Liver and Pancreas Tumors   

Post-operative surgical course was complicated by anastomotic leak, septic shock, candidemia, wound infections, PE & DVT. Now recovering well.

The patient declined palliative measures only and is motivated to receive treatment

Would you treat as cholangiocarcinoma with a gemcitabine/platinum regimen or would you use a more HCC regimen like atezo/bev or durva/trem?

The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, wha...

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

When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently?  Options for systemic therapy in NCC...

Would portal hypertensive gastropathy or colopathy sway you away from using it?

And if delayed, should chemotherapy be started?

And is there any role in utilizing FGFR2 inhibitors in first line setting? The PROOF trial utilizing Infigratinib in first line was stopped after the...

Do you continue atezo alone if responding or switch to an alternative therapy such as dual IO or TKI? What about if the patient were experiencing subt...

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

Or offer resection followed by adjuvant therapy? 

Would you offer single agent immunotherapy or chemo-immunotherapy with gem/cis durva/pembro?

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

Please specify how your institution is allocating resources now or will be soon.

Would you use immunotherapy based on the TOPAZ trial?

If borderline resectable, can the TOPAZ regimen be considered for downstaging effects?

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

Is data sufficient to adopt this as the new standard of care? Can you comment on the reported regional and race-based variations in outcomes?  ...

Would you consider switching to a different regimen?

If multi-agent systemic therapy, i.e. FOLFIRINOX, is also planned, is there a preferred sequence of therapies?

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

The patient was started on a beta blocker, as this is standard in the area.

Would you consider using infigratinib after progression on pemigatinib?

What therapy would you offer if the patient had a baseline grade 2 neuropathy?

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

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

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

Would you offer low dose or standard dose aspirin instead?

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

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

i.e. CA 19-9 >100

When would you consider gemcitabine/abraxane as an alternative treatment? 

Specifically, would you consider incorporating immunotherapy in this setting?

For example in a patient with a history of PE?

i.e. EGD surveillance for varices?

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

ex. VEGFR2 expression, inflammatory signature, PDL1, etc.

Do you continue atezolizumab alone? Would you avoid anticoagulation?

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

Do you screen even asymptomatic patients?

Patient had a solitary lung metastasis 

For example, a FANC mutation

Would age influence your decision?

Is there evidence for radiation therapy in this setting? 

What are there most evidence-based options?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

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

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

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

Quite often we encounter cholestatic hyperbilirubinemia, wherein GI and IR do not believe ERCP with stents or PTC will alleviate jaundice. If the pati...

Does this also apply to somatic mutations?

With extensive use of NGS testing, it is commonplace to identify mutations that have no validated therapeutic intervention, but strong biologic signal...

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

ex. age, surgical risk, and/or performance status

Up to six cycles of treatment were given in the ABC02 trial.  Do you offer other treatments if you don't continue gem/cis beyond 24 weeks?

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

Given the variable and sometimes indolent disease course of these patients, as well as the absence of a clear overall survival benefit in the PROMID&n...

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

If you do employ this strategy, are there a number of liver lesions (eg <4) or duration of response that guide your decision making?

Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?

A pilot study has shown activity of this combination in a small patient group. 

A number of phase 2 trials support various combinations (e.g. gem/ox, cape/cis, cape/ox, 5-FU based) -- how do you decide either between these regimen...

Would you consider adding trastuzumab to cis/gem in the first line? If not, would you consider adding Her2 directed therapy to FOLFIRI or FOLFOX in th...

Do you continue with FOLFIRI for a period and then switch to olaparib (and if so, when do you make that switch) or do you switch directly after FOLFIR...

How would you approach this situation in the absence of BRCA mutation data?

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

Patient characteristics would unarguably be a deciding factor, but outside of these how would you approach the situation?

Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...

Is there a role for SBRT with or without the addition of systemic therapy?

The patient had minimal to no response to neoadjuvant therapy. 

What features would make you more likely to recommend radiation therapy with chemotherapy?

If so, which agent(s) do you prefer?

The GTX (gemcitabine, docetaxel, capecitabine) regimen is listed as a category 2B recommendation in the NCCN guidelines- when would this be ...

Stenting is not possible/not able to bring down the bilirubin level.

Regorafenib has been approved for patients with advanced HCC post-sorafenib, but the benefits are slight and toxicity substantial.  Nivolumab has...

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

What are the targets (tumor bed, positive margin, nodes etc.)?