Questions discussed in this category
Would you consider it for a patient who had bulky thoracic disease, with limited extrathoracic disease at diagnosis and achieved a CR after induction ...
Per NCCN exclusion of EGFR/ALK alterations at a minimum is recommended prior to consideration of neoadjuvant chemoimmunotherapy.
Do you increase the dosage of the TKI or switch to a different generation TKI? How does your answer differ for EGFR vs. ALK, and for discrete brain me...
How do you decide between entrectinib or crizotinib? Since no head-to-head comparison, can real-world datasets (such as Doebele et al., Journal of Cli...
Are there specific patient factors for which you would more preferentially use this regimen?
Should we switch to a new TKI?
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...
Does the site of treatment factor into your decision?
Does the type of autoimmune disease (ex IBD, rheumatoid arthritis, interstitial lung disease) matter?
Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?
For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...
The left breast cancer is an ER-negative, PR-negative, HER2-negative cT2N0 invasive ductal carcinoma, while the left lung primary is a cT2N1 squamous ...
This has become standard practice at our institution for patients with a good performance status, with whole brain radiotherapy given after the comple...
What clinical or radiographic factors would lean you in either direction - ie. time since index diagnosis, distribution or appearance of lung and noda...
Patient already on methotrexate and plaquenil.
Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?
What specific platforms do you use, individual biomarker/PD-L1 status vs NGS, tissue vs liquid or both?
Must you wait for PD-L1 testing if mutation t...
Or would you conduct tissue or blood testing if no actionable results are found?
Ex. TP53, BRCA, T790M, or another? As of now, T790M mutation is one of the few de novo mutations found in treatment naïve patients that have been...
Would you recommend standard definitive chemoradiation followed by adjuvant durvalumab? Would you treat pre- or post-systemic therapy volumes?
Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...
If so, how often do you check these labs?
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?
Would you still use ram/doce in 3rd or later lines after ram/pembro?
Did S1800a stratify by prior treatment response? Would you choose different 2L treatment for a patient who progresses rapidlly on pembro + platinum do...
How do you counsel patients on the available second line options?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
Would the timing of the relapse (eg within 6 months) impact your decision making?
Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...
Patient has been on pembrolizumab and had two symptomatic soft tissue mass treated with radiation.
How and when do you plan to perform HER2 testing in patients with NSCLC?
How does trastuzumab deruxtecan compare to other HER2 targeted strategies?
How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...
Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?
Do you feel the dosing used in...
If yes, do you recommend it be given concurrently with chemotherapy or sequentially? What is your target volume and dose?
Would you offer topotecan, lurbinectedin, or another agent given the CNS progression as well?
Given that prophylactic cranial irradiation (PCI) has been shown to decrease the incidence of symptomatic brain metastases in patients with extensive ...
Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...
Would you consider afatinib? Afatinib has shown some activity in NRG1 fusion + patients but amplifications is unclear.
Conversely: In a patient with N2 EGFR+ NSCLC receiving radiation, would you still consider use of osimertinib?
Are there any data to support a specific TKI therapy for non-T790M exon 20 mutations/insertions?
Is data available regarding the percentages of patients in each arm who underwent staging PET or the breakdown of CNS imaging modalities?
Are the rates of adjuvant chemotherapy used in ADAURA consistent with real-world practice?
SRS done to the single brain met, PD-L1 5%, BRAF G469A mutation
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 it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?
Would you continue pembrolizumab with a re-challenge with carboplatin/taxane or move to second line therapy?
How do you approach this given the limited # of patients this applies to? Checkmate 017 and 057 only had 5-7% of patients still on nivolumab at ...
NCCN recommends annual CT surveillance indefinitely after year 5, but I’m curious how many physicians continue and for how long?
1st-line pembrolizumab is supposed to be used AFTER failure of appropriate targeted agents in this setting, but would you consider the reverse sequenc...
Would PDL-1 status impact your decision?
Medical inoperability is clearly defined, anatomical resectability is also pretty much clear (invasion of trachea/carina/esophagus, etc). But what abo...
If you are using a standard 30/10 fractionation, is there a benefit to keeping chemo on board for radio-sensitization?
Is the timing of progression (in relation to chemoradiation) a factor, and is there any role for repeat PD-L1 testing at the time of progression?
If it is still within the 12 month period and no disease recurrence?
Since the randomized phase II data from Gomez et al presented at ASTRO 2018 showed a survival benefit, is there concern about randomizing patients to ...
Would starting with chemotherapy be preferred in this situation and consider concurrent radiation, then switch over to Pembrolizumab once some control...
Do you prefer carboplatin-paclitaxel-bevacizumab, carboplatin-pemetrexed-pembrolizumab, or chemotherapy alone?
Can SRS or whole brain radiotherapy be reserved for progression in these young, healthy patients?
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?
If you treat pre-chemotherapy volumes, is there a benefit to induction chemotherapy even in bulky disease. If so, how do you define disease that ...
What factors influence your decision (R1 v. R2 resection? T stage?) If sequential, do you typically prefer radiation before or after chemotherapy?
Can T790M mutation develop within this early time frame, or are these perhaps patients who may benefit from switch to chemotherapy?
Or do you recommend treatment with systemic therapy alone, as this represents Stage IV disease?
Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?
What is the best evidence for what dose to use? When would you give it in relation to the checkpoint inhibitors? Which metastatic sites do you choose ...
Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is t...
How long do you typically wait before starting consolidation chemotherapy, and do you routinely perform re-staging scans prior to consolidation?
What immunosuppressive agents are used and in what order? Does your approach differ depending on the organ involved, e.g. colitis vs. pneumoniti...
In addition to addresing the brain met (surgery vs. SBRT), would you proceed with systemic "adjuvant" chemotherapy, or would you treat the patient as ...
Is there any data to support this approach? If not, are there trials you are aware of looking at "rescuing" these patients with a different chec...
Does the extent/duration of systemic disease control (complete response vs. stable disease, for example) influence your decision? What about whe...
Does the risk of severe inflammation of the liver lead you to choose other therapies in in this population? What about in patients with mild liv...
If these are presumed to be immune-mediated (e.g. immune neutropenia or immune thrombocytopenia), do you treat with steroids?
The Phase III J-ALEX study and two phase II studies seem to suggest favorable intracranial response rates for alectinib.
What about patients who are still on steroids for radiation pneumonitis?
Would you consider giving the therapy with concominant steroids, or with a dose reduction?
Do you add bevacizumab regardless of whether you are using paclitaxel or pemetrexed with the platinum agent?
Also, are you testing for PD-L1 routinely prior to initiation of first-line systemic therapy?
Based on recently published data from CheckMate 032, do you now offer nivolumab to small cell patients who have progressed after first-line chemothera...
What about specifically in never-smokers?
4cm has historically been used as the cutpoint for determining benefit from adjuvant chemotherapy in this population (Strauss et al, JCO 2008; Bu...
Although PD-1 inhibitors are now standard of care for second-line therapy of advanced NSCLC, there remains the question of which therapy is best to us...
Would you offer adjuvant TKI following ADAURA data? Or proceed with durvalumab based on PACIFIC data?
As it is suggested for larger tumors treated with surgery, based on post hoc CALGB analysis?
Based on the European data published in the Lancet (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961085-0/abstract), are you s...
For example, should nivolumab be considered standard second-line therapy for adenocarcinoma patients? Can it be considered for first-line thera...
I am aware that chemotherapy can obviate the need for RT in patients with SVC syndrome, but I'm not sure if this can be extrapolated to spinal cord co...
If so, what would you include in the target and what dose?
Should mutations other then EGFR and ALK be routinely tested for? Should next generation sequencing be routinely done?
Would you stop the Tarceva at this point?
I've read about patients who were treated with concurrent bevacizumab-RT who developed lethal tracheoesophageal fistulas. How long would you have to w...
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