NCI-CCC Tumor Board Question

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

4 Answers available

When would you offer ovarian suppression in addition to endocrine therapy for premenopausal women who omit adjuvant chemotherapy?

How do clinical risk and Mammaprint/Oncotype scores affect your decision?

1 Answer available

How will you counsel patients with breast cancer receiving adjuvant chemotherapy regarding COVID-19 vaccine administration?

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

1 Answer available

Would ITCs in a single axillary node push you towards recommending adjuvant chemotherapy for a young woman with a T1a (<2mm) triple negative breast cancer?

Patient underwent an axillary dissection with ITCs in 1/23 nodes.

1 Answer available

What second line therapy would you use for metastatic clear cell RCC after a 6-12 month response to ipilimumab/nivolumab followed by development of multiple bone metastases but stable soft tissue disease?

Ex: TKI alone, TKI + checkpoint inhibitor, checkpoint inhibitor alone, TKI + mTOR inhibitor. Please specify drug regimen, if applicable.

1 Answer available

When would you consider adjuvant chemotherapy for resected, intermediate grade lung neuroendocrine tumors?

Pathology is not carcinoid or small cell.

1 Answer available

Would you use maintenance avelumab for a patient with metastatic urothelial carcinoma who progressed on first-line pembrolizumab, then had stable disease after at least four cycles of second-line carboplatin plus gemcitabine?

Would it change your decision if they had progressed on a first-line trial with cisplatin followed by pembrolizumab plus enfortumab vedotin maintenanc...

1 Answer available

How would you manage a patient with localized prostate cancer treated with radical prostatectomy and found to have a single involved pelvic lymph node on final pathology and a detectable postoperative PSA?

2 Answers available

How would you approach adjuvant systemic therapy for a patient with a history of localized triple negative breast cancer 7 years prior for which she received adjuvant AC-T, now presenting with another ipsilateral T1cN0 triple negative breast cancer?

What factors would determine your consideration of this as a recurrence versus a new primary and how would that influence your decision?

2 Answers available

When would you offer anthracycline based adjuvant chemotherapy for a T1cN0 TNBC?

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

2 Answers available

For a metastatic neuroendocrine tumor patient who has experienced prolonged progression free survival, how would you approach surgical debulking?

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

1 Answer available

What would you recommend as the next line treatment in a post-menopausal woman with hormone receptor positive, HER2 positive breast cancer, with progression on T-DM1 in combination with aromatase inhibitor?

1 Answer available

Would you give immunotherapy to patient with metastatic NSCLC who had liver transplant for hepatocellular carcinoma and now is progressing on chemotherapy?

1 Answer available

How would you treat a patient with squamous NSCLC with NRG1 amplification (no fusion) who has progressed on first-line treatment?

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

1 Answer available

How would you manage a premenopausal woman with a poorly differentiated pT2 HR+/HER2- breast cancer and 3/3 SLNs with ITCs?

Would you consider ALND and /or XRT to axilla?

1 Answer available

How would you council a woman in her 50s with Stage I HR+/HER2- breast cancer with a high risk Mammaprint but intermediate OncotypeDx regarding adjuvant chemotherapy?

3 Answers available

Would you use a platinum containing regimen such as docetaxel + carboplatin for an aggressive ER+ breast cancer in a patient with a deleterious mutation in ATM?

1 Answer available

How do you decide to choose TC vs CMF for HER2 negative breast cancer patients who warrant adjuvant chemotherapy?

2 Answers available

Would you consider HRT after BSO in a pre-menopausal gBRCA2+ patient who has no intention of ever having prophylactic bilateral mastectomies and who declines chemoprophylaxis?

2 Answers available

How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?

1 Answer available

What is your adjuvant treatment approach to patients with strongly hormone-receptor positive breast cancer who have minimal response to neoadjuvant chemotherapy?

2 Answers available

What is the maximum cumulative anthracycline dose you would administer in a patient with metastatic breast cancer who is asymptomatic with good disease control on liposomal doxorubicin?

2 Answers available

For a patient with isolated CNS recurrence of HR+HER2+ breast cancer after completion of adjuvant therapy, what, if any, systemic therapy would you start after completion of local therapy?

Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.

2 Answers available

How do you decide what induction chemotherapy regimen to use for a patient with locally advanced rectal cancer (cT4N1) receiving total neoadjuvant therapy?

Would you use FOLFIRINOX as in Prodige 23 or FOLFOX as in RAPIDO?

1 Answer available

How would you approach adjuvant systemic therapy for a pT3N0(i+) HR+/HER2 negative breast cancer with an intermediate oncotype in a post-menopausal woman?

3 Answers available

How do you counsel patients with a curable breast cancer that there is no indication for additional surveillance imaging after treatment other than continuing annual mammograms?

4 Answers available

Would you consider adjuvant nivolumab in stage II/III esophageal/GE junction cancer after completion of neoadjuvant chemoradiotherapy and surgery?

Based on CheckMate 577?

1 Answer available

Would you consider giving FLOT entirely in the neoadjuvant setting for resectable gastric cancer?

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

1 Answer available

How would you treat patient with a recurrent thymic carcinoma after prior surgery and concurrent chemoradiation?

Chemoradiation completed 1.5 years prior

1 Answer available

How would you manage subsequent treatment for a patient with metastatic ER+HER2- breast cancer that develops pneumonitis on a CDK4/6 inhibitor but had an excellent response to therapy?

Would you change to a different CDK4/6 inhibitor or avoid the entire class of drugs?

1 Answer available

When do you offer adjuvant radiation in addition to chemotherapy for patients with high risk localized gastric adenocarcinoma who did not receive pre-operative therapy?

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

1 Answer available

Are pre-menopausal women on tamoxifen at risk for endometrial cancer?

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

3 Answers available

What systemic therapy would you consider, if any, for an isolated but multifocal CNS recurrence of HER2+ HR negative breast cancer treated with local therapy (>4 lesions treated with resection and SRS)?

Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.

1 Answer available

In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?

1 Answer available

For a post-menopausal patient with a pT2N0 HR+/HER2- breast cancer at surgery after 4 months of neoadjuvant anastrozole with minimal clinical or pathologic response, would you utilize genomic testing to guide decision about adjuvant chemotherapy?

Would you test initial core biopsy (prior to neoadjuvant anastrozole) or surgical specimen? Any preference for Oncotype vs. Mammaprint?

1 Answer available

How would you treat oligometastatic NSCLC (brain and bone) with Non-V600E BRAF mutations?

SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation

1 Answer available

What changes, if any, would you make to a patient’s endocrine therapy for a patient with DCIS on tamoxifen for risk reduction who develops a new lesion (LCIS) while on tamoxifen?

Would your answer change if the new lesion is ALH/ADH?

2 Answers available

In light of the recent approval of Nivolumab and Ipilimumab for metastatic NSCLC with PDL1 >1%, what is your preferred first line treatment option for a fit patient who is PDL1 positive (<50%) with no driver mutations?

1 Answer available

As consolidative thoracic radiation (cTRT) was prohibited on the seminal chemoimmunotherapy trials in ES-SCLC, how do you approach cTRT in practice?

Would you consider it for a patient who had bulky thoracic disease, only a single extrathoracic site of involvement and achieved a CR after induction ...

2 Answers available

For extensive stage small cell lung cancer, are there any data to guide choice of immunotherapy agent in first line treatment (ie chemo/durvalumab vs chemo/atezolizumab)?

Is immunotherapy plus chemotherapy now standard of care for small cell lung cancer, even though overall survival differences are small? Are there any ...

1 Answer available

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

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

1 Answer available

How would you treat a patient with metastatic NSCLC with repeated episodes of CNS brain metastases but otherwise with good systemic disease control on maintenance therapy?

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

2 Answers available

In very rapidly progressive/poorly differentiated hepatocellular cancer, would you use the targeted options (sorafenib/lenvatinib) or would you try a traditional cytotoxic regimen?

1 Answer available

When do you add chemotherapy to post-operative RT for thymomas after a R2 resection?

1 Answer available

How do you approach a stage IIIC triple positive IDC, s/p neoadjuvant TCH and P, lumpectomy, and ALND with significant residual disease at the time of surgery?

Would you recommend additional cytotoxic chemotherapy and/or switch her anti-Her therapy to T-DM1?

5 Answers available

How might you alter treatment for a breast cancer patient receiving standard taxane-based adjuvant therapy who develops an adverse reaction to the taxane (e.g. severe pneumonitis) after completion of ddAC?

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

2 Answers available

Can fulvestrant cause a tumor flare reaction in hormone receptor positive breast cancer?

1 Answer available

What is your approach to oligometastatic HER2 positive breast cancer, particularly after excellent clinical response in all sites of disease to trastuzumab, pertuzumab, and a taxane?

1 Answer available

Would you assume a diagnosis of metastatic recurrence and initiate therapy for a patient with history of locally advanced NSCLC treated with definitive chemoradiation who develops multiple enlarging lung nodules that are too small to biopsy?

Is there an advantage to early diagnosis and intervention versus observation until the nodules are amenable to percutaneous biopsy?

1 Answer available

Will you recommend abemaciclib in combination with standard adjuvant endocrine therapy in patients with high risk hormone receptor positive, HER2 normal early breast cancer?

With the recent announcement that the phase 3 MonarchE trial met its primary endpoint.

3 Answers available

In the setting of COVID-19, would you perform a SLNB for a patient incidentally found to have microinvasive ER+ ILC in contralateral prophylactic mastectomy following neoadjuvant chemotherapy for a locally advanced triple positive breast cancer?

2 Answers available

Would you offer adjuvant therapy to a patient who underwent bilateral mastectomies for DCIS and was found to have isolated tumor cells on sentinel node biopsy?

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

1 Answer available

How would you manage a young patient with newly recurrent metastatic triple negative breast cancer less than a year after completing adjuvant chemotherapy and worsening liver function due to intrahepatic disease?

Patient completed adjuvant AC-T 8 months prior to recurrence. BRCA negative, foundation medicine NGS pending.

2 Answers available

How would you manage a patient who develops pleural and skin metastases shortly after completing neoadjuvant ddAC-T and surgery for a locally advanced triple negative breast cancer?

PD-L1 is low and she has residual neuropathy from neoadjuvant paclitaxel.

5 Answers available

How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?

What are there most evidence-based options?

1 Answer available

Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

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

2 Answers available

What would you use as adjuvant endocrine therapy for a patient who developed an invasive, hormone receptor positive breast cancer while on raloxifene for almost a decade prior?

Out of curiosity, I did tumor testing, and she does not have an activating ESR1 mutation.

1 Answer available

After WBRT, what systemic therapy would you favor for maximal CNS penetrance in a patient with triple negative metastatic breast cancer and multifocal CNS disease?

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

1 Answer available

Would weak PR positivity make you consider adjuvant endocrine therapy for a young pre-menopausal woman with a HER2 positive ER negative breast cancer?

If yes, would you offer tamoxifen or ovarian suppression plus AI?

1 Answer available

What is your strategy for a patient who develops an enlarging ipsilateral axillary lymph node shortly after undergoing mastectomy and ALND for a pT2N3 ER+/HER2+ right breast cancer?

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

1 Answer available

What is your strategy for ovarian suppression if unable to achieve goal estradiol levels with leuprolide 3.75mg monthly dose?

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

3 Answers available

With the approval of capmatinib, how would you approach a newly diagnosed metastatic NSCLC with MET Exon 14 skipping mutation?

1 Answer available

Which adjuvant chemotherapy regimen would you recommend for a peri-menopausal woman with synchronous stage IA primary breast tumors, one that is ER+HER2+ and the second ER+HER2-?

1 Answer available

Do you recommend routine surveillance MRI brain for asymptomatic patients with metastatic HER2+ breast cancer?

1 Answer available

How would you approach a stage 1 HR+/HER2- pre-menopausal patient <50 years old with Oncotype DX RS of 24?

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

3 Answers available

How would you treat a patient with metastatic NSCLC on pembrolizumab with a sustained complete response, now with 2 isolated small liver lesions?

Would you treated with local therapies (RFA or SRS) and continue pembrolizumab or would you move to second line treatment?

1 Answer available

What neoadjuvant therapy would you choose for a post menopausal woman with ER negative, PR positive high grade node negative breast cancer?

Would you consider genomic assays before neoadjuvant chemotherapy? How would you modify your treatment given the COVID-19 pandemic?

5 Answers available

How would you incorporate ctDNA to follow up a patient status post surgical resection of the primary colon adenocarcinoma and omental deposits after 6 months of FOLFOX?

Would you continue to trend ctDNA to detect early recurrence?

1 Answer available

What would you recommend for an elderly patient (> 80 year old) with resectable pancreatic cancer?

Upfront surgery vs neoadjuvant therapy? And if neoadjuvant therapy, which regimen? Patient has a good PS.

1 Answer available

Would you withhold immunotherapy for ES-SCLC during the COVID-19 pandemic?

What are the risks of infection with COVID-19 if using immunotherapy?

2 Answers available

Would you choose neoadjuvant endocrine therapy for a low grade, node negative, ER/PR positive, breast cancer given delays in definitive surgery due to the COVID-19 pandemic?

Would your choice vary based on the patient's gender?

1 Answer available

Do you consider neoadjuvant pertuzumab for node negative multifocal HER2+/ER+ IDC without any single focus >2 cm?

2 Answers available

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

2 Answers available

How should our selection for neoadjuvant chemotherapy for breast cancer change in light of COVID-19?

2 Answers available

Are you more inclined to use neoadjuvant endocrine therapy over neoadjuvant chemotherapy or upfront surgery for your ER+HER2- breast cancer patients during the COVID19 pandemic?

Personally, my practice is to guide patients directly to surgery or to do neoadjuvant chemotherapy rather than to do neoadjuvant endocrine therapy, bu...

1 Answer available

How would differing breast cancer receptors between biopsy and surgery affect your treatment recommendations?

For example, if you had a triple positive breast cancer found on breast biopsy and repeat ER/PR/HER2 testing at the time of surgical resection showed ...

1 Answer available

Would you offer trastuzumab + pertuzumab alone for patients with early stage, HER2+ breast cancer for whom TCHP is clearly indicated but who adamantly refuse any cytotoxic therapy?

3 Answers available

Should we consider deferring adjuvant chemotherapy for resected early-stage NSCLC in light of COVID-19?

If so, how long is too long to wait?

1 Answer available

In which group of patients you would send for RNAseq for translocations/fusions that might be missed by NGS in advanced NSCLC?

4 Answers available

Would you consider chemo-radiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?

4 Answers available

How long after lumpectomy for DCIS in a premenopausal patient can tamoxifen be started and still retain the benefit?

This patient is interested in conceiving and therefore would like to wait to start the tamoxifen.

1 Answer available

How long do you give maintenance pemetrexed/pembrolizumab in metastatic NSCLC treated with upfront chemoimmunotherapy?

Do you ever consider stopping if stable disease and good tolerance?

3 Answers available

Would you re-introduce bisphosphonate or denosumab in a bone-only metastatic ER+ breast cancer patient with history of osteonecrosis of the jaw?

2 Answers available

Does the use of slow release hormone replacement therapy impact your adjuvant treatment recommendations for a perimenopausal patient with an intermediate Oncotype score?

For example, if a patient had testosterone pellets injected, perhaps making endocrine therapy less efficacious, would that sway you to use chemo?

1 Answer available

Does mucinous histology impact your recommendations for neoadjuvant therapy in a postmenopausal patient with HR+ HER2- breast cancer with multiple positive lymph nodes?

Being that this is a favorable histology would you use Oncotype Dx to help decide on neoadjuvant chemotherapy? Would you recommend neoadjuvant endocri...

1 Answer available

Is there evidence to support the use of definitive CRT in patients with NSCLC in separate ipsilateral lobes and mediastinal lymph node involvement?

Most trials establishing CRT as standard of care for IIIB NSCLC excluded patients with separate ipsilateral lung nodules given that they were categori...

2 Answers available

How would you approach a patient with a new axillary skin lesion with pathology suspecting a metastatic breast cancer, and no other sites of disease noted on PET imaging?

Would you treat this differently than someone who only presents with axillary nodal disease?

1 Answer available

What neoadjuvant strategies do you utilize for initially unresectable biliary tract cancer?

In your experience, what approach has been successful to bridge to surgery?

2 Answers available

When would you consider gemcitabine/cisplatin with Y90 for patients with unresectable intrahepatic cholangiocarcinoma ?

1 Answer available

How do you approach treatment for solitary fibrous tumor with a multifocal pleural-based metastatic recurrence that is surgically inoperable in a patient with good performance status?

How, if any, do you utilize genomic testing to guide systemic therapy?

2 Answers available

How would you approach a patient with metastatic squamous NSCLC that progressed on carbo/paclitaxel/pembro and has a FGFR3 S249C mutation?

Especially if you don't have trials available at the moment. Would you try off-label erdafitinib (given recent data on bladder cancer) or 2nd line ge...

1 Answer available

Would you offer additional therapy for a patient with HR+ breast cancer on AI+OS who is found to have a focus of ovarian metastasis at the time of elective BSO?

Additionally, would the finding of any mutations, such as ESR1, change your recommendation?

2 Answers available

Do you recommend ovarian suppression in all premenopausal women under age 35 with ER positive breast cancer based on the SOFT/TEXT data, regardless of other risk features?

For example, is this still your approach in women with small tumors or node negative disease?

2 Answers available

Are you routinely using thrombopoietin agonists in patients with hep C and HCC?

If so, for what platelet count threshold and do you have a preference as to which agent?

1 Answer available

What is the role for adjuvant chemotherapy and/or radiation in ampullary carcinoma?

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

1 Answer available

How would you approach frontline treatment for a metastatic non-squamous NSCLC patient with MET amplification and a concurrent KRAS mutation?

1 Answer available

Is tamoxifen absolutely contraindicated in pre-menopausal women with Lynch syndrome?

2 Answers available

How do you treat a fit patient with a solitary pulmonary nodule (2cm) which is biopsy-proven small cell lung carcinoma?

PET-CT and Brain MRI are negative for other evidence of disease.

2 Answers available

Would you consider checkpoint inhibitor therapy alone in a patient with metastatic NSCLC with PDL-1 < 1% who is otherwise refusing chemotherapy?

Would nivo + Ipi be appropriate in this situation, especially if high TMB?

4 Answers available

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

Especially in light of the new Guardant data presented at AACR 2019

2 Answers available

How would you approach frontline treatment of a patient with metastatic non-squamous NSCLC with ERBB2 amplification and PD-L1 > 50%?

In the absence of a frontline clinical trial, would you treat with carboplatin+pemetrexed+pembrolizumab or consider IMPOWER 150 or other?

3 Answers available

How do you advise women who are at high risk for breast cancer and for whom annual screening breast MRIs are recommended regarding the long-term risks of gadolinium contrast?

1 Answer available

How do you proceed if a breast cancer patient has imaging concerning for pulmonary lymphangitic carcinomatosis but no other evidence of metastatic disease?

1 Answer available

How would you approach metastatic adenocarcinoma of the lung with ROS1 rearrangement by FISH and EGFR L858R mutation by NGS?

2 Answers available

Would you offer contralateral prophylactic mastectomy in an older BRCA1 + woman who is getting treated for newly diagnosed BC with mastectomy and SLNB?

Knowing that benefit of contralateral mastectomy is lower in older women who has already manifested BRCA related cancer and 10-20 % mastectomy related...

1 Answer available

How would you approach a patient with grade 1/2 pancreatic neuroendocrine tumor after progressing on octreotide?

What would be the next line of treatment, PRRT, capecitabine and temozolomide or other?

1 Answer available

How would you treat a case of mixed histology NSCLC/SCLC that rapidly progresses following chemoradiation and durvalumab?

In a patient with lung cancer with both NSCLC and SCLC components, would you offer carbo/pem/pembro or carbo/etoposide/atezolizumab? Or any other alte...

2 Answers available

How would you treat a metastatic lung adenocarcinoma with MET exon 14 skip mutation on ctDNA, negative tissue NGS and PD-L1 of >50%?

The NCCN guidelines regard MET exon 14 skip mutation as an emerging biomarker but no formal recommendation to start crizotinib. If high P...

1 Answer available

What is your preferred induction chemotherapy for stage IIIA NSCLC squamous and adenocarcinoma?

Is there any advantage of one regimen over the others?

1 Answer available

How would you manage a postmenopausal female with a history of early stage invasive ductal ER+/HER2- breast cancer s/p mastectomy who has a local recurrence of ER+/Her2 - lobular carcinoma while on letrozole?

2 Answers available

Do you skip sentinel lymph node biopsy for women >70 years old with small (< 2cm) HR+ node-negative breast cancer?

Is this new SSO choosing widely guideline being widely adopted and are there any concerns regarding this for clinical practice?

1 Answer available

Would you finish neoadjuvant TC in a postmenopausal stage I TNBC patient who transferred care to your practice after 1 cycle or would you proceed with surgery and finish chemo adjuvantly?

If finished adjuvantly, what would you do -- continue TC or change chemotherapy?

1 Answer available

Should neoadjuvant chemotherapy be recommended for HER2+, clinically LN- breast cancer measuring 2-3cm?

If yes, would you still recommend dual HER2 directed therapy? After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has beco...

2 Answers available

How would you approach adjuvant chemotherapy and radiation options in a patient with locally advanced TNBC and Diamond-Blackfan Anemia s/p lumpectomy?

Given that DBA is associated with increased incidence of MDS, AML and other solid tumors, would this modify your treatment recommendations?

1 Answer available

How would you manage a patient with newly diagnosed synchronous triple positive and metaplastic triple negative breast cancers?

For early stage disease in a single breast, would you consider neoadjuvant chemotherapy or upfront surgical staging followed by adjuvant therapy? What...

2 Answers available

How would you approach a patient with Stage III EGFR+ NSCLC who develops oligometastatic disease while on consolidation durvalumab?

Given the potential high risk of developing pneumonitis with TKI post checkpoint inhibitor, do you avoid TKIs and try a different regimen (ex carbo/pa...

1 Answer available

Is there a role for incorporating local therapy into the management of oligometastatic EGFR-mutant NSCLC with curative intent?

If so, what is your approach to sequencing and timing of targeted therapy and local therapy?

1 Answer available

How would you manage a patient with synchronous breast and ovarian cancer, s/p neoadjuvant chemotherapy and surgery for ER+/HER2- breast cancer and found to have an ER+ ovarian cancer nodal metastases at TAH/BSO?

RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.

1 Answer available

How long do you give neoadjuvant therapy in resectable/borderline resectable pancreatic cancer, when you are considering chemoradiotherapy as part of your neoadjuvant strategy?

I have seen anywhere from 4-6 months utilized. Is there any data to guide your strategy?

1 Answer available

Will you consider additional capecitabine in a patient with TNBC, residual disease after neo-adjuvant chemo, before getting adjuvant pembrolizumab or placebo on SWOG 1418 clinical trial?

3 Answers available

In light of recent data from ASCO 2019 and the NEJM, would you recommend induction chemotherapy or an adjuvant approach in combination with chemoradiation for locally advanced nasopharyngeal carcinoma?

Does your approach differ by EBV status?

1 Answer available

What systemic therapy would you offer a postmenopausal women with oligometastatic sternal disease which developed while on tamoxifen?

Provided the sternal lesion was low volume and treated with curative intent and patient has been on tamoxifen for < 5 years, would you switch to AI...

1 Answer available

Do you recommend switching from chemotherapy to AI+CDK4/6 inhibitor after resolution of visceral crisis in a patient with HR+, HER2- metastatic breast cancer?

If so, after how many cycles of chemotherapy would you switch?

5 Answers available

Do you offer neoadjuvant therapy to a postmenopausal cT1cN0 , HER2+, ER/PR+ breast IDC or recommend surgery first?

4 Answers available

In what circumstances, if any, do you administer concurrent capecitabine with radiation therapy in the treatment of breast cancer?

1 Answer available

For patients with HER2+ breast cancer with a resectable HER2+ local relapse within 12 months of completion of standard adjuvant therapy including 1 year of trastuzumab, what adjuvant therapy would you recommend?

Does hormone receptor status impact your decision?

2 Answers available

Do you consider omitting adjuvant radiation therapy in an older patient with node positive TNBC who achieve pCR to neoadjuvant chemotherapy?

2 Answers available

How do you manage patients with HER2 positive breast cancer who have progressive CNS metastases after prior exposure to pertuzumab, trastuzumab, TDM1, and lapatinib?

1 Answer available

Do you give systemic therapy for triple negative breast cancer with brain metastasis and no other sites of disease?

Following SRS to the brain lesions, is it safe to closely follow the patient for recurrence?

4 Answers available

Should breast cancer patients with never-treated latent TB and for whom chemotherapy is indicated be treated for latent TB during chemotherapy?

2 Answers available

How do you treat patients with metastatic ER+HER2- breast cancer with activating PI3K mutations after progression on everolimus?

2 Answers available

Would you consider giving tamoxifen prophylaxis to young women with pathogenic BRCA2 muations who are <35 years old?

Tamoxifen prophylaxis has not been studied in women <35 years old, but it would be reasonable to assume they would benefit.

1 Answer available

What systemic therapy would you offer to a postmenopausal patient with an unresectable local recurrence of HER2+/ER weakly + IDC?

In a patient with who had undergone neoadjuvant TCH-P, lumpectomy, and RT and is currently on AI, pertuzumab, and trastuzumab, how do you think about ...

1 Answer available

For patients with EGFR-mutant NSCLC who progress on osimertinib, do you repeat tumor molecular profiling?

If so do you favor repeat tumor biopsy or cfDNA?

2 Answers available

What is the most appropriate adjuvant chemotherpay regimen for pre-menopausal, pT1bN0, TNBC?

Would you forego anthracycline?

1 Answer available

Do you offer consolidation chemotherapy prior to durvalumab in locally advanced, unresectable NSCLC?

In clinical practice, consolidation chemotherapy is sometimes used, though this was not implemented in the PACIFIC trial. https://www.ncbi.nlm.nih.go...

3 Answers available

For ER+ breast cancers that are clinical Stage IIB (T2N1) nearing locally advanced stages, what criteria do you use to determine if you would offer neoadjuvant chemotherapy?

3 Answers available

Would you use CTS5 to help you decide whether to offer prolonged adjuvant ET to HR+ breast cancer?

1 Answer available

What would be your next line of therapy for a postmenopausal metastatic ER+/Her 2- BC, s/p anastrazole and palbociclib/fulvestrant who has progressive disease and ESR1 mutation on ctDNA?

2 Answers available

After partial mastectomy, would you consider Oncotype for an older male with HR +/Her 2- IDC, T1cN0, Grade 2 disease?

Do you see a role for adjuvant radiation therapy?

1 Answer available

What is the preferred clinical management of hyperglycemia related to alpelisib?

1 Answer available

With the FDA approval of third line pembrolizumab for patients with SCLC, how would you select a candidate for pembrolizumab or nivolumab in the third line management of SCLC?

1 Answer available

If a patient on ovarian suppression with goserelin for ER+HER2- BC achieves post-menopausal-range estradiol levels but does not achieve post-menopausal FSH levels, is she suppressed?

Patient has hot flashes.

2 Answers available

In light of recent data suggesting limited activity of Atezolizumab monotherapy in the 2nd line treatment of ES-SCLC, would you still offer Atezolizumab maintenance following combination chemo-IO in the first line setting?

1 Answer available

Based on new data from ASCO2019, would you consider gefitinib +chemotherapy instead of osimertinib frontline for EGFRm metastatic NSCLC pts?

http://abstracts.asco.org/239/AbstView_239_262655.html

5 Answers available

Would you extrapolate data from PACIFIC trial for unresectable disease to consider consolidation therapy with durvalumab for Stage III NSCLC with single-station N2 disease amenable to lobectomy?

4 Answers available

How would you manage a locally advanced TNBC and a malignant appearing renal mass suspicious for a synchronous renal cell carcinoma?

1 Answer available

In a germline BRCA2 positive pt with NSCLC after chemoIO frontline and taxotere as a second line, would you consider PARP inhibitors?

If so, would you combine them vs monotherapy? Patient ECOG is 1

1 Answer available

In which patients with stage 1 triple negative breast cancer would you utilize neoadjuvant chemotherapy?

Why do the NCCN guidelines suggest using neoadjuvant therapy only for patients with T2 or greater tumors?

4 Answers available

Would you preform Mammaprint to determine whether or not to offer neoadjuvant chemotherapy to a high risk ER+ breast cancer?

1 Answer available

Would you offer adjuvant chemotherapy in a patient with extensive LCIS/DCIS s/p mastectomy and multiple positive lymph nodes due to surgical seeding?

If so, would you treat as node + BC with anthracycline and taxane regimen or non-anthracycline regimen (i.e docetaxel and cyc...

1 Answer available

When do you consider total neoadjuvant therapy (chemotherapy and chemoradiation) for rectal cancer?

1 Answer available

How do you advise patients looking for 2nd opinions while on standard-of-care, first line treatment for metastatic ER+HER2- BC(i.e. a CDK4/6 inhibitor + aromatase inhibitor) to bolster requests for chemotherapy when non indicated?

1 Answer available

How would your treat a pregnant woman (2nd trimester) with multifocal HER2+ ER- early stage breast cancer?

greatest measuring 1.0cm.

1 Answer available

Would you give additional chemotherapy to women with stage III HER2+ breast cancer who have a grossly suboptimal response to neoadjuvant TCHP x6?

Or would you proceed with standard-of-care adjuvant approach for high risk patients?

1 Answer available

Do you continue ovarian suppression for pre-menopausal women with HR+ breast cancer after progression on ovarian suppression + AI + CDK4/6 inhibitor (i.e. when fulvestrant is the appropriate next line of therapy)?

1 Answer available

When would you consider neratinib in a patient with locally advanced HR positive, Her2 positive breast cancer who received one year of trastuzumab and pertuzumab?

1 Answer available

Which patients with metastatic breast cancer should have mastectomy?

1 Answer available

What chemotherapy regimen would you recommend for high risk ER+/Her2- LN negative breast cancer with high genomic risk disease?

I.e. according to Mammaprint test?

1 Answer available

After progression on osimertinib, do you recommend overlapping TKI with 2nd line chemotherapy to avoid accelerated disease progression?

Retrospective data suggest clinically significant disease flare after tyrosine kinase inhibitor discontinuation in patients with EGFR-mutant lung canc...

1 Answer available

With the approval of frontline pembrolizumab monotherapy for advanced NSCLC with PD-L1 of 1% or above, how do you select who gets Chemo-IO versus pembro monotherapy if PD-L1 between 1-49%?

1 Answer available

How would you manage an elderly patient with a history of stage I CLL and newly diagnosed metastatic ER+/HER2+ breast cancer?

1 Answer available

Are you offering durvalumab to patients with Stage III NSCLC with known targeted mutations (ie ALK, EGFR, ROS1, BRAF) after completion of chemoradiation per PACIFIC?

The EGFR subgroup appeared not have benefited as much as other patients in the publication. However, recently it was reported that the PACIFIC study m...

1 Answer available

How would you treat frontline metastatic ER+HER2- breast cancer with activating PI3K mutations?

1 Answer available

Should GnRH agonist therapy be continued beyond 5 years (along with an aromatase inhibitor) in young pre-menopausal women with high risk breast cancer who continue to have ovarian function at 5 years of endocrine treatment?

1 Answer available

How would you manage DCIS diagnosed in the first trimester of pregnancy?

1 Answer available

Would you perform an oncotype DX in a patient with a 0.5cm ER positive breast cancer with one lymph node positive for macrometastatic disease?

2 Answers available

What would you use as next line of treatment for a patient with ROS1 positive metastatic NSCLC progressing on crizotinib?

Would you use Lorlatinib , chemotherapy, immunotherapy or Chemo- immunonotherapy?

1 Answer available

How do you manage a newly diagnosed locally advanced ER+/HER2- breast cancer with synchronous diagnosis of metastatic melanoma?

1 Answer available

How do you manage a patient with newly diagnosed stage IIA triple negative breast cancer with a history of renal transplantation on immunosuppressive therapy?

1 Answer available

What is the preferred treatment approach for patients with metastatic phyllodes tumor?

1 Answer available

How will the findings from the study of adjuvant capecitabine in TNBC presented at SABCS 2018 (CIBOMA/2004-01_GEICAM/2003-11) affect standard of care?

1 Answer available

What adjuvant treatment would you use in a pT1miN0M0 ER -/HER2 IDC of the breast after bilateral mastectomies?

Patient did not receive neoadjuvant therapy.

3 Answers available

How would you advise a pre-menopausal, HR-, HER2+ BC with treated brain metastases and NED while on trastuzumab/pertuzumab who wants to conceive?

1 Answer available

When do you recommend broader molecular testing for clinical trials in stage IV NSCLC patients who have negative initial molecular testing for FDA-approved targetable mutations?

1 Answer available

Is post-mastectomy chest wall radiotherapy indicated for DCIS with very close (<1mm) or positive margins?

4 Answers available

Would you resume durvalumab after several month hiatus due to IO unrelated medical comorbidities that has since resolved?

If it is still within the 12 month period and no disease recurrence?

3 Answers available

When do you consider it too late after breast surgery to offer adjuvant chemotherapy to a patient with high risk non-metastatic breast cancer?

Is there a point at which there may be no benefit? More than 3 months from breast surgery? 6 months? 1 year?

1 Answer available

How would you treat a pregnant woman in the third trimester with locally advanced, hormone receptor positive, HER2 positive breast cancer?

Would you maintain dose density of chemotherapy and use peg-filgrastim prior to delivery of the baby? Would you defer taxane and anti-HER2 therapy unt...

2 Answers available

Would you consider adjuvant chemotherapy for a patient with T1a N0 triple negative breast cancer?

If so, what would be the regimen that you would consider and what factors would sway you for or against chemotherapy for such patients?

1 Answer available

How would you treat a patient with EGFR+ oligo-metastatic lung adenocarcinoma status post resection of the primary and metastatic sites?

Would you give adjuvant chemotherapy or start osimertinib?

1 Answer available

What chemotherapy regimen would you recommend to a patient with local regional recurrent ER negative, HER2 positive breast cancer who received TCH more than 5 years ago?

The CALOR trial included patients that could receive HER2-targeted therapy.

1 Answer available

What would you offer as systemic therapy to an elderly woman (age >75 years) with HR negative, HER2 positive, lymph node negative breast cancer whose tumor is 2 cm or less?

1 Answer available

Do you offer pembrolizumab monotherapy or carbo-pemetrexed-pembrolizumab to a patient with Stage IV large cell NSCLC with PD-L1 of 80% and KRAS+STK11 mutation?

Some retrospective data reports that STK11 (AKA LKB1) makes NSCLC resistant to immunotherapy.

2 Answers available

How would you approach a biopsy proven NSCLC patient with mediastinum negative disease and contralateral suspicious spiculated PET avid nodule without pathologic diagnosis?

No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.

2 Answers available

In a premenopausal woman with low risk, early stage HR-positive breast cancer who is unable to discontinue a strong CYP2D6 inhibitor, do you use still utilize tamoxifen versus an AI with ovarian suppression?

2 Answers available

How do you manage elderly patients with borderline PS and ER+ inflammatory breast cancer without metastasis?

Would you consider neo-adjuvant chemotherapy or treat with endocrine therapy?

1 Answer available

How do you counsel your breast-cancer survivors about weight-loss/dietary modifications?

Do your recommendations differ if patients are pre or postmenopausal given the data?

3 Answers available

Should atezolizumab and nab-paclitaxel now be used in first line therapy for metastatic, triple negative breast cancer?

Have the results from IMpassion130 changed the standard of care?

2 Answers available

For patients with triple negative breast cancer who have a minimal response to neoadjuvant chemotherapy, do you do additional testing to sub-categorize the cancer and find a potential target (e.g. androgen receptor, etc)?

5 Answers available

In patients who develop a VTE on palbociclib, do you discontinue therapy or continue as long as the patient is receiving adequate anticoagulation therapy?

1 Answer available

Do you use docetaxel interchangeably with paclitaxel in breast cancer?

Does the answer vary based on whether it is neo/adjuvant or metastatic setting?

1 Answer available

What is your approach to adjuvant endocrine therapy in high-risk premenopausal women with ER/PR+ Her2+ breast cancer?

How applicable is the SOFT/TEXT data in this setting ?

4 Answers available

Do you offer adjuvant chemotherapy and/or radiotherapy for patients with resected atypical carcinoid of the lung with positive mediastinal lymph nodes (T3N2M0)?

1 Answer available

Do you routinely offer neo-adjuvant chemotherapy for patient with triple negative metaplastic breast cancer?

2 Answers available

Would you offer upfront osimertinib rather than whole brain irradiation for a patient with stage IV, EGFR exon 19 mutated lung adenocarcinoma who presents with leptomeningeal metastases?

1 Answer available

Would you offer chemotherapy to a patient with an in-breast recurrence less than 2 years after a history of lymph node positive ER+PR+HER2- breast cancer treated with mastectomy and adjuvant hormonal blockade?

1 Answer available

Would you re-challenge patients with an EGFR TKI beyond progression if repeated biopsies show redemostration of a sensitizing mutation (exon 19 deletion) and no other resistance mechanisms?

1 Answer available

What adjuvant systemic therapy do you recommend for a pre-menopausal patient with a localized recurrence of ER+PR+HER2- invasive ductal carcinoma while on adjuvant ovarian suppression with an aromatase inhibitor?

2 Answers available

What is the next step in management following surgical resection of a primary adenoid cystic carcinoma of the lung?

Would you consider radiation and/or chemotherapy?

1 Answer available

Would you consider neoadjuvant endocrine therapy instead of chemotherapy for a pre-menopausal patient with a node-positive, ER+PR+, lobular breast cancer?

Initial pathology additionally yields low Ki-67 and is HER2 negative.

1 Answer available

Is there a role for checkpoint inhibition in patients with advanced, high PD-L1 expressing, chemotherapy-refractory thymoma?

What if the patient has thymoma-associated myasthenia gravis?

2 Answers available

What would you choose as the second line treatment option for a stage IV EGFR mutant lung adenocarcinoma that has progressed on osimertinib?

Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?

1 Answer available

Would you send a lung cancer patient for genetic counseling/germline mutation testing if they are harboring mutations in NGS with variation allele frequency between >=50%?

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

2 Answers available

Would you offer adjuvant chemotherapy to a patient with T3N0M0 NSCLC if the reason for the T3 stage was due to multiple tumor nodules in the same lobe?

All tumors in this case were <2cm in size.

1 Answer available

When do you add an adjuvant bone-modifying agent in patients with history of localized breast cancer?

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

1 Answer available

Would you add HER2 targeted therapy to adjuvant chemotherapy for a patient with initial breast biopsy showing a ER/PR positive, HER2 negative invasive ductal carcinoma but mastectomy sample showing equivocal Her2 by FISH on initial assay with an alternative probe testing positive?

(HER2/CEP17 ratio <2.0, copy number >4.0 and <6.0 signals/cell)

1 Answer available

Would you consider neoadjuvant endocrine therapy in a postmenopausal patient with ER + locally advanced breast cancer with nodal disease who wants to avoid chemotherapy?

3 Answers available

How do you manage a patient with multiple similar appearing ground glass opacities (~8-9) on Chest CT where one has been surgically removed and confirmed to be adenocarcinoma in situ?

There is no evidence of disease outside the lung on PET, and the patient is completely asymptomatic with negative EGFR, ALK, ROS1, and BRAF and a PD-L...

1 Answer available

What would be your next line of treatment for NSCLC adenocarcinoma that has recurred after chemoradiation with cis/etoposide?

PD-L1 < 50% and no targetable mutations. Would you use carbo/pemetrexed/pembrolizumab or Nivolumab or pembrolizumab?

1 Answer available

What is your systemic therapy approach to women with isolated local recurrences of hormone-receptor positive breast cancer?

How does the timing of recurrence play into your decision?

2 Answers available

How would you treat metastatic NSCLC in a non-smoker with bone biopsy showing adenocarcinoma of lung origin but inadequate tissue for mutational panel or PD-L1?

Lung primary is inaccessible for biopsy and metastatic sites are only 2 small bone lesions. In a non-smoker, a driver mutation is suspected but would ...

2 Answers available

How would you approach the treatment of resectable NSCLC with a solitary resectable brain metastasis and no other sites of metastasis?

Would you offer adjuvant therapy post resection?

3 Answers available

Do you routinely offer ovarian suppression in addition to aromatase-inhibitor in premenopausal patients under 50 with an intermediate oncotype score (11-25)?

In the setting of the recent TailorRx data, would these patients be considered more high risk?

1 Answer available

How do you counsel an early stage breast cancer patient with lupus regarding decisions on radiation?

3 Answers available

Would you recommend 10 years instead of 5 years of tamoxifen in a premenopausal woman with early stage, node negative ER/PR/HER2 positive breast cancer?

Pt is healthy and tolerating Tamoxifen well.

1 Answer available

How would you treat a patient with a history of ER+ breast cancer over 10 years ago, now presenting with an ER+ loco-regional recurrence while still on Tamoxifen?

In a patient treated over 10 years ago with mastectomy and chemo now with recurrence in the ipislateral axilla, would you offer additional with chemot...

1 Answer available

What is your approach to adjuvant HER-2 directed therapy in a patient who developed cardiotoxicity following neoadjuvant TC-HP?

Can these patients be re-challenged with Herceptin?

6 Answers available

Is it safe and/or necessary to combine osimertinib and carboplatin/paclixel for a patient with stage IV EGFR mutated NSCLC and advanced ovarian carcinoma?

Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...

1 Answer available

In which patients with stage IV NSCLC and PD-L1 TPS >50% plus concomitant autoimmune disease is it considered safe to give immune checkpoint blockers?

1 Answer available

Would you use 6 months (instead of 12 months) of trastuzumab for locally advanced Her-2 positive breast cancer patients?

Would you do this for ER+ patients? According to the PERSEPHONE trial presented on ASCO 2018, in HER2+, non-metastatic breast cancer, 6 months Hercep...

3 Answers available

Do you use gene expression profiling for premenopausal women with hormone receptor positive breast cancer with 1-3 positive lymph nodes?

2 Answers available

For patients at high risk of breast cancer, do you recommend tomosynthesis over traditional two-view screening mammogram?

1 Answer available

How do you manage a locally advanced hormone receptor positive invasive ductal carcinoma with neuroendocrine (small cell) features?

If there is no response to neoadjuvant AC -->T, would you offer additional adjuvant chemotherapy?

1 Answer available

How do you explain the risks and benefits of palliative radiation therapy to patients with fungating breast masses?

Patients are understandably concerned about the risks and benefits of radiation to an oozing, bleeding, ulcerated breast.

2 Answers available

For pre-menopausal patients with high-risk ER+ disease, and who desire pregnancy, what is the best time frame to pause endocrine therapy to allow for pregnancy?

High enough risk to justify anthracycline+taxane chemotherapy followed by ovarian suppression + aromatase inhibition.

1 Answer available

For early-stage, HR+ Her2- breast cancers, when do you use OncotypeDx v. Mammaprint?

2 Answers available

Do you ever consider local therapy to oligometastatic hormone-receptor positive breast cancer?

3 Answers available

What is your approach to women with early-stage hormone responsive breast cancer intolerant of AI's who want to remain on endocrine therapy but have contraindications to tamoxifen?

1 Answer available

Do you routinely check echocardiograms for patients getting Her2 directed therapy for metastatic breast cancer?

If so, how frequently?

5 Answers available

What is the role of neoadjuvant breast radiation in patients with triple negative breast cancer progressing on AC-T?

Pt clinically has inflammatory breast cancer making mastectomy a poor option.

1 Answer available

What would be your choice of endocrine therapy (if any) for a premenopausal woman with an ER positive 2nd DCIS in ipsilateral breast who has completed 5 years of tamoxifen after lumpectomy of 1st DCIS?

First episode was 10 years ago and patient did not receive XRT. Would you give XRT now?

1 Answer available

When (if ever) would you use fulvestrant up-front instead of an aromatase inhibitor for ER+ or PR+ metastatic breast cancer?

4 Answers available

What do you do for patients with HR+ inflammatory breast cancer who do not achieve a pCR with neoadjuvant chemotherapy?

Do you offer additional adjuvant chemotherapy, proceed to adjuvant endocrine therapy, or search for a suitable clinical trial?

2 Answers available

How do you approach adjuvant therapy in patients who have a poor clinical response to neoadjuvant endocrine therapy?

No prior chemotherapy.

2 Answers available

How do you counsel a patient with a history of breast cancer regarding use of breast MRI for screening?

Patient does not qualify for breast cancer screening by annual MRI per criteria (IBIS lifetime risk<20%, no known genetic predisposition,...

1 Answer available

How do you decide on the sequence of systemic and local therapy for patients with oligometastatic NSCLC?

When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?

1 Answer available

What is your approach to young healthy women with locally advanced breast cancer and biopsy-proven low cervical lymph nodes?

Would you treat this as a locally advanced breast cancer and offer surgery, radiation, and systemic therapy? Does your management change depending on ...

2 Answers available

Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?

These patients have been largely excluded from these trials. What if the infection is well controlled?

3 Answers available

Are mirena (progesterone-coated) IUDs contraindicated in patient with a history of hormone-receptor positive breast cancer?

1 Answer available

How would you treat a patient with a small (<0.5 cm) node negative, grade 3 BRCA1 mutated triple negative breast cancer?

An article (BRCA mutation and outcome in BC. Ellen Copson, et al. Lancet Oncol. 2018) showed G3, BRCA+ breast cancer had poorer prognos...

2 Answers available

Do you pursue testing for ERBB2 mutations in patients with metastatic breast cancer who are clinically HER2-negative by IHC and FISH?

If so, when? Are there certain ERBB2 mutations that would predict response to trastuzumab and/or neratinib?

1 Answer available

Do you use an alternative dosing regimen for CDK4/6 inhibitor in patient with benign ethnic leukopenia?

Following the dosage guidelines based on absolute neutrophil count may cause the patient to end up receiving lower doses.

1 Answer available

Do you intentionally modify your breast cancer treatment plans for those on chronic immunosuppression to avoid secondary cancers?

This is in regards to the risk of secondary cancers after radiation therapy or cytotoxic chemotherapy (such as anthracyclines) in an immunosuppre...

1 Answer available

In what circumstances would you repeat bio markers (ER, PR, HER2) in a patient with breast cancer who has residual disease after neo-adjuvant chemotherapy?

2 Answers available

Do you send Oncotype or Mammaprint as a predictive tool for patients with high grade (3/3) lymph node negative ER+ breast cancers?

What do you do with low grade (grade 1/3) tumors? In other words, does high grade pathology over rules?

1 Answer available

What regimen would you choose for patients with breast cancer requiring adjuvant chemotherapy whose livelihoods depend on fine dexterity (such as a professional musician)?

Would you use a regimen with lower incidence of neurotoxicity such as CMF or a taxane-based regimen with a low threshold to dose-reduce?

1 Answer available

Would you feel comfortable giving a HER2+ breast cancer patient her next cycle of TCHP (Taxotere + carboplatin + Herceptin + Perjeta) on day 17 of the previous cycle?

Some patients request chemotherapy scheduling adjustments to avoid feeling ill on major holidays. Delaying chemotherapy by a few days isn't of particu...

1 Answer available

What is your preferred non-taxane chemotherapy regimen for early-stage HER2 negative breast cancer patients who develop grade 3/4 neuropathy before completion of taxane-based therapy?

Example case: Patient given neoadjuvant docetaxel + cyclophophamide achieves a partial response after 3 cycles of Taxotere + cyclophosphamide but is u...

1 Answer available

Are Mammaprint and OncotypeDx as useful in stratifying risk in patients with early stage HR+, HER2 negative lobular carcinomas, as in those with ductal carcinomas?

1 Answer available

In the high-risk adjuvant or metastatic setting when you initiate patients on ovarian suppression with the plan to start an AI, what protocol do you follow in terms of rechecking estradiol?

How often will you monitor it? In the setting that patient is morbidly obese, does your strategy change?

2 Answers available

What factors do you consider when you are deciding whether to recommend endocrine therapy for a woman who has had a mastectomy for DCIS for contralateral breast cancer risk reduction?

1 Answer available

Would you prescribe an aromatase inhibitor prophylactically for a post-menopausal woman with a deleterious BRCA2 mutation and a history of DCIS who declines prophylactic mastectomy?

Tamoxifen prophylaxis is FDA-approved, but would you extrapolate from adjuvant/metatastic data for hormone receptor positive breast cancer in post-men...

1 Answer available

Do you use endocrine therapy concurrently or sequentially with radiation therapy in hormone receptor positive breast cancer patients?

In the absence of data demonstrating a clinical benefit for one strategy versus the other, what do you do in practice?

1 Answer available

Is sentinel lymph node biopsy several weeks after partial mastectomy as reliable as sentinel lymph node biopsy done at the time of partial mastectomy?

2 Answers available

Would you consider localized therapies such as radiofrequency ablation to a lung metastasis or Yttrium-90 for liver metastases for disease control for ER+HER2- breast cancer patients with visceral oligometastatic disease who have progressed on all hormonally-targeted therapies and have chemotherapy as their next standard-of-care systemic treatment option?

1 Answer available

Would you consider exemestane (instead of fulvestrant) in post-menopausal patients with hormone receptor pos, HER2- breast cancer who progress on letrozole or anastrozole?

There is limited data that suggests steroidal AI exemestane could be of some benefit after nonsteroidal AI failure (Lonning PE et al. J Clin Oncol 200...

1 Answer available

Knowing that spread of lobular carcinoma is often more insidious than ductal carcinoma, do you order different staging studies for lobular cancer?

For example, would you order a PET/CT to evaluate for lymphatic or distant metastatic disease?

1 Answer available

How do you handle hormonal therapy for premenopausal women with breast cancer who are heterozygous for factor V Leiden but have no history of thrombosis?

1 Answer available

Should additional molecular testing be performed on triple negative breast cancers up-front to identify potentially targetable mutations (e.g. activating HER2 mutations, homologous recombination repair deficiency assays, etc)?

Does your institution do this routinely?

1 Answer available

In women in whom you suspect chemotherapy-induced amenorrhea and are required to start an AI, what is your strategy with regard to ovarian suppression?

I.e. either for treatment of high-risk disease or intolerance/contraindication to tamoxifen. Will you continue it for the full 5 year course?

1 Answer available

Based on the findings of the CALOR trial, among which group of patients with locoregional recurrence of hormone-receptor positive breast cancer would you treat with chemotherapy?

Do you prefer doing this through a "neoadjuvant" approach vs. post-operatively? CALOR trial

1 Answer available

In which patients will you consider the use of adjuvant pertuzumab for HER2 positive early stage breast cancer?

How does the modest results of the APHINITY trial impact your practice?

1 Answer available

Is there a preferential approach for systemic therapy for triple negative breast cancer patients with leptomeningeal disease?

In a patient with isolated leptomeningeal disease (no systemic disease), would you still recommend systemic therapy?

1 Answer available

When do you suggest ovarian suppression for fertility preservation in premenopausal women receiving neo/adjuvant chemotherapy?

Do you reserve this approach for only women with triple negative breast cancer or all-comers?

1 Answer available

Do you rely on Ki67 as an estimate of proliferation to guide the decision for chemotherapy in premenopausal women with hormonally-driven breast tumors?

Is this in addition to or mutually exclusive from oncotype/mammaprint?

1 Answer available

What is the upper limits of anthracycline dose you are willing to give in a treatment-refractory metastatic breast cancer patient if the patient is responding to salvage weekly adriamycin after progression on multiple prior regimens?

Patient has hormone-refracatory disease, had high visceral burden (pulmonary mets, bone, lymph). Progressed on taxane, xeloda, gemcitabine. Now ...

1 Answer available

How do you treat HER2-equivocal breast cancer in the neoadjuvant setting?

What would you choose if there is no response to neoadjuvant AC-T? Taxol, THP, TCHP?

1 Answer available

Do you have a certain size threshold below which you change chemotherapy recommendations for a small, triple negative breast cancer?

(For instance, TCX4 instead of AC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemotherap...

2 Answers available

In which patients would you recommend extending adjuvant AI-based therapy beyond 5 years?

2 Answers available

Will you continue anti-estrogen therapy in the setting of initiation of TDM-1 for patients with metastatic ER+/HER2+ breast cancer?

1 Answer available

How does genomic profiling/next-generation sequencing assays influence your treatment recommendations in metastatic breast cancer?

At what point do you send these test, and in what instances do the results influence your treatment recommendations?

1 Answer available

At what point do you prescribe duloxetine for the treatment of AIMS (aromatase inhibitor induced musculoskeletal syndrome)?

2 Answers available

What is the role of platinum agents in the treatment of metastatic breast cancer in patients with BRCA mutations?

2 Answers available

How would you approach the management of a patient with oligometastatic NSCLC characterized by a LUL mass and a solitary adrenal metastasis, assuming a good performance status?

1 Answer available

Would you recommend the SOFT/TEXT adjuvant approach of ovarian suppression/AI in a premenopausal woman with high-risk disease who still desires to have a pregnancy?

1 Answer available

Papers discussed in this category

International journal of radiation oncology, biology, physics, 2013-03-15

Impact of margin status on local recurrence after mastectomy for ductal carcinoma in situ.

International journal of radiation oncology, biology, physics, 2011-05-01

Is radiation indicated in patients with ductal carcinoma in situ and close or positive mastectomy margins?

International journal of radiation oncology, biology, physics, 2011-11-01

Patterns and risk factors of locoregional recurrence in T1-T2 node negative breast cancer patients treated with mastectomy: implications for postmastectomy radiotherapy.

The New England journal of medicine, 2015-03-05

Goserelin for ovarian protection during breast-cancer adjuvant chemotherapy.

N. Engl. J. Med., 2015-01-29

Adjuvant ovarian suppression in premenopausal breast cancer.

Lancet, 2007-05-19

Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor-positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials.

The Lancet. Oncology, 2016-12

Local consolidative therapy versus maintenance therapy or observation for patients with oligometastatic non-small-cell lung cancer without progression after first-line systemic therapy: a multicentre, randomised, controlled, phase 2 study.

Nat. Med.,

Carboplatin in BRCA1/2-mutated and triple-negative breast cancer BRCAness subgroups: the TNT Trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-02-01

Randomized, Multicenter, Placebo-Controlled Clinical Trial of Duloxetine Versus Placebo for Aromatase Inhibitor-Associated Arthralgias in Early-Stage Breast Cancer: SWOG S1202.

Clinical breast cancer, 2006-12

NSABP B-42: a clinical trial to determine the efficacy of five years of letrozole compared with placebo in patients completing five years of hormonal therapy consisting of an aromatase inhibitor (AI) or tamoxifen followed by an AI in prolonging disease-free survival in postmenopausal women with hormone receptor-positive breast cancer.

Lancet (London, England), 2009-12-19

Adjuvant chemotherapy and timing of tamoxifen in postmenopausal patients with endocrine-responsive, node-positive breast cancer: a phase 3, open-label, randomised controlled trial.

The Lancet. Oncology, 2014-06

Trastuzumab emtansine versus treatment of physician's choice for pretreated HER2-positive advanced breast cancer (TH3RESA): a randomised, open-label, phase 3 trial.

The New England journal of medicine, 2012-11-08

Trastuzumab emtansine for HER2-positive advanced breast cancer.

J. Clin. Oncol.,

A randomized trial in postmenopausal patients with advanced breast cancer comparing endocrine and cytotoxic therapy given sequentially or in combination. The Australian and New Zealand Breast Cancer Trials Group, Clinical Oncological Society of Australia.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-03-15

Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-03-10

Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-10

Anthracyclines in Early Breast Cancer: The ABC Trials-USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 (NRG Oncology).

J. Clin. Oncol., 2019 Oct 16

Improving Adjuvant Endocrine Treatment Tailoring in Premenopausal Women With Hormone Receptor–Positive Breast Cancer

N. Engl. J. Med., 2017-07-13

Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer.

Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2015-04

Treatment of leptomeningeal carcinomatosis: current challenges and future opportunities.

Am J Case Rep, 2017-02-28

Metronomic Capecitabine Effectively Blocks Leptomeningeal Carcinomatosis From Breast Cancer: A Case Report and Literature Review.

The New England journal of medicine, 2016-08-25

70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer.

N. Engl. J. Med.,

Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy.

Lancet, 2017-09-09

Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial.

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-09

Utility of gonadotropin-releasing hormone agonists for fertility preservation in young breast cancer patients: the benefit remains uncertain.

Oncologist, 2007-09-01

How to preserve fertility in young women exposed to chemotherapy? The role of GnRH agonist cotreatment in addition to cryopreservation of embrya, oocytes, or ovaries.

Journal of the National Cancer Institute, 2006-12-20

Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study.

Medicine and science in sports and exercise, 2010-07

American College of Sports Medicine roundtable on exercise guidelines for cancer survivors.

J Clin Oncol, 2016 Feb 20

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline.

Curr Breast Cancer Rep, 2016-01-01

Reducing the Risk of Breast Cancer Recurrence: an Evaluation of the Effects and Mechanisms of Diet and Exercise.

Crit Rev Food Sci Nutr, 2018 Apr 19

Meat, eggs, full-fat dairy, and nutritional boogeymen: Does the way in which animals are raised affect health differently in humans?

JAMA, 2018-02-20

Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial.

JAMA Oncol,

Prolonged Nightly Fasting and Breast Cancer Prognosis.

The New England journal of medicine, 2012-08-02

Combination anastrozole and fulvestrant in metastatic breast cancer.

Lancet (London, England), 2016-12-17

Fulvestrant 500 mg versus anastrozole 1 mg for hormone receptor-positive advanced breast cancer (FALCON): an international, randomised, double-blind, phase 3 trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-09-01

Plasma ESR1 Mutations and the Treatment of Estrogen Receptor-Positive Advanced Breast Cancer.

Breast cancer research and treatment, 2012-11

Fulvestrant 500 mg versus anastrozole 1 mg for the first-line treatment of advanced breast cancer: follow-up analysis from the randomized 'FIRST' study.

British journal of clinical pharmacology, 2016-06

Fulvestrant decreases anastrozole drug concentrations when taken concurrently by patients with metastatic breast cancer treated on SWOG study S0226.

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Effect of Adjuvant Paclitaxel and Carboplatin on Survival in Women With Triple-Negative Breast Cancer: A Phase 3 Randomized Clinical Trial.

Journal of the National Cancer Institute, 2005-11-16

Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-05-10

Molecular Characterization and Mortality From Breast Cancer in Men.

N Engl J Med,

Micrometastases or isolated tumor cells and the outcome of breast cancer.

Lancet, 2019 Apr 11

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial.

Lancet Oncol.,

Lenvatinib in patients with advanced or metastatic thymic carcinoma (REMORA): a multicentre, phase 2 trial.

Cancer, 2020 Jun 10

Propensity score analysis of the prognostic value of genomic assays for breast cancer in diverse populations using the National Cancer Data Base.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-08-10

Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer.

Journal of the National Cancer Institute, 1997-11-19

Tamoxifen and chemotherapy for lymph node-negative, estrogen receptor-positive breast cancer.

Journal of surgical oncology, 2017-06

Using the 21-gene assay from core needle biopsies to choose neoadjuvant therapy for breast cancer: A multicenter trial.

Annals of oncology : official journal of the European Society for Medical Oncology, 2000-08

Pegylated liposomal doxorubicin (doxil): reduced clinical cardiotoxicity in patients reaching or exceeding cumulative doses of 500 mg/m2.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2001-03-15

Second-line chemotherapy in patients with relapsed extragonadal nonseminomatous germ cell tumors: results of an international multicenter analysis.

Clin Nutr, 2015 Aug 28

The association of substituting carbohydrates with total fat and different types of fatty acids with mortality and weight change among diabetes patients.

Obstet Gynecol,

Long-term mortality associated with oophorectomy compared with ovarian conservation in the nurses' health study.

JAMA,

Association of Menopausal Hormone Therapy With Breast Cancer Incidence and Mortality During Long-term Follow-up of the Women's Health Initiative Randomized Clinical Trials.

Cancer Prev Res (Phila), 2019 Aug 16

Effect of Bazedoxifene and Conjugated Estrogen (Duavee) on Breast Cancer Risk Biomarkers in High-Risk Women: A Pilot Study.

Pancreas, 2017-07

The Surgical Management of Small Bowel Neuroendocrine Tumors: Consensus Guidelines of the North American Neuroendocrine Tumor Society.

Pancreas, 2020 Jan

The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors.

Surg Oncol Clin N Am, 2020 Oct 20

Surgical Management of Neuroendocrine Tumor Liver Metastases.

Scand J Gastroenterol, 2019 Aug 01

Hepatic micrometastases outside macrometastases are present in all patients with ileal neuroendocrine primary tumour at the time of liver resection.

J Am Coll Surg, 2017 Jan 11

Aggressive Surgical Approach to the Management of Neuroendocrine Tumors: A Report of 1,000 Surgical Cytoreductions by a Single Institution.

Lancet Oncol., 2014-11-01

Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-08-01

Use of Biomarkers to Guide Decisions on Adjuvant Systemic Therapy for Women With Early-Stage Invasive Breast Cancer: ASCO Clinical Practice Guideline Update-Integration of Results From TAILORx.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-12-10

Impact of adjuvant radiotherapy on survival of patients with node-positive prostate cancer.

Ann. Oncol.,

Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005-02-01

Androgen suppression plus radiation versus radiation alone for patients with stage D1/pathologic node-positive adenocarcinoma of the prostate: updated results based on national prospective randomized trial Radiation Therapy Oncology Group 85-31.

JAMA Oncol,

Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial.

Urology, 2001-08

Addition of radiation therapy to androgen ablation improves outcome for subclinically node-positive prostate cancer.

The New England journal of medicine, 2016-03-03

Tumor Regression and Allograft Rejection after Administration of Anti-PD-1.

Cancer immunology, immunotherapy : CII, 2017-01

Cardiac allograft rejection as a complication of PD-1 checkpoint blockade for cancer immunotherapy: a case report.

Cancer, 2017-06-01

Immune checkpoint inhibitors in challenging populations.

J Immunother,

Administration of ipilimumab to a liver transplant recipient with unresectable metastatic melanoma.

Oncologist, 2020 Feb 11

The Safety and Efficacy of Checkpoint Inhibitors in Transplant Recipients: A Case Series and Systematic Review of Literature.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2015-09

The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification.

J Thorac Dis,

Lung neuroendocrine tumors: pathological characteristics.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-03-10

Cabozantinib, a New Standard of Care for Patients With Advanced Renal Cell Carcinoma and Bone Metastases? Subgroup Analysis of the METEOR Trial.

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