NCI-CCC Tumor Board Question&nbsp;&nbsp;&nbsp;

How do you approach pelvic radiation therapy for a patient with multiple myeloma who needs more intensive therapy (e.g., Dara-KRd or impending CAR-T) with a risk of cytopenias?

For example, a large iliac or sacral plasmacytoma causing symptoms. Both medical oncologists and radiation oncologists get nervous about RT-related cy...

How would you manage a frail patient with GCB DLBCL who is unable to complete R-CHOP but has moderate residual disease?

How do you manage adjuvant endocrine therapy for microinvasive HR-positive disease measuring >=1 mm in extension?

For patients with KRAS G12C mutated NSCLC, how would you decide between using targeted therapy with sotorasib vs adagrasib?

Is there anything to differentiate the two agents? CNS penetration reportedly with adagrasib, FDA accelerated approval has been given with sotorasib.&...

How would you manage LPL with associated AL amyloidosis?

Bendamustine or Cy-Bor-D? Or another induction regimen? Would you consider autologous transplant in CR1 like you would for AL amyloid on its own or wi...

Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?

What is your management approach for CAR-T induced motor neurologic deficits (cyclophosphamide/IVIG/Steroids, etc) and any prophylactic approach to an early, rapid rise in absolute lymphocyte count post CAR-T infusion?

For a patient with a metastatic solid tumor in remission on a checkpoint inhibitor who also has R/R multiple myeloma, would you feel comfortable with a bispecific T-cell engager antibody?

This is rare but I've seen it twice last year! One with melanoma on nivolumab and one with lung cancer on pembrolizumab (both cases in deep remission)...

How would you manage a patient with primary CNS lymphoma who received R-MTX followed by autologous transplant with systemic relapse 5 years later for which R-Pola-CHP was given now followed by CNS relapse?

Pt not interested in another auto transplant, but willing to consider other consolidation. Systemic DLBCL appears morphologically similar to the CNS r...

In patients with T1 anal squamous cell cancer status post local excision with a close margin, would you recommend close observation or adjuvant concurrent chemoradiation?

Margin is less than 1 mm. Would the grade of the tumor affect your decision? Would any other factors go into your decision?

In which clinical settings do you use the Cerianna (fluoroestradiol F18) PET scan for breast cancer?

What is your approach to managing follicular lymphoma with central nervous system involvement?

Have you treated such cases with systemic therapies? If so, which ones (e.g., cytotoxic chemotherapy, anti-CD20 monoclonal antibodies, or targeted age...

Would you consider hormone replacement therapy in young women with germline BRCA1 mutation and history of triple negative breast cancer who underwent bilateral mastectomy and prophylactic bilateral salpingo-oophorectomy?

This situation can feel uncomfortable. Would this feel safer if the patient is s/p mastectomy and had TNBC?

What is the role of surveillance imaging after first line therapy in patients with aggressive lymphomas?

With the CANOVA results in mind, would you continue using venetoclax in patients with multiple myeloma with t(11;14)?

How do you approach the treatment of de novo, brain-only metastatic HER2 positive breast cancer?

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

(For instance, TCx4 instead of ddAC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemother...

How would you manage a patient with marginal zone lymphoma who progress after treatment on a BKTI?

What do you recommend for patients with stage 3 MSI-H colorectal cancer who are ineligible for oxaliplatin-based adjuvant therapy?

Would you consider daratumumab monotherapy as standard of care for smoldering multiple myeloma based on the AQUILA trial?

AQUILA trial - NEJM

How do you approach patients with AL amyloidosis with t(11;14) who have not achieved a hematologic complete response to induction therapy with 6 cycles of Dara-CyBorD?

Specifically, in the setting of patients that have had a PR or VGPR and are not actively progressing.

What is your current practice for de-escalation of frequency of administration of bispecific antibodies among responders in patients with relapsed/refractory multiple myeloma?

Do you recommend utilizing daratumumab in the maintenance phase after a quadruplet induction for transplant eligible multiple myeloma?

In patients with cholangiocarcinoma who qualify for HAIP therapy, would you recommend treating with chemotherapy and immunotherapy?

PUMP-2 trial combined FUDR via HAIP with gemcitabine and cisplatin, no immunotherapy was on the protocol.

How often do you assess for frailty in your clinical practice for patients with Multiple Myeloma and what tool do you use?

For example: eyeball test, simplified frailty assessment (Facon et al.), IMWG frailty score, ECOG only?

For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?

I am not sure there is much efficacy for a regimen that does not include asparaginase. The patient received 2 cycles of P-GemOx, then was admitted for...

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...

How do you approach treatment for patients with proliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) with end-stage renal disease who are considering kidney transplant?

Most patients with PGNMID have no detectable disease in their marrow or blood and urine protein cannot adequately be monitored.

How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?

At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CS...

What is your preferred approach to a patient with myeloma who has refractory disease to Dara-VRd in the frontline setting?

How are you dosing IVIG following BCMA CAR-T or bispecific antibodies in multiple myeloma?

Do you only offer it for patients with a documented IgG < 400? Do you check the IgG at all, or are you doing primary prophylaxis?

How do you approach initial treatment for AL amyloidosis with excess plasmacytosis in the bone marrow, that has cardiac involvement and is not a transplant candidate?

Let's assume they have cardiac involvement and transplant may not be feasible.

How would you approach dose modifications and/or frequency of lenalidomide in patients with advanced renal impairment (eGFR <30)?

The FDA package insert suggests 2.5 mg daily in these settings, while the PrE1003 study demonstrated that a higher dose is feasible. Many oncologists ...

What is your approach to determining fitness for patients to undergo CAR-T therapy for relapsed/refractory multiple myeloma, and any absolute perceived contraindications for CAR-T?

In what scenarios (if ever) would you check peripheral blood flow cytometry in a patient with known multiple myeloma to evaluate for circulating plasma cells (CPCs) in the absence of an abnormal smear?

There are some retrospective data that CPCs are associated with worsened outcomes after transplantation. Anecdotally, CPCs could be collected as part ...

In which scenarios do you stage breast cancer using CT and nuclear bone scans versus PET-CT?

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.

For patients with well differentiated NET whose carcinoid symptoms are controlled on SSAs but have persistently elevated 5HIAA, would you consider adding telotristat for prevention of carcinoid heart disease?

How aggressive should we be in bringing elevated plasma/urine 5HIAA to normal levels in patients whose symptoms are controlled? Before we have the res...

How would you treat an elderly patient with Stage IIA cHL with 3 nodal sites of involvement who has a contraindication to bleomycin?

DLCO 65% that is of unclear etiology but not due to disease and no cardiac or pulmonary functional limitations.

How would you treat an elderly newly diagnosed tDLBCL that has previously seen R-CHOP and Bendamustine-Obinutuzumab prior to the transformative event?

7 Answers available

Do you consider post-NAC isolated tumor cells in LNs to be residual disease in TNBC to justify capecitabine?

Would clinical stage or nodal status affect your decision?

Is there evidence for development of more severe autoimmune toxicities for young patients vs older patients on immune checkpoint inhibitors?

As immune checkpoint inhibitors have expanded into the neoadjuvant breast cancer setting, severe and unexpected autoimmune toxicities may cause delays...

What chemotherapy regimen would you offer to a patient with DLBCL who was originally diagnosed and treated (R-CHOP) 15 years ago, now with a 2nd primary/late recurrence of DLBCL?

Based on the DREAMM-7 and DREAMM-8 data, if approved again in the US, how would you incorporate belantamab mafadotin in your practice?

Based on the IMROZ and BENEFIT data, would you recommend quadruplet therapy for non transplant eligible newly diagnosed multiple myeloma?

Do you offer local consolidative therapy for patients with polymetastatic driver mutation-positive NSCLC who respond well to targeted therapy?

If so, when and to what extent?

How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?

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?

In 2024, do you consider isolated gain(1q) [not amp(1q)] to be a high-risk cytogenetic abnormality in multiple myeloma?

Most would argue that gain(1q) in combination with another high-risk feature constitutes ultra-high-risk multiple myeloma, and most would argue (with ...

How long should we treat patients with newly diagnosed myeloma with bisphosphonates or RANKL inhibitors for their myeloma bone disease given recent data?

The OS benefit with Zometa was seen only in patients with myeloma bone disease achieving less than or equal to a partial response. SRE risk reduction ...

How would you manage a patient with p53 mutated MCL who has progressed after a BTKi and CAR-T with a CD20 negative clone?

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?

Is there any value to getting a bone marrow biopsy at the time of biochemical relapse in multiple myeloma before switching to a new line of therapy?

For many clinical trials, a screening bone marrow biopsy is necessary to get a new baseline. Do you do the same in real-world practice?

Do you resume zoledronic acid or denosumab at relapse in multiple myeloma?

Previous questions have focused on the newly diagnosed setting and choice of bisphosphonate versus denosumab. IMWG guidelines do recommend resuming zo...

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...

In which situations are you comfortable with alternative dosing of ovarian suppression (e.g Lupron q3m) for premenopausal patients during adjuvant breast cancer treatment?

In the current myeloma landscape, do you make treatment decisions based on MRD results, either for MRD negativity or MRD resurgence?

With the recent ODAC review of the commerically available CAR-T therapies in relapsed/refractory myeloma post 1-3 lines of therapy, what is your preferred regimen/therapy for first relapse, and which are the situations where you would absolutely consider CAR-T therapy at first relpase?

For patients on commercial teclistamab who achieve a response, are there patient-specific or response-specific parameters that would prompt you to de-escalate therapy from once per week?

For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?

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?

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)?

7 Answers available

In patients with EGFR mutant L858R stage III NSCLC who are unresectable due to multistation N2 disease, would you consider upfront osimertinib over definitive intent CCRT?

If CCRT is pursued, would you move forward with durvalumab consolidation? Assume the patient with ECOG PS 0 and no co-morbidities. How might this chan...

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

Would you extrapolate from EMBARK to use an ARPI other than enzalutamide in high risk biochemically recurrent prostate cancer for a patient with contraindications to enzalutamide?

How would you treat a patient who received 2 cycles of R-CHOP for DLBCL who was subsequently diagnosed with follicular lymphoma?

Would you continue R-CHOP or would you switch therapy?

For a Jehovah's Witness patient with multiple myeloma, could you safely offer a BCMA-directed bispecific antibody or CAR-T therapy?

Please assume that IVIG is fine (as it is for many Jehovah's Witness patients, since IgG is often not considered a blood product per se).

How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?

How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?

For muscle-invasive bladder cancer with predominant (>90%) squamous differentiation, would you consider cisplatin-based neoadjuvant chemotherapy prior to radical cystectomy or upfront surgery?

Would a PET avid pelvic lymph node without distant metastatic disease change your management?

In which scenarios do you use vaginal estrogen in patients with history of HR positive breast cancer?

Do you feel differently about using these in patients with a history of HR-negative breast cancer?

When would you feel comfortable with patients who have a history of hormone-receptor positive breast cancer using hormonal IUDs (e.g. Mirena)?

Are there any circumstances where you recommend early institution of systemic therapy for patients with solitary plasmacytoma?

Specifically, do you offer closer follow-up for certain patients after local radiation?

How would you manage biopsy-proven DLBCL in a patient who was treated with 6 cycles of R-CHOP 15 years ago for DLBCL?

Would you consider this de novo DLBCL (unable to assess for clonality)? How would you handle prior anthracycline exposure?

In light of RIGHT Choice trial data, when will you opt for a CDK 4/6 inhibitor plus AI instead of chemotherapy in patients with metastatic HR-positive HER2-negative breast cancer with visceral crisis?

RIGHT Choice trial presented at SABCS 2022

Would you offer definitive local therapy to a patient with ER/PR+, Her2 neg breast cancer with oligometastatic disease that responded well to CDK 4/6 inhibitor +AI, despite NRG-BR002 results?

Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...

How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

Are there any scenarios you would use CDK 4/6i to treat HR-positive HER2-positive breast cancer in combination with anti-HER2 agents?

How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?

What is your preferred third-line therapy for a fit patient with symptomatic, relapsed follicular lymphoma who has failed bendamustine-rituximab and lenalidomide-rituximab?

For patients with rectal cancer being treated along PROSPECT paradigm, would you extrapolate from the IDEA literature and offer 3 months of CAPOX neoadjuvantly, without adjuvant therapy?

How would you manage a patient with NLPHL and CKD who relapsed after a long disease free interval (i.e. 7 years) following bendamustine?

Would you recommend axillary lymph node dissection in a pre-menopausal woman with ER+ PR+ HER2- IDC, s/p lumpectomy and SLN with pT1c pN1 cM0 disease, where 2 sentinel nodes are positive for macrometastasis and 1 SN is positive for micrometastasis?

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, and ulcerated breast.

How do you approach the initial dosing of carfilzomib for patients with relapsed multiple myeloma?

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

What is your approach to adjuvant therapy for an R0, ALK+ resected lung adenocarcinoma with N2 disease?

How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?

Would you do a 24-hour urine and echocardiogram in all of these patients? Cardiac biomarkers, PT/PTT, or any other such blood tests?

In patients who have received neoadjuvant endocrine therapy for localized ER/PR+, HER2 negative breast cancer, how do you decide which patients to offer adjuvant chemotherapy to?

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

Do you 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?

For a patient with triple-class-refractory myeloma and cytopenias who has been collected for CAR-T, would you choose aggressive chemotherapy or a bispecific antibody for bridging?

This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispeci...

What is the preferred treatment for a patient with an EBV+ monomorphic PTLD (DLBCL) not currently on immunosuppressive therapy?

When will you recommend enfortumab vedotin plus pembrolizumab as first-line treatment of metastatic urothelial carcinoma for cisplatin-ineligible patients?

Will you use it rather than a carboplatin-containing regimen?

Would you still obtain Ki-67 prior to use of adjuvant abemaciclib in a patient who has otherwise met MonarchE treatment criteria, such as 1-3 positive LNs, grade 3 and/or tumor >5 cm?

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 ...

What is your approach to mitigating the infection risk with bispecific antibodies in multiple myeloma?

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

6 Answers available

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

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

How do you choose between the different recently approved Bispecifics Antibodies for Relapsed/Refractory Multiple Myeloma?

I.e. dosing regimen frequency, side effect profile, duration of follow up, etc.

How would you treat a BTKi naive p53 mutated MCL in 1st relapse with disease noted both systemically and in the CNS?

For patients who require aggressive debulking in multiple myeloma, what is your preferred chemotherapy regimen and why?

Modified HyperCVAD? V(R)D-PACE? DCEP? Are there any data to favor one over the other?

How do you manage IgM related peripheral neuropathy?

Do you utilize rituximab or any other specific management strategies?

What is your preferred adjuvant chemotherapy regimen for a patient with local recurrence of TNBC two years after completing neoadjuvant ddAC-T who declined prior adjuvant capecitabine?

Had mastectomy resulting in ypT1cN1a. Post menopausal female with good PS.

Would you offer capecitabine re-challenge for a patient with metastatic breast cancer and a history of coronary vasospasm?

If so, under what circumstances?

Do you prefer cisplatin or carboplatin in combination with nivolumab per CheckMate 816 for patients with resectable NSCLC?

Based on subgroup analysis, do you have a preference for cisplatin over carboplatin?

How would you approach BCMA-directed therapy in a patient with myeloma and renal failure on dialysis?

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

For patients with metastatic thymic carcinoma, is there a role for local treatment options such as SBRT for oligoprogressive or oligopersistent disease after systemic therapy?

How do you approach post-transplant maintenance for patients with high-risk myeloma?

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 recommend routinely getting periodic 24-hour urine monoclonal protein study for patients with active multiple myeloma?

If so, why?

Would you offer adjuvant capecitabine to a patient with resected intrahepatic cholangiocarcinoma after being treated with neoadjuvant GAP chemotherapy?

4 months of Neoadjuvant GAP resulted in conversion from unresectable to resectable.

Do you consider an ovarian cancer patient who progresses on PARP inhibitor, either for treatment or maintenance, to be platinum resistant regardless of time since last platinum based chemotherapy?

Does the exact time since last platinum-based chemotherapy change your answer?

Would you implement CAR-T therapy earlier in practice if approved in earlier lines for multiple myeloma based on the KarMMa-3 and CARTITUTUDE-4 studies?

How would you approach treatment for a R/R mantle cell lymphoma patient with a history of autoimmune hepatitis who has progressed on both a covalent and non-covalent BTKi?

Is there any scenario where you would consider treating a relapsed AYA patient with Hodgkin Lymphoma without consolidative auto transplant?

If so, what treatment regimen would you recommend?

Do you routinely obtain next generation sequencing for patients with metastatic renal cell carcinoma and if so, what is your approach to incorporating these results into treatment decision making?

Would you recommend olaparib for a patient with germline BRCA1 mutation and HER2+ metastatic breast cancer who has progressed through multiple lines of HER2-directed therapy including trastuzumab deruxtecan?

Does your approach differ across the HER2 IHC spectrum?

What is your approach to systemic treatment of de novo metastatic hormone-sensitive prostate ductal adenocarcinoma with lung only metastases?

What systemic therapy do you recommend for prostate cancer pelvic nodal recurrence on PSMA PET-CT after prostatectomy and salvage radiation?

If ADT +/- ARPI + RT, what duration of systemic therapy do you recommend?

Do you always start treatment for patients who meet diagnostic criteria for multiple myeloma by SLiM criteria alone?

i.e., 60+% bone marrow plasmacytosis, light chain ratio >100, and/or >1 MRI lesion

Would you offer adjuvant abemaciclib plus endocrine therapy for favorable histology ER+/PR+/HER2-negative tumors such as pure tubular, mucinous, cribriform, or papillary that otherwise meet MonarchE trial criteria?

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...

Do you change treatment for confirmed biochemical progression in patients with otherwise secretory MM even if the M-spike is <0.5 g/dL?

How would you approach therapy for a patient with newly diagnosed non-GC DLBCL with previous anthracycline exposure?

240-300 mg/m2 prior exposure. How would your management change in young fit/older individuals with comorbidities? Would you obtain interval TTE during...

How do you approach imaging in patients with M0 castration-resistant prostate cancer with rising PSA on an ARSI?

What imaging modality do you use (conventional, PSMA PET, etc.)? When do you image (ex: a PSA threshold or PSADT)?

How would you approach therapy for a patient with symptomatic secondary CNS marginal zone lymphoma, but with low-volume systemic disease that would otherwise not warrant therapy?

Would your approach differ for a 30 year old and a 70 year old?

What adjuvant therapy would you give to a patient with resected pT4bN2M0 MSI-H colon cancer and post-op markedly elevated CEA but no metastatic disease seen on imaging?

In which situations do you offer ovarian suppression with chemotherapy to prevent the development of premature menopause in premenopausal women with ER negative breast cancer?

Fertility preservation already complete with embryo cryopreservation

Do you utilize Mammaprint testing to determine whether or not to offer neoadjuvant chemotherapy for high risk ER+ breast cancer?

In which situations do you consider post-mastectomy radiation therapy when the patient has a localized node-positive breast cancer with a complete nodal response and minimal residual disease in the breast post-neoadjuvant chemotherapy?

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

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

Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?

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 that have been...

What is your approach to curative-intent therapy for a young, fit patient with newly-diagnosed monomorphic epitheliotropic intestinal T cell lymphoma (MEITL)?

Do you incorporate PEG-asparaginase or brentuximab vedotin (for CD30-expressing malignant cells) into anthracycline-based induction regimens? Do you c...

Should high-dose methotrexate be used in the treatment of AYA patients with osteosarcoma?

In light of the TRIANGLE data at ASH, how should we now approach a transplant-eligible patient with a new diagnosis of aggressive mantle cell lymphoma?

How would you manage a transplant-eligible patient with DLBCL who relapsed 6-12 months following a CR1 to R-CHOP and then attained a CR2 to platinum-based salvage chemoimmunotherapy?

How do you choose between CAR-T and autoSCT, for example?

How would you treat a fit patient with a history of relapsed CLL who now presents with Richter transformation s/p autologous anti-CD19 chimeric antigen receptor (CAR) T-cells?

In which clinical situations, if any, would you use imiquimod for treatment of breast cancer skin metastases?

Is there still a role for plasma exchange/PLEX for confirmed or suspected cast nephropathy in multiple myeloma to rapidly reduce light chain burden?

In addition to reversing hypercalcemia, initiating myeloma therapy, etc.

In light of the recent rEECur trial interim analysis, would you offer high-dose ifosfamide to an AYA patient with relapsed Ewing's sarcoma who initially had a complete response to up-front therapy?

J Clin Oncol 40, 2022 (suppl 17; abstr LBA2). https://meetings.asco.org/abstracts-presentations/209024

How would you approach therapy for a transplant-eligible patient with peripheral T cell lymphoma NOS who experiences early relapse after CHOEP, but achieves remission to salvage therapy?

Would you still go to auto or consider allo?

How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?

Would you intercalate HD-MTX with her CHOEP?

Would you recommend adjuvant chemotherapy for a patient with subcentimeter pancreatic adenocarcinoma incidentally found during a Whipple resection for high risk IPMN?

Assuming all options for BCMA-directed therapy are available, how would you approach treatment for a patient with 4 prior lines of myeloma-directed therapy who is eligible for a BCMA-directed therapy?

Ide-cel? Cilta-cel? Teclistamab?

Did the approval of lutetium Lu 177 vipivotide tetraxetan (Pluvicto) change how you image and manage patients with metastatic castrate-resistant prostate cancer?

When do you order PSMA PET? Do you preferably order Locametz (gallium Ga 68 gozetotide) PET?

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 ...

For patients with IgG kappa multiple myeloma receiving an IgG kappa mAb (i.e., daratumumab), how important is it clinically to use an interference assay if they're in a VGPR to see if their M-spike might actually be 0?

For example, would you use a tool like the Hydrashift assay? Would this change your management?

When you use selinexor for relapsed/refractory myeloma, with what total weekly dose do you practically start?

If tolerated through Cycle #1, how aggressively do you try to titrate the selinexor dose up toward 100mg weekly or 80mg twice-weekly? And does your a...

What is your approach for using anticoagulation/aspirin in patients with multiple myeloma?

What is your preferred management for diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)?

Does your management change if symptomatic or asymptomatic?

In what circumstances would you stop therapy for patients with metastatic HER2+ breast cancer with long-term complete response to HER2-directed therapy?

How do you choose between neoadjuvant and adjuvant chemo-immunotherapy for patients with resectable stage II-IIIA NSCLC?

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

How would you approach adjuvant therapy for a patient with pT2N2 lung adenocarcinoma who underwent an R1 resection and is not amenable to further surgical intervention?

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

For patients with NSCLC on osimertinib who progress, would you continue osimertinib when moving onto chemotherapy for 2nd line therapy?

Based on results from ADAURA, in clinical practice, how likely are you to recommend adjuvant chemotherapy prior to adjuvant osimertinib for stage IIA T2bN0 EGFR mutant NSCLC?

What is your preferred up-front treatment for transplant-eligible patients with primary (de novo) plasma cell leukemia?

What is your approach to pRBC transfusion support for myeloma-related anemia?

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

What chemotherapy do you use with radiation for urothelial carcinoma with squamous differentiation?

How do you treat colorectal cancer with heterogeneous loss of mismatch repair protein expression?

How does your approach to low-risk gestational trophoblastic neoplasia differ for patients whose hCG levels plateau following initial single agent systemic therapy vs those who have a good initial response and then plateau?

How do you incorporate ctDNA in the management of metastatic breast cancer?

What are your takeaways from the GPRC5D-Targeted CAR-T trial (Mailankody et al. NEJM Sept 2022) and any key differences compared to the BCMA directed products?

How would you manage tucatinib-associated grade 2 indirect hyperbilirubinemia in a patient with metastatic HER2-positive breast cancer involving the CNS receiving trastuzumab + capecitabine + tucatinib?

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

How do positive pelvic washings influence your decision to administer adjuvant therapy to early stage endometrial cancer who otherwise meets no criteria for adjuvant therapy?

<60y/o, grade 1 endometrioid endometrial cancer. TLH, BSO, sentinel nodes. Stage IA, focal LVSI, 20% myometrial invasion, negative sentinel nodes, ...

If you treat a patient with high-risk smoldering myeloma on trial and they develop biochemical progression by M-spike, but still no CRAB-SLiM criteria, what would you do next?

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

Is there a role for repeat CAR-T with a potentially different product in relapsed and refractory multiple myeloma?

How would you manage a CLL patient with Richters transformation that is resistant to R-CHOP with transfusion dependent cytopenias and a marrow demonstrating significant involvement by DLBCL and CLL?

What is your approach in a fit patient, advanced stage, bulky classical Hodgkin lymphoma who has decreased disease burden in areas but a persistent, hypermetabolic (Deauville 5) anterior mediastinal mass following two cycles of AAVD?

In terms of contraception, what do you recommend for patients with a history of hormone receptor-negative compared to hormone receptor-positive breast cancer?

When would you use adjuvant abemaciclib in patients with clinically high-risk ER+, HER2-negative breast cancer, but pCR following neoadjuvant chemotherapy?

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...

How do you approach adjuvant therapy for resected lung adenocarcinoma that was found unexpectedly postop to be N2?

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

10 Answers available

Do you perform a periodic PET CT to screen for extramedullary disease in patients with MM who are in remission?

Where does Elotuzumab-based combination therapy, specifically EPd, fit in your treatment paradigm for relapsed MM?

Does sequence matter?

What induction regimen would you choose for a patient with newly diagnosed multiple myeloma with incidental amyloidosis noted on bone marrow biopsy, but with no end-organ damage as a result of amyloid deposition?

Would you consider Dara-CyBorD or a MM triplet/quadruplet such as VRd or Dara-VRd?

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

What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?

How do you approach treatment for a patient with a biochemical relapse while on maintenance lenalidomide after autologous stem cell transplant for multiple myeloma?

What factors (i.e. timing from transplant, dose, prior therapy) impact your decision?

How would you approach therapy for a patient with a history of classical HL who achieved a CR to 6 cycles of Brentuximab plus AVD who now presents with widespread non-GC DLBCL?

How would you approach therapy for BR-refractory Waldenstrom Macroglobulinemia when there is a mixed response to zanabrutinib?

Outside of a clinical trial, what is your preferred third-line systemic therapy option for a patient with relapsed/refractory ES-SCLC?

In a life-time non-smoker with stage IV lung adenocarcinoma presenting in visceral crisis, what therapy would you recommend to avoid organ failure while awaiting mutational status?

What treatment would you recommend in an older patient with multiply relapsed double-hit lymphoma with recurrence following ASCT, pola-BR, and CAR-T therapy?

How does urinary obstruction impact your choice of therapy for metastatic or locally advanced prostate cancer?

How do you approach the decision to pursue early versus delayed autologous stem cell transplantation in newly diagnosed multiple myeloma?

Would you recommend adjuvant chemotherapy for a patient who achieved a CR after TNT for stage III rectal adenocarcinoma but underwent no initial surgery, and now has a local recurrence >12 months later with plans to undergo low-anterior resection?

Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT

How would you treat a patient with blastoid mantle cell lymphoma with hepatic involvement causing significantly elevated bilirubin?

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.

What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?

How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?

What adjuvant systemic therapy would you recommend for a woman s/p ALND for a nodal recurrence of ER-/HER2+ breast cancer 1 year after completing adjuvant therapy with paclitaxel/trastuzumab for her initial disease?

At initial diagnosis she had T1cN0 disease treated with lumpectomy and SLNB followed by 12 weeks of paclitaxel with 1 year of trastuzumab.

What is the optimal treatment strategy for patients with stage IV NSCLC who have an actionable molecular target identified after initiation of first-line systemic therapy?

When would you use PSMA PET over conventional imaging for prostate cancer?

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

How do you define cisplatin ineligibility for muscle invasive bladder cancer?

Do you treat de novo metastatic hormone sensitive prostate cancer presenting with a paraneoplastic syndrome more aggressively?

How would you approach a young patient with oligometastatic inflammatory triple negative breast cancer with bone only metastases?

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

What is your preferred adjuvant therapy for a patient with triple negative breast cancer and has a BRCA germline mutation who had minimal to no response to neoadjuvant chemotherapy?

Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.

In light of ALK-directed therapy, what is the role of chemotherapy for patients with newly diagnosed ALK+ DLBCL?

In light of ARASENS presented at GU ASCO 2022, how do you approach treatment of de novo metastatic hormone sensitive prostate cancer?

How do you sequence therapy in an older patient with newly-diagnosed blastoid mantle cell lymphoma with a 17p deletion?

How would you approach therapy for a patient with smoldering multiple myeloma whose light chain ratio has increased to greater than 100 over several years in the absence of any other myeloma-defining events?

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...

How would you approach therapy for relapsed/refractory mantle cell lymphoma restricted to the CNS?

How would you approach therapy for newly diagnosed germinal-center DLBCL who previously received an unknown systemic regimen with radiation for history of Hodgkin Lymphoma?

Would you give R-CHOP without knowing if there was use of prior anthracycline?

For a patient with metastatic NSCLC who had progression x2 at a single site treated w RT, would you switch systemic treatment?

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

How would you treat a patient with metastatic RCC who developed posterior reversible encephalopathy syndrome (PRES) on a TKI-containing regimen?

Would you consider re-challenging with a different TKI?

Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?

How would you approach a patient with newly diagnosed hepatocellular carcinoma with very high AFP (>100,000) but no clear radiographic evidence of metastatic disease?

Previously untreated

Do you offer adjuvant bisphosphonates to high-risk premenopausal women on ovarian suppression for early-stage breast cancer who would want to consider pregnancy in the future?

Which agents would you select and for how long would you treat them?

How would you approach a patient with imaging and labs suggestive of potentially resectable cholangiocarcinoma when several core biopsies reveal bridging fibrosis with no malignant cells?

In patients with HCC and asymptomatic but endoscopically visible varices, how long do you wait to start bevacizumab after banding?

In which situations do you offer neoadjuvant chemotherapy for a nodal recurrence alone of ER/PR positive, HER2 negative breast cancer?

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

For relapsed/refractory myeloma, how long of a disease-free interval from first autologous transplant do you recommend before considering a second autologous transplant?

For patients with mild CKD, how do you decide between zoledronic acid and denosumab for bone protection in patients with multiple myeloma?

For pts w/ eGFR between 30-60

What is your experience with using Frailty Index or other geriatric screening in making decisions for elderly patients with multiple myeloma?

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

What is your approach to chemoprevention for HR+ DCIS in the ipsilateral breast in a patient who already completed 7 years of an AI for a prior HR+ invasive breast cancer?

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

In what clinical scenarios do you utilize venetoclax-based therapy in relapsed/refractory multiple myeloma?

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...

What is your preferred first line treatment option for a fit patient with non-squamous NSCLC who is PDL1 positive (1-49%) with no driver mutations?

Does the 2020 approval of Nivolumab and Ipilimumab for mNSCLC with PDL1 >1% impact your decision?

For metastatic prostate cancer, when would you add carboplatin to docetaxel or cabazitaxel?

In which cases would you use adjuvant abemaciclib for a patient with extensive residual disease that is triple-positive (ER+PR+HER2+) following neoadjuvant TCHP?

Patient is ypT2N1

Which systemic therapy (if any) do you offer premenopausal women with a second TNBC local resectable recurrence and an extensive chemotherapy history?

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

How would you approach systemic therapy for a pre-menopausal woman with ER+/PR+/HER2 positive breast cancer who had a local recurrence 6 months after completing adjuvant TCH and a year of trastuzumab + tamoxifen?

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

How would you approach systemic therapy for a young post-menopausal woman with locoregional TNBC chest wall recurrence treated with definitive radiation?

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

How would you approach adjuvant therapy for a patient with resected T4N1 high grade large cell neuroendocrine tumor of the cecum with adenocarcinoma component?

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...

How do you approach patients with recurrent grade 3+ neutropenia on IMiD-containing regimens (e.g., VRd or KRd) beyond dose reductions?

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

What infectious prophylaxis do you use for patients with newly diagnosed multiple myeloma?

How do you decide how long to continue?

What treatment would you consider for small cell neuroendocrine carcinoma of the bladder with a metastatic recurrence within 3 months of neoadjuvant cisplatin/etoposide followed by radical cystectomy (ypT0N0)?

NGS of TURBT specimen had high TMB (18 Muts/Mb).

How do you manage patients with oligometastatic renal cell carcinoma after nephrectomy and metastatectomy?

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...

Would you offer adjuvant abemaciclib + an aromatase inhibitor to a patient with a local HR+HER- breast cancer reoccurrence while on tamoxifen that meets high-risk criteria?

High-risk criteria meaning >4 positive nodes and Ki67 >20%

What is your treatment of choice for triple class refractory multiple myeloma?

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

How does one interpret persistently positive lambda light chains on serum immunofixation but without measurable serum monoclonal protein and a normal light chains and ratio?

Is a repeatedly abnormal serum immunofixation all it takes for MGUS?

Are there effective adjunct therapies to relieve tumor flare pain from tamoxifen in the metastatic setting?

Which patients with smoldering myeloma do you treat?

How would you manage asymptomatic radiographic progression from M0 CRPC to M1 CRPC to bone?

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 ...

How would one alter therapy in a transplant-ineligible AL amyloidosis with less than a complete response to six cycles of Dara-CyBorD?

Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?

What is the optimal prophylaxis regimen to use prior to a selinexor based regimen in the treatment of multiple myeloma for nausea and electrolyte abnormalities?

How would you manage an asymptomatic elderly frail patient with newly diagnosed mantle cell lymphoma with TP53 mutation?

Ki67 = 90% with multiple small nodes on PET scan and normal CBC

How would you approach a patient with mediastinal-only recurrence of small cell lung cancer < 6 months after primary surgical resection and adjuvant platinum-etoposide for Stage I disease?

How would you manage a patient with history of follicular lymphoma treated with Bendamustine-Rituximab who now has a new FDG avid lesion that is biopsy proven CD30 positive CD20 negative DLBCL?

For metastatic clear cell RCC, would you consider cabozantinib + nivolumab after progression on first line ipilimumab + nivolumab?

Or what is your preferred regimen for stage IV ccRCC following progression on IO/IO?

How would you manage metastatic small cell/neuroendocrine bladder cancer after response to 6 cycles of platinum/etoposide?

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

What treatment would you consider for metastatic urachal carcinoma following progression on FOLFOX and FOLFIRI?

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

What's the optimal management of stage IA nodal ATLL in a young fit patient?

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

How would you manage adjuvant treatment of a premenopausal woman with HER2 positive, ER/PR negative multifocal micro-invasive node-negative breast cancer?

Largest invasive focus is 0.4mm

How do you approach a patient with an anaplastic plasmacytoma without systemic evidence of disease in the bone marrow?

What about multiple anaplastic plasmacytoma without bone marrow involvement?

What is your preferred regimen for metastatic clear cell RCC following progression on IO/TKI?

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

What is your approach to the treatment of metastatic renal cell carcinoma with unclassified histology?

For a young patient who had a prior pCR to neoadjuvant therapy, would you consider systemic therapy after local resection and radiation of an isolated brain metastatic recurrence of triple negative breast cancer?

CNS recurrence occurred within two years of prior neoadjuvant therapy

How are you choosing between ipilimumab/nivolumab versus platinum/pemetrexed for unresectable epithelioid mesotheliomas?

Would you recommend surgery or radiation for newly diagnosed localized prostate cancer diagnosed on a urethral lesion biopsy?

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

Do you continue bortezomib past 8 cycles for transplant ineligible patients with multiple myeloma on VRd who are tolerating therapy well with no neuropathy?

Would you use MRD status to guide your decision making?

Would you move to a venetoclax-based regimen for a patient with pentarefractory MM and t(11;14) translocation, previously treated with bortezomib and carfilzomib?

If so, venetoclax/dexamethasone by itself or do you include a PI?

For a young patient with small cell bladder cancer, what would you recommend following cisplatin + etoposide, if scans show no evidence of distant disease and repeat TURBT shows no malignancy?

Do you prefer carboplatin or cisplatin with etoposide for stage IV extra-pulmonary neuroendocrine carcinomas with a Ki-67 > 55%?

Which chemotherapy regimen would you recommend for locally recurrent TNBC several years after therapy with docetaxel + cyclophosphamide for four cycles?

For locally advanced rectal cancer, would you consider utilizing the RAPIDO trial approach of short course radiation followed by neoadjuvant chemotherapy prior to surgery?

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

For patients with metastatic triple negative breast cancer on nab-paclitaxel + atezolizumab who have an ongoing response, are you continuing immunotherapy after the FDA withdrawal of atezolizumab?

What is your preferred maintenance strategy for high risk multiple myeloma?

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?

Would you treat a postmenopausal women with high grade T2N0 ER-, PR+, HER2- invasive ductal carcinoma with upfront surgery or neoadjuvant chemotherapy?

ER <1%; PR 45%, Her2 negative by IHC and FISH. Grade 3, Ki67: 80%.

How do you manage HR+HER2 negative ILC metastatic recurrence in a post-menopausal woman with extensive GI involvement complicated by a small bowel obstruction?

Patient was on tamoxifen when progression occurred; unable to tolerate adjuvant AI.

In light of RxPonder results for postmenopausal women with early stage node positive HR+HER2- breast cancer, when is there a role for full axillary LN dissection to confirm degree of nodal involvement and when would sentinel LN evaluation be sufficient?

How would this affect adjuvant radiation plan in breast conservation therapy patients and mastectomy patients?

What is your preferred treatment for Stage IIA seminoma or IIB seminoma with LN <3 cm and normal tumor markers after orchiectomy?

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...

How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?

How does age factor into your planning whether to give a high risk pre-menopausal patient with breast cancer ovarian function suppression?

Do you have a specific age cutoff?

Would you consider surgical management of a TNBC primary after a patient has had radiographic resolution of oligometastatic disease?

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

Would you consider PRRT re-treatment in a patient with a well differentiated NET previously treated with 4 cycles of PRRT?

How and when are you using sipuleucel-T in metastatic prostate cancer given the increase in available treatment options?

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

Would you give adjuvant therapy for a urothelial carcinoma T2 on TURBT but pTis at margins on cystectomy?

Patient has not had any prior systemic treatment and is cisplatin-eligible.

Would you offer adjuvant chemotherapy to a young adult with undifferentiated embryonal sarcoma of the liver?

What factors make you more likely to offer or omit chemotherapy?

What is the role of liver transplant in NET?

Do you recommend adjuvant treatment for nodal isolated tumor cells in an otherwise low-risk endometrial cancer?

What is the preferred regimen for AYA patients with T-Cell Lymphoblastic Lymphoma?

What is the preferred adjuvant therapy for high-risk non-clear cell RCC?

How would you proceed for a patient with metastatic gastric-type adenocarcinoma, with vaginal and inguinofemoral disease only, who experiences complete response to her vaginal tumor but residual inguinal disease?

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

How would you treat stage II pediatric type follicular lymphoma that is not amenable to surgical resection in an adolescent and young adult patient?

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.

How do you treat patients with newly diagnosed metastatic MiT Family Translocation Renal Cell Carcinoma?

MiT subfamily translocations = TFE3, TFEB, TFC, or MiTF

Would you consider radical prostatectomy for a young male with unfavorable intermediate risk cT3a prostate cancer and PSMA PET concerning for regional lymph nodes involvement but negative conventional imaging?

Gleason 4+3=7 and PSA 4

For persistent localized muscle-invasive bladder cancer following chemoradiation in patients who are not surgical candidates, what is an appropriate next therapy?

Is there evidence that oral contraceptive pills are less effective in pre-menopausal women on tamoxifen chemoprevention?

We usually recommend copper IUDs, but that's not feasible in all women.

Do you recommend trilaciclib as primary prophylaxis for myelosuppression in certain patients with ES-SCLC treated with first line chemo-immunotherapy?

How would you manage adjuvant therapy for a premenopausal female with a T1cN1mi breast IDC that is HR+ HER2 positive on biopsy, but HR+ HER2 negative on lumpectomy surgical specimen?

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

What dose of PEG-asparaginase do you recommend for teens with high BMI treated on a pediatric ALL regimen?

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

How do you approach adjuvant treatment of pT1cN0 metaplastic triple negative breast cancer?

Healthy 67 y/o woman, 1.5cm tumor, grade 3

Should a teenager diagnosed with CML in blast crisis go to transplant once MRD is negative?

What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?

How would you adjust therapy for a patient with high risk, stage III choriocarcinoma (lung mets) in the context of renal insufficiency (Cr 3.8)?

In a patient with metastatic clear cell RCC who achieved a prolonged PR with first line nivolumab/ipilimumab, discontinued due to IRAEs, would you consider a TKI/checkpoint inhibitor combination regimen?

In this case, nivo/ipi discontinued for immune-related arthralgias requiring steroids and an anti-TNFa agent, now off all immunosuppression.

How do you approach adjuvant therapy for a premenopausal patient with a pathologic BRCA1 mutation whose TNBC had a complete response to neoadjuvant chemotherapy except for an ITC in one LN?

Patient was given ddAC + T

When would you recommend adjuvant therapy for a patient with urethral adenocarcinoma after partial urethrectomy?

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

After completing 6 cycles of docetaxel plus ADT for metastatic hormone-sensitive prostate cancer per CHAARTED, are there clinical scenarios in which you would add an additional AR targeted agent (ex: enzalutamide, abiraterone, or apalutamide) to ADT?

Does post docetaxel PSA influence your decision?

For persistent PSA elevation after prostatectomy, would you recommend salvage radiation if pathologically negative nodes, but regional and non-regional lymphadenopathy on PSMA PET?

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

How would you sequence therapies for a patient with chemotherapy-naive metastatic castration-resistant prostate cancer who is MSI-H on tissue-based NGS?

What line would you give pembrolizumab?

How would you manage a patient with recurrent granulosa tumor following secondary, R0 cytoreduction, and negative inhibins postoperatively?

Primary, R0 debulking in 2019, stage IA. Low volume recurrence, now again optimally cytoreduced.

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?

After an optimal tertiary cytoreduction for recurrent granulosa cell tumor previously treated with BEP and hormonal therapy, would you recommend systemic chemotherapy?

Initial diagnosis was 15+ years ago

What adjuvant systemic therapy would you offer to a healthy elderly woman with a 5mm, node negative, grade 2 HR+HER2+ invasive lobular carcinoma?

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

What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?

What is your approach for endocrine therapy in young women (<35 years old) with HR+/HER2+ breast CA with residual disease after TCHP who will start adjuvant T-DM1?

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?

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-?

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 ...

Should end-of-therapy echocardiograms be obtained for AYA patients with sarcomas who have received high-dose anthracyclines?

At what frequency and for how long should echos be monitored?

How would you treat/counsel a patient with Stage IB3 SCC of the cervix who is 18 weeks pregnant and desires to maintain pregnancy?

If neoadjuvant therapy is indicated for luminal A breast cancer, when do you decide to use chemotherapy versus endocrine therapy?

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

How do you manage adjuvant endocrine therapy for pre-menopausal women with locally advanced, weakly positive ER/PR, HER2 negative breast cancer?

Would a pCR to neoadjuvant chemotherapy change your management? (ER <5%, PR <5%)

For anatomic stage III ER/PR+ breast cancer treated upfront with surgery, how do you decide which adjuvant chemotherapy to offer?

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

How do you treat a patient with widely metastatic, non T790M mutated, EGFR exon 20 insertion mutated lung cancer?

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

How does clinical intramammary lymph node involvement in HER2+ breast cancer affect your neoadjuvant chemotherapy choice?

Would you prefer TCHP over TCH? Would you consider adding an anthracycline?

How do you manage a HR-/HER2+ breast cancer patient with local progression during neoadjuvant TCHP?

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

What is your approach to consolidation for localized small cell bladder cancer after neoadjuvant cisplatin and etoposide?

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

What is your platelet cutoff for atezolizumab + bevacizumab in HCC in the absence of bleeding (variceal or otherwise)?

What is your approach to patients with malignant breast adenomyoepithelioma?

Is adjuvant radiation and/or adjuvant chemotherapy indicated?

Are there any clinical scenarios where you would recommend adjuvant docetaxel for localized prostate cancer?

What is your preferred second line therapy for an HCC patient who progressed after first line checkpoint inhibitor monotherapy?

Would you try atezolizumab/bevacizumab or switch to a TKI?

How do recent RxPonder results affect your adjuvant therapy choice for premenopausal women with HR+/HER2 negative breast cancer with 1-3 positive LNs?

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

For a patient on dialysis with metastatic clear cell renal cancer, what regimen would you use after front line immunotherapy?

When might you recommend adjuvant chemotherapy for fully staged/resected stage IA clear cell ovarian carcinoma?

What adjuvant therapy do you recommend for comprehensively staged, stage II, FIGO grade 3 deeply invasive endometrial cancer?

For a patient who is cisplatin-eligible with localized, high-grade upper tract urothelial carcinoma, but no muscularis propria seen on biopsy, what is your approach?

What neoadjuvant or adjuvant therapy would you give?

How would you manage a clinically inoperable, stage IIIB, MMR deficient uterine cancer?

Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement. ER/PR and HER2 testing are pending.

In what situations would you offer systemic therapy for HER2+ microinvasive invasive ductal carcinoma?

What are your recommendations for post-menopausal patients who would fit into RxPonder trial criteria (HR+/HER2- breast cancer, 1-3 positive LNs) and have already started on adjuvant chemotherapy?

Would you send Oncotype during chemotherapy if not sent already? Would you stop adjuvant chemotherapy if a prior Oncotype was 25 or less?

For patients on a bone-modifying agent for osteoporosis/severe osteopenia in the context of adjuvant AI therapy, how do you manage the bone-modifying agent once their AI course is complete?

How long should breast cancer patients whose surgeries are delayed due to COVID-19 remain on neoadjuvant endocrine therapy?

For patients with low risk, early stage, HR+/HER2- breast cancer who initiated endocrine therapy in order to delay their surgery due to the COVID 19 e...

How do you approach adjuvant endocrine therapy in a pre-menopausal patient with node negative HR+HER2- breast cancer with a high Oncotype RS who received adjuvant chemotherapy?

What is your specific therapy choice and duration?

How do the new RxPONDER results affect your choice of adjuvant therapy for postmenopausal women with HR+/HER2 negative breast cancer and 1-3 positive lymph nodes?

Would you send an Oncotype RS to determine the role of adjuvant chemotherapy and/or endocrine therapy?

How would you approach adjuvant therapy for a young post-menopausal woman with a grade 3 pT1a (5mm) node negative ER+/HER2- invasive ductal carcinoma?

Would you consider gene profiling to determine need for chemotherapy?

How would you manage a middle aged woman with history of severe alcoholic liver cirrhosis and a small node negative ER/PR positive, HER2 negative breast cancer?

How would you balance the competing risks of these two diagnoses in her treatment?

How would you manage adjuvant treatment of a patient with ER+/PR+/HER2+ breast cancer and a small amount of residual disease (e.g. T1mi) following neoadjuvant TCHP?

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

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?

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 ...

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.

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

Pathology is not carcinoid or small cell.

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...

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?

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?

Given the data from KEYNOTE-522, would you try to incorporate chemotherapy in the treatment regimen?

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

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

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...

How do you manage ovarian suppression for premenopausal patients with HR+/HER2 positive breast cancer?

Does lymph node positivity change your management?

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

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?

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?

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?

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

Is it acceptable to use TCHP instead of AC-T + trastuzumab as neoadjuvant chemotherapy for HER2+ inflammatory breast cancer?

Patient case is triple positive inflammatory breast cancer

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?

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

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

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?

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.

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?

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?

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

Chemoradiation completed 1.5 years prior

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...

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...

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.

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

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?

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

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?

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,...

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

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

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?

How would you treat a metastatic pancreatic cancer patient who develops symptomatic leptomeningeal disease on first line FOLFIRINOX?

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

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?

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?

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?

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?

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.

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.

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

What are there most evidence-based options?

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.

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?

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?

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...

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 ...

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

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

Would you continue pembrolizumab in an asymptomatic metastatic NSCLC patient with high PD-L1, who develops granulomatous mediastinal lymphadenopathy biopsy proven as sarcoid?

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?

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?

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?

Would you recommend adjuvant chemotherapy for a stage IIB triple negative apocrine carcinoma?

What chemotherapy regimen would you recommend?

Would you recommend PMRT for a patient with a right breast mastectomy with closest margin less than 0.1cm?

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.

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

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

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?

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

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

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

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

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...

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 ...

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?

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?

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

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.

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?

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

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?

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...

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...

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?

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

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

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

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?

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...

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?

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?

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?

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

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

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.

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?

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?

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?

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

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...

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?

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...

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...

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

Is there any advantage of one regimen over the others?

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?

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?

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?

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...

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?

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...

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...

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?

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.

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?

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?

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?

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...

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?

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

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

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?

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

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

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

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.

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 ...

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?

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

Would you forego anthracycline?

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.Antonia et al., PMID 28885881...

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?

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

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?

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?

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

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?

0 Answers 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.

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?

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

6 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?

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

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

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...

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

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?

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

greatest measuring 1.0cm.

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?

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)?

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?

Which patients with metastatic breast cancer should have mastectomy?

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?

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...

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%?

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

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

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?

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

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?

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

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

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

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?

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

Patient did not receive neoadjuvant therapy.

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

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?

0 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?

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?

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...

In which scenarios 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?

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?

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.

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?

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.

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.

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?

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?

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?

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?

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

Do you use docetaxel interchangeably with paclitaxel in breast cancer?

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

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 ?

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

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

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?

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?

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?

Would you offer adjuvant therapy for poorly differentiated adenocarcinoma of the galbladder s/p R0 resection with negative nodes?

Would you offer chemotherapy alone per data from BILCAP or is there any role of radiation?

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?

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?

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.

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?

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)?

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.

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)

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...

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?

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?

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 ...

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?

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

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.

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...

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 ...

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?

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...

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

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

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?

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

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?

Do you routinely check echocardiograms for patients getting HER2 directed therapy for metastatic breast cancer?

If so, how frequently?

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.

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?

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

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?

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

No prior chemotherapy.

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,...

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?

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?

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...

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?

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.

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...

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?

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?

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?

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...

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...

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?

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?

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?

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...

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?

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

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?

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...

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?

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

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?

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?

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

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?

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?

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?

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?

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 ...

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?

Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?

How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?

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

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

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?

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

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

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?

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?

Would you offer adjuvant TKI to patients with Stage III, EGFR-mutant NSCLC after standard chemoradiation?

Would you offer adjuvant TKI following ADAURA data? Or proceed with durvalumab based on PACIFIC data?

What is the best management for a local recurrence for a stage I NSCLC treated previously with SBRT?

Should fractionated EBRT be administered or can repeat SBRT be used?