm central NSCLC, would you offer 8 fx SBRT or ChemoRT? Patient is not a surgical candidate.
One example of this scenario would be a patient receiving consolidative durvalumab after chemoRT for stage III NSCLC who develops a new peripheral lun...
AIM or doxorubicin/cisplatin? Would you recommend adding methotrexate?
Would your treatment approach be similar for a patient with suboptimal performance status?
If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?