NCI-CCC Tumor Board Question
These are questions being discussed by academics at NCI-Cancer Centers
Questions discussed in this category
Patients are understandably concerned about the risks and benefits of radiation to an oozing, bleeding, ulcerated breast.
With the recent announcement that the phase 3 MonarchE trial met its primary endpoint.
If so, when and to what extent?
For example - minimum number of months of therapy, driving distance to clinic, at least a CR with or without MRD negativity?
I.e. dosing regimen frequency, side effect profile, duration of follow up, etc.
Modified HyperCVAD? V(R)D-PACE? DCEP? Are there any data to favor one over the other?
Do you utilize rituximab or any other specific management strategies?
Had mastectomy resulting in ypT1cN1a. Post menopausal female with good PS.
If so, under what circumstances?
Based on subgroup analysis, do you have a preference for cisplatin over carboplatin?
Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion?
Which PI and at what dosing intervals? Dexamethasone or not?
Emory has now published data with VRd consolidation as well as KPd consolidation, while ...
If so, why?
4 months of Neoadjuvant GAP resulted in conversion from unresectable to resectable.
Does the exact time since last platinum-based chemotherapy change your answer?
If so, what treatment regimen would you recommend?
Does your approach differ across the HER2 IHC spectrum?
Will you use it rather than a carboplatin-containing regimen?
If ADT +/- ARPI + RT, what duration of systemic therapy do you recommend?
i.e., 60+% bone marrow plasmacytosis, light chain ratio >100, and/or >1 MRI lesion
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...
240-300 mg/m2 prior exposure. How would your management change in young fit/older individuals with comorbidities? Would you obtain interval TTE during...
What imaging modality do you use (conventional, PSMA PET, etc.)? When do you image (ex: a PSA threshold or PSADT)?
Would your approach differ for a 30 year old and a 70 year old?
In the DAISY trial, ORR of 30.6% in T-DXd treated patients (n = 38) with HER2-null breast cancer
Fertility preservation already complete with embryo cryopreservation
Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?
Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients that have been...
Do you incorporate PEG-asparaginase or brentuximab vedotin (for CD30-expressing malignant cells) into anthracycline-based induction regimens? Do you c...
Are you adding ibrutinib? Should we add ibrutinib to NORDIC? Still referring to transplant?
How do you choose between CAR-T and autoSCT, for example?
In addition to reversing hypercalcemia, initiating myeloma therapy, etc.
J Clin Oncol 40, 2022 (suppl 17; abstr LBA2). https://meetings.asco.org/abstracts-presentations/209024
Would you still go to auto or consider allo?
Would you intercalate HD-MTX with her CHOEP?
Ide-cel? Cilta-cel? Teclistamab?
When do you order PSMA PET? Do you preferably order Locametz (gallium Ga 68 gozetotide) PET?
Would you treat this as a locally advanced breast cancer and offer surgery, radiation, and systemic therapy? Does your management change depending on ...
For example, would you use a tool like the Hydrashift assay? Would this change your management?
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...
Does your management change if symptomatic or asymptomatic?
In light of CheckMate 816 and IMpower010 and FDA approval for neoadjuvant chemo-nivolumab and adjuvant chemo-atezolizumab, how do you decide which sys...
NGS without any actionable mutations and PD-L1 TPS 15%.
Would you offer chemotherapy, radiation, or immunotherapy and, if so, in what order?
How much weight do you give to a hgb/hct threshold versus symptoms?
Patient is young. Bilirubin normalizes when tucatinib is held, but again increases to grade 2 when it is restarted. Evaluation for hemolysis was negat...
<60y/o, grade 1 endometrioid endometrial cancer. TLH, BSO, sentinel nodes. Stage IA, focal LVSI, 20% myometrial invasion, negative sentinel nodes, ...
In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...
Young healthy patient, ER/PR positive HER2 negative right breast cancer with a synchronous single site of oligometastatic disease in the right 4th rib...
Patient is BRCA 1/2 wild type; completed four cycles of carboplatin/paclitaxel and two cycles of AC with pembrolizumab in the neoadjuvant setting.
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...
Do you routinely offer post-operative adjuvant radiation in addition to chemotherapy? Are the results of the recently published negative phase II...
Does sequence matter?
Would you consider Dara-CyBorD or a MM triplet/quadruplet such as VRd or Dara-VRd?
Is there anything to differentiate the two agents? CNS penetration reportedly with adagrasib, FDA accelerated approval has been given with sotorasib.&...
What factors (i.e. timing from transplant, dose, prior therapy) impact your decision?
Do the results change your clinical practice?
Total neoadjuvant therapy (TNT) included FOLFOX x 4 months and concurrent chemo-RT
If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.
At initial diagnosis she had T1cN0 disease treated with lumpectomy and SLNB followed by 12 weeks of paclitaxel with 1 year of trastuzumab.
Would you use it for initial staging or at time of biochemical recurrence?
What type of adjuvant chemotherapy would you offer?
Would clinically positive lymph nodes or residual disease at time of surgery change your decision...
Would you consider definitive local therapy (surgery, radiation?) if she achieved a good response to initial systemic therapy?
Young patient, germline BRCA carrier with cT1cN0 to ypT2N0 disease after docetaxel/ cyclophosphamide x 4.
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...
Would you give R-CHOP without knowing if there was use of prior anthracycline?
Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation.
Would you consider re-challenging with a different TKI?
Previously untreated
Which agents would you select and for how long would you treat them?
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 pts w/ eGFR between 30-60
Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?
Patient underwent mastectomy for DCIS in the setting of previous lumpectomy and adjuvant radiation for the invasive breast cancer.
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...
Does the 2020 approval of Nivolumab and Ipilimumab for mNSCLC with PDL1 >1% impact your decision?
Patient is ypT2N1
Patient has already received neo/adjuvant treatment with AC, paclitaxel, capecitabine, docetaxel, and carboplatin.
Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...
Patient previously received neoadjuvant ddAC-T with residual disease at surgery, followed by adjuvant capecitabine which was completed 2 months prior ...
Pathology details: 75% high grade large cell neuroendocrine tumor of the cecum (20-30 mitoses per 10 hpf, Ki67 75%) and 25% adenocarcinoma. Patient ha...
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 ...
For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.
How do you decide how long to continue?
NGS of TURBT specimen had high TMB (18 Muts/Mb).
Do you observe, offer adjuvant pembrolizumab, or give a first-line metastatic regimen (IO/IO or IO/TKI)? Does your recommendation vary based on risk c...
High-risk criteria meaning >4 positive nodes and Ki67 >20%
CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?
Is a repeatedly abnormal serum immunofixation all it takes for MGUS?
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 ...
Would you continue with daratumumab maintenance per ANDROMEDA or switch regimen?
Would a PET avid pelvic lymph node without distant metastatic disease change your management?
Ki67 = 90% with multiple small nodes on PET scan and normal CBC
This situation can feel uncomfortable. Would this feel safer if patient is s/p mastectomy and had TNBC?
Or what is your preferred regimen for stage IV ccRCC following progression on IO/IO?
If any clinical benefit (ie. CR, PR or SD) would you consider switch maintenance avelumab, surveillance until progression, or an alternate regimen?
Molecular profiling revealed no targetable alterations, however tumor mutational burden was >10 mut/Mb.
Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...
Largest invasive focus is 0.4mm
What about multiple anaplastic plasmacytoma without bone marrow involvement?
Patient has progression of liver metastases while on pembrolzumab/axitinib. ECOG PS 1 and limited comorbidities.
CNS recurrence occurred within two years of prior neoadjuvant therapy
GS 4+4. PSA low (1-2). CT and bone scan negative for lymphadenopathy or metastatic disease. Prostate MRI pending.
Would you use MRD status to guide your decision making?
If so, venetoclax/dexamethasone by itself or do you include a PI?
Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?
Colleagues in surgery have raised concerns about post radiation effects in the pelvis with the ordering of short course RT->chemo ->surgery.
Is there any role for denosumab? How do you counsel patients regarding the benefit of bisphosphonates on breast cancer outcomes?
ER <1%; PR 45%, Her2 negative by IHC and FISH. Grade 3, Ki67: 80%.
Patient was on tamoxifen when progression occurred; unable to tolerate adjuvant AI.
How would this affect adjuvant radiation plan in breast conservation therapy patients and mastectomy patients?
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...
Do you have a specific age cutoff?
Patient with T2N1 disease and isolated liver metastases. Axilla and liver completely responded to chemo + IO, but limited residual breast enhancement ...
Do prior treatments for mHSPC change your thinking on whether or not to use sipuleucel-T?
Patient has not had any prior systemic treatment and is cisplatin-eligible.
What factors make you more likely to offer or omit chemotherapy?
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...
History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis.
Vaginal tumor completely resp...
Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear.
MiT subfamily translocations = TFE3, TFEB, TFC, or MiTF
Gleason 4+3=7 and PSA 4
We usually recommend copper IUDs, but that's not feasible in all women.
<40y/o female w/ initial biopsy showing G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 copies/nucleus.)...
Would you 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...
Healthy 67 y/o woman, 1.5cm tumor, grade 3
In this case, nivo/ipi discontinued for immune-related arthralgias requiring steroids and an anti-TNFa agent, now off all immunosuppression.
Patient was given ddAC + T
What clinicopathological features would need to be present for you to recommend adjuvant chemotherapy? Would you treat pT3 disease? Any specific histo...
Does post docetaxel PSA influence your decision?
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...
What line would you give pembrolizumab?
Primary, R0 debulking in 2019, stage IA. Low volume recurrence, now again optimally cytoreduced.
Would you offer this patient chemotherapy? What are your thoughts about OFS plus AI and avoiding chemotherapy?
Initial diagnosis was 15+ years ago
Would you choose to incorporate HER2-targeting agents, chemotherapy, endocrine therapy, or a mix of these?
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 ...
At what frequency and for how long should echos be monitored?
Are there particular patient characteristics (e.g. age, ER%, Ki67, grade) that make you more likely to choose neoadjuvant endocrine therapy?
Would a pCR to neoadjuvant chemotherapy change your management? (ER <5%, PR <5%)
Do features such as nodal involvement, Ki-67, degree of ER positivity, etc. change your management? Would you use any gene expression assays to help y...
Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?
Would you prefer TCHP over TCH? Would you consider adding an anthracycline?
How would you approach additional systemic therapy? Would the clinical stage of the cancer affect your management?
Specifically, for cT2N0M0 small cell bladder cancer without response to neoadjuvant cisplatin and etoposide on imaging, would you proceed with cystect...
Is adjuvant radiation and/or adjuvant chemotherapy indicated?
Would you try atezolizumab/bevacizumab or switch to a TKI?
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)?
What neoadjuvant or adjuvant therapy would you give?
Tumor felt to be technically unresectable due to extensive cervical/parametrial involvement.
ER/PR and HER2 testing are pending.
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 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...
What is your specific therapy choice and duration?
Would you send an Oncotype RS to determine the role of adjuvant chemotherapy and/or endocrine therapy?
Would you consider gene profiling to determine need for chemotherapy?
How would you balance the competing risks of these two diagnoses in her treatment?
Patient had a clinical T2N0 cancer at diagnosis, completed 6 cycles TCHP, and had 0.2mm residual disease with 80% cellularity, negative sentinel node.
How do clinical risk and Mammaprint/Oncotype scores affect your decision?
For example, will you recommend a certain vaccination timing in relationship to their treatment? Any concerns for reduced immune response or risks of ...
Patient underwent an axillary dissection with ITCs in 1/23 nodes.
Ex: TKI alone, TKI + checkpoint inhibitor, checkpoint inhibitor alone, TKI + mTOR inhibitor. Please specify drug regimen, if applicable.
Pathology is not carcinoid or small cell.
Would it change your decision if they had progressed on a first-line trial with cisplatin followed by pembrolizumab plus enfortumab vedotin maintenanc...
Given the data from KEYNOTE-522, would you try to incorporate chemotherapy in the treatment regimen?
Does tumor size impact your recommendation? High grade? Young patient age?
Does the advent of more effective therapies like peptide receptor radioligand therapy (PRRT) and capecitabine and temozolomide (CAPTEM) dampen enthusi...
Does lymph node positivity change your management?
Would you consider ALND and /or XRT to axilla?
Patient case is triple positive inflammatory breast cancer
Of note, the patient received cytotoxic plus HER2 directed adjuvant therapy but declined endocrine therapy.
Would you use FOLFIRINOX as in Prodige 23 or FOLFOX as in RAPIDO?
Chemoradiation completed 1.5 years prior
The patient went straight to gastrectomy for clinical T1 gastric adenocarcinoma, but post-op was up-graded to T4 disease.
Both ARTIST and Inte...
Pre-menopausal women make progesterone and their menses are typically lighter on tamoxifen because it's a mild endometrial ER stimulant blocking their...
Patient completed neoadjuvant therapy with TCH 2 years prior, and has no evidence of disease outside the CNS on PET/CT.
Would you test initial core biopsy (prior to neoadjuvant anastrozole) or surgical specimen? Any preference for Oncotype vs. Mammaprint?
SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation
Would your answer change if the new lesion is ALH/ADH?
The patient remains without evidence of systemic disease outside of the CNS on serial imaging. Would you continue treating with SRS as lesions appear,...
Would you recommend additional cytotoxic chemotherapy and/or switch her anti-Her therapy to T-DM1?
For a patient with high risk disease and a severe enough reaction that additional taxane-based therapy is contraindicated, do you consider alternate c...
Is there an advantage to early diagnosis and intervention versus observation until the nodules are amenable to percutaneous biopsy?
She had had 4 prior biopsies. Would the fact that she received 2 months of neoadjuvant tamoxifen due to COVID change your approach?
Patient completed adjuvant AC-T 8 months prior to recurrence. BRCA negative, foundation medicine NGS pending.
PD-L1 is low and she has residual neuropathy from neoadjuvant paclitaxel.
What are there most evidence-based options?
Out of curiosity, I did tumor testing, and she does not have an activating ESR1 mutation.
Is there any evidence for sacituzumab govitecan (IMMU-132) in this situation with progressive systemic disease after prior anthracycline and taxane?
If yes, would you offer tamoxifen or ovarian suppression plus AI?
This patient underwent mastectomy and ALND (10/28 positive lymph nodes). Immediately following axillary LN dissection (and prior to radiation) imaging...
Data from the SOFT/TEXT trials showed clinical benefit in ovarian suppression + aromatase inhibition for high risk, premenopausal ...
Would you treated with local therapies (RFA or SRS) and continue pembrolizumab or would you move to second line treatment?
Would you consider genomic assays before neoadjuvant chemotherapy? How would you modify your treatment given the COVID-19 pandemic?
Would you continue to trend ctDNA to detect early recurrence?
What chemotherapy regimen would you recommend?
Upfront surgery vs neoadjuvant therapy? And if neoadjuvant therapy, which regimen?
Patient has a good PS.
What are the risks of infection with COVID-19 if using immunotherapy?
Would your choice vary based on the patient's gender?
Should staging and treatment decisions be made based on imaging alone?
Personally, my practice is to guide patients directly to surgery or to do neoadjuvant chemotherapy rather than to do neoadjuvant endocrine therapy, bu...
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 ...
If so, how long is too long to wait?
This patient is interested in conceiving and therefore would like to wait to start the tamoxifen.
Do you ever consider stopping if stable disease and good tolerance?
For example, if a patient had testosterone pellets injected, perhaps making endocrine therapy less efficacious, would that sway you to use chemo?
Being that this is a favorable histology would you use Oncotype Dx to help decide on neoadjuvant chemotherapy? Would you recommend neoadjuvant endocri...
Most trials establishing CRT as standard of care for IIIB NSCLC excluded patients with separate ipsilateral lung nodules given that they were categori...
Would you treat this differently than someone who only presents with axillary nodal disease?
In your experience, what approach has been successful to bridge to surgery?
How, if any, do you utilize genomic testing to guide systemic therapy?
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...
Additionally, would the finding of any mutations, such as ESR1, change your recommendation?
For example, is this still your approach in women with small tumors or node negative disease?
If so, for what platelet count threshold and do you have a preference as to which agent?
PET-CT and Brain MRI are negative for other evidence of disease.
Would nivo + Ipi be appropriate in this situation, especially if high TMB?
In the absence of a frontline clinical trial, would you treat with carboplatin+pemetrexed+pembrolizumab or consider IMPOWER 150 or other?
Knowing that benefit of contralateral mastectomy is lower in older women who has already manifested BRCA related cancer and 10-20 % mastectomy related...
What would be the next line of treatment, PRRT, capecitabine and temozolomide or other?
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...
The NCCN guidelines regard MET exon 14 skip mutation as an emerging biomarker but no formal recommendation to start crizotinib. If high P...
Is there any advantage of one regimen over the others?
Is this new SSO choosing widely guideline being widely adopted and are there any concerns regarding this for clinical practice?
If finished adjuvantly, what would you do -- continue TC or change chemotherapy?
If yes, would you still recommend dual HER2 directed therapy?
After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has beco...
Given that DBA is associated with increased incidence of MDS, AML and other solid tumors, would this modify your treatment recommendations?
For early stage disease in a single breast, would you consider neoadjuvant chemotherapy or upfront surgical staging followed by adjuvant therapy? What...
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...
If so, what is your approach to sequencing and timing of targeted therapy and local therapy?
RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.
I have seen anywhere from 4-6 months utilized. Is there any data to guide your strategy?
Does your approach differ by EBV status?
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...
Does hormone receptor status impact your decision?
Following SRS to the brain lesions, is it safe to closely follow the patient for recurrence?
Tamoxifen prophylaxis has not been studied in women <35 years old, but it would be reasonable to assume they would benefit.
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 ...
If so do you favor repeat tumor biopsy or cfDNA?
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...
Do you see a role for adjuvant radiation therapy?
Patient has hot flashes.
http://abstracts.asco.org/239/AbstView_239_262655.html
If so, would you combine them vs monotherapy? Patient ECOG is 1
Why do the NCCN guidelines suggest using neoadjuvant therapy only for patients with T2 or greater tumors?
If so, would you treat as node + BC with anthracycline and taxane regimen or non-anthracycline regimen (i.e docetaxel and cyc...
greatest measuring 1.0cm.
Or would you proceed with standard-of-care adjuvant approach for high risk patients?
I.e. according to Mammaprint test?
Retrospective data suggest clinically significant disease flare after tyrosine kinase inhibitor discontinuation in patients with EGFR-mutant lung canc...
Patient did not receive neoadjuvant therapy.
If it is still within the 12 month period and no disease recurrence?
Is there a point at which there may be no benefit? More than 3 months from breast surgery? 6 months? 1 year?
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...
If so, what would be the regimen that you would consider and what factors would sway you for or against chemotherapy for such patients?
Would you give adjuvant chemotherapy or start osimertinib?
The CALOR trial included patients that could receive HER2-targeted therapy.
Some retrospective data reports that STK11 (AKA LKB1) makes NSCLC resistant to immunotherapy.
No other site of metastatic disease. It is unclear if this situation should be managed as two separate primaries or metastatic disease.
Would you consider neo-adjuvant chemotherapy or treat with endocrine therapy?
Do your recommendations differ if patients are pre or postmenopausal given the data?
Have the results from IMpassion130 changed the standard of care?
Does the answer vary based on whether it is neo/adjuvant or metastatic setting?
How applicable is the SOFT/TEXT data in this setting ?
Would you offer chemotherapy alone per data from BILCAP or is there any role of radiation?
Would you consider radiation and/or chemotherapy?
Initial pathology additionally yields low Ki-67 and is HER2 negative.
What if the patient has thymoma-associated myasthenia gravis?
Carbo/pemetrexed/pembrolizumab, carbo/pemtrexed without immunotherapy or second line immunotherapy (Nivo, Pem or atezolizumab)?
All tumors in this case were <2cm in size.
(HER2/CEP17 ratio <2.0, copy number >4.0 and <6.0 signals/cell)
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...
PD-L1 < 50% and no targetable mutations. Would you use carbo/pemetrexed/pembrolizumab or Nivolumab or pembrolizumab?
How does the timing of recurrence play into your decision?
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 ...
Would you offer adjuvant therapy post resection?
In the setting of the recent TailorRx data, would these patients be considered more high risk?
Pt is healthy and tolerating Tamoxifen well.
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...
Can these patients be re-challenged with Herceptin?
Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...
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...
If there is no response to neoadjuvant AC -->T, would you offer additional adjuvant chemotherapy?
High enough risk to justify anthracycline+taxane chemotherapy followed by ovarian suppression + aromatase inhibition.
If so, how frequently?
Pt clinically has inflammatory breast cancer making mastectomy a poor option.
First episode was 10 years ago and patient did not receive XRT. Would you give XRT now?
Do you offer additional adjuvant chemotherapy, proceed to adjuvant endocrine therapy, or search for a suitable clinical trial?
No prior chemotherapy.
Patient does not qualify for breast cancer screening by annual MRI per criteria (IBIS lifetime risk<20%, no known genetic predisposition,...
When would you favor delivering local therapy (e.g. SBRT) prior to systemic therapy?
These patients have been largely excluded from these trials. What if the infection is well controlled?
An article (BRCA mutation and outcome in BC. Ellen Copson, et al. Lancet Oncol. 2018) showed G3, BRCA+ breast cancer had poorer prognos...
If so, when? Are there certain ERBB2 mutations that would predict response to trastuzumab and/or neratinib?
Following the dosage guidelines based on absolute neutrophil count may cause the patient to end up receiving lower doses.
This is in regards to the risk of secondary cancers after radiation therapy or cytotoxic chemotherapy (such as anthracyclines) in an immunosuppre...
What do you do with low grade (grade 1/3) tumors? In other words, does high grade pathology over rules?
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?
Some patients request chemotherapy scheduling adjustments to avoid feeling ill on major holidays. Delaying chemotherapy by a few days isn't of particu...
Example case: Patient given neoadjuvant docetaxel + cyclophophamide achieves a partial response after 3 cycles of Taxotere + cyclophosphamide but is u...
How often will you monitor it? In the setting that patient is morbidly obese, does your strategy change?
Tamoxifen prophylaxis is FDA-approved, but would you extrapolate from adjuvant/metatastic data for hormone receptor positive breast cancer in post-men...
In the absence of data demonstrating a clinical benefit for one strategy versus the other, what do you do in practice?
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...
For example, would you order a PET/CT to evaluate for lymphatic or distant metastatic disease?
Does your institution do this routinely?
I.e. either for treatment of high-risk disease or intolerance/contraindication to tamoxifen. Will you continue it for the full 5 year course?
Do you prefer doing this through a "neoadjuvant" approach vs. post-operatively?
CALOR trial
How does the modest results of the APHINITY trial impact your practice?
In a patient with isolated leptomeningeal disease (no systemic disease), would you still recommend systemic therapy?
Do you reserve this approach for only women with triple negative breast cancer or all-comers?
Is this in addition to or mutually exclusive from oncotype/mammaprint?
Patient has hormone-refracatory disease, had high visceral burden (pulmonary mets, bone, lymph). Progressed on taxane, xeloda, gemcitabine. Now ...
What would you choose if there is no response to neoadjuvant AC-T? Taxol, THP, TCHP?
(For instance, TCX4 instead of AC->T for smaller tumors?)Does this affect your decision about treating with neoadjuvant versus adjuvant chemotherap...
How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?
At what point do you send these test, and in what instances do the results influence your treatment recommendations?
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?
Papers discussed in this category
International journal of radiation oncology, biology, physics, 2013-03-15
International journal of radiation oncology, biology, physics, 2011-05-01
International journal of radiation oncology, biology, physics, 2011-11-01
The New England journal of medicine, 2015-03-05
N. Engl. J. Med., 2015-01-29
Lancet, 2007-05-19
The Lancet. Oncology, 2016-12
Nat. Med.,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-02-01
Clinical breast cancer, 2006-12
Lancet (London, England), 2009-12-19
The Lancet. Oncology, 2014-06
The New England journal of medicine, 2012-11-08
J. Clin. Oncol.,
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-03-15
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-03-10
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-10
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