NCI-CCC GU Tumor Board Question   

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

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

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

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

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

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

Would you consider re-challenging with a different TKI?

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...

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 ...

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

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

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 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.

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

Gleason 4+3=7 and PSA 4

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

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?

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

What neoadjuvant or adjuvant therapy would you give?

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

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