Questions discussed in this category
The patient is a female in her 40s. No mucosal changes were evidenced on clinical exam. Chemo-RT is recommended by GynOnc at an academic center. ...
What are your volumes and dose/fractionation for external beam boost in lieu of tandem and ovoid or tandem and ring implant?
Tumor is HER2 3+ on IHC staining.
Do you think it works better if incorporated as early as possible in the patient's course, or is it better to "save it" for future recurrences after u...
For some patients, it may be overburdensome to make an extra trip to an ophthalmologist every other cycle. They may live far away from an ophthalmolog...
What is the reasonable expected benefit to be gained, if any?
What do you think is the role of radiation for this patient and how should it be timed?
If so, what do you typically prescribe?
Do you offer observation for POLE mutated tumors?
Would you consider the addition of carboplatin/paclitaxel + dostarlimab to radiation as opposed to radiation alone?
Would you consider this stage IVA (spread to adjacent organ) or IVB (spread to distant organ)? For instance, would the presence of direct lumbar verte...
My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...
How do you advise patients who strongly desire chemotherapy?
Cervical cancer FIGO stage IIIC2. Bloodwork shows elevated ESR and CRP.
The 4 cm cuff recurrence occurred 3 years after definitive treatment with hysterectomy and vaginal cuff brachytherapy to 21 Gy. The recurrence had a c...
Would your management change given that this recurrent lesion is over 10 cm and the patient previously achieved complete response on immunotherapy 5 y...
When, if ever, do you utilize adjuvant RT or chemotherapy?
This would apply to gynecologic and GI cancers as well. And as long as the patient's partner is within the recommend age of <45 yo
There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?
The patient was initially treated with Carboplatin/Paclitaxel and progressed after 1 year. She was switched to pembrolizumab and had significant progr...
Are there certain patient subgroups for whom you would use the IO+PARPi?
Is there data from DUO-E regarding BRCA status and its potential impact on ...
If yes, would you apply this broadly or reserve the addition of IO to chemotherapy for patients with high-risk histologies (e.g., carcinosarcoma) or o...
Does your decision depend on MMR status? Would you use the same approach for neoadjuvant treatment?In light of relevant trials including RUBY, GY018, ...
DUO-E, GY-018, and RUBY included patients with stage III and IV endometrial cancer WITH measurable disease.Would your decision change based on the mis...
Are there patients for whom you would still reserve IO for salvage/recurrent setting (eg IO + lenvatinib)? Would you base this on MMR status or other ...
How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...
What would you recommend for a patient in their 60s with stage IB grade 1 endometrial cancer without LVSI? How would this differ for a patient with st...
Do you proceed with sequential, concurrent, or sandwich treatment?
For example, do you think young patients might potentially benefit from the addition of cisplatin, knowing the average age in this study was 65.
Example: in a patient with a non-resectable pelvic mass involving the vagina but without evidence of distant disease, would you favor pelvic RT (as on...
How will you translate treatment recommendations from older studies to the new staging system?
Does the presence of parametrial or cervical involvement impact your decision?
How do you sequence treatment modalities?
This case involves an impressive ‘high volume’ vaginal recurrence and patient was not originally planned for adjuvant therapy. Concerned t...
Consider treatment of stage IVB cervical cancer with systemic therapy and local pelvic radiation therapy as in Perkins et al., PMID 31810653.
Considering this is stage IV disease, do your recommendations for definitive or adjuvant treatment (after surgery) change?
Considering the ASTRO guidelines recommend against systemic therapy for patients with FIGO stage I-II endometrioid adenocarcinoma, would your recommen...
Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...
MRI pelvis shows a 3.5 cm primary that appears infiltrative and without clear parametrial extension on MRI. Staging PET negative.
Is there any ...
Do you extrapolate from first line maintenance studies for duration of therapy?
Does the patient's MMR status affect your opinions? What is/are your current preferred second-line regimen(s)?
Please comment on toxicity profiles and the insufficient evidence regarding overall survival.
Front-line PARP inhibitor maintenance therapy discontinued without progression.
Considering updated trials, such as final OS data from NOVA, and recent society guideline updates?
Given the crossover that occurred in the various clinical trials and the potential for prolonged disease duration, how do you integrate OS, PFS, treat...
Does your approach change depending on the patients initial somatic BRCA status?
Please specify how your institution is allocating resources now or will be soon.
(i.e. frequency of serial BNP, troponin, cMRI)
If you do not use the PORTEC-3 regimen for p53 mutated IA endometrial cancer, what specific protocol or combination of chemotherapy and radiation ther...
How do you take into account pathologic factors like %clear cell histology, myometrial invasion, and LVSI?
How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation?
When would you use 5-fluorouracil instead of, or in addition to, cisplatin during chemoradiation? When, if ever, would you offer adjuvant hysterectomy...
For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...
In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...
Would your systemic therapy choice be more similar to treatment of ovarian carcinoma or soft tissue sarcoma?
How does your approach differ for patients under age 60, between 60-70, and over age 70?
How does histology and/or molecular testing change your approach? How does the length of the disease free interval change your approach?
How is your approach different from or similar to those who undergo surgical menopause?
How would you approach the treatment if the tumor is PDL1+?
Is there an optimal chemotherapy regimen that optimizes cure rates while minimizing side effects?
Do you include pembrolizumab with platinum-taxane + bevacizumab or reserve it as a second line option?
If considering systemic therapy, would you consider standard chemotherapy or use biomarker-directed therapy (e.g., imatinib if ckit+, larotrectinib/en...
How does your approach vary based on residual disease left at the time of surgery? Please specify your approach for the amount of residual disease at ...
In what situations would you use a neuroendocrine chemotherapy regimen over carboplatin+paclitaxel?
Is there a role for using pembrolizumab alone in microsatellite stable endometrial cancer if patients are unable to tolerate lenvatinib?
Are there specific clinical or social scenarios that would preclude the use of this treatment?
In the KEYNOTE-775 study, what was the proportion of patients who had a recurrence free interval ≥1 year from platinum-based cytotoxic chemotherapy...
Are there any planned trials to compare lenvatinib + pembrolizumab and platinum-based cytotoxic chemotherapy for advanced or recurrent endometrial can...
Does your approach to the number of cycles vary based on plan to include radiation therapy or presence of certain histopathologic features?
Anecdotally, I have seen more serious IRAEs in patients I'm treating with this regimen than anticipated. Is there higher risk with this drug combinati...
Are there certain patient or disease related factors that would lead you to incorporate lenvatinib + pembrolizumab earlier?
If so, do you use it for all patients or only cisplatin doses >= 70 mg/m2? What dose of mannitol do you use?
And if the tumor is MSI-H, does that alter your thoughts?
Do you prophylactically start all patients on B12, B-complex, and/or omega-3? If so, what dose? What about ice mittens and booties?
Considering the treatment of platinum resistant ovarian cancer as done in the AURELIA trial (Pujade-Lauraine et al., PMID 24637997).
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice?
...
How does the presence of specific mutations affect your adjuvant treatment planning or patient counseling?
Given POLE mutation status can currently o...
Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.
In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?
Assuming minimal toxicities except fatigue from long, recurrent infusions.
Do you stop therapy at 2 years or continue until progression of disease?
What is the impact among patients and providers?
Has your documentation been adjusted now that patients can readily review?
How do you maintain a trusting relationship with your patients when this relapse occurs?
Assuming low risk of progression to AML and eligible for low-risk chemotherapies per hematologic/oncology.
How do you decide if it may be safe to continue immunotherapy?
Do you try to keep Hb> 10 or 12? Or somewhere in between?
Do you routinely recommend any dietary changes or is the evidence not convincing?
Genes such as ATM, CHEK2, PALB2, RAD51C/D, BRIP1 seem to show some potential increased risk of ovarian cancer. Should these patients under prophylacti...
Do you allow patients with breast cancer on tamoxifen to use black cohosh?
If not, how often do you repeat pelvic imaging?
History of CDH1 mutation and prophylactic gastrectomy in 2017 - no other primary site found beyond vagina at diagnosis.
Vaginal tumor completely resp...
In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.
How do you manage the initial event, including length of steroid taper and the role of pancreatic enzyme monitoring?
What is your experience of subse...
Previously received pelvic EBRT and intracavitary brachytherapy. IORT was administered to the node-positive side wall at the time of exenteration.
Initially treated with definitive chemoRT but recurred with distant mets. Completed 6 cycles carb/tax/bev with minimal toxicity. Excellent performance...
Lung is biopsy proven met cervix, SBRT is planned.
Patient did not previously receive para-aortic radiation. Considering RT vs RT + chemo vs chemo alone
Are there any effective non-pharm or pharm interventions?
Recurrence was 2cm and PET confirmed local. Excision with positive margins. Current plan for salvage whole pelvic RT and vaginal cuff brachytherapy +/...
s/p optimal debulking.
If this was an early-stage cancer would it change your adjuvant therapy recommendations?
If confirmed neuroendocrine and PD-L1 pending, how would you treat?
Recurrence picked up incidentally on CT. No germ line mutations, somatic tumor testing of node resulted negative.
PET confirmed isolated recurrence
What non-pharmacological interventions do you recommend? Do you routinely prescribe prophylactic laxatives to patients initiating opioids? How do you ...
Initial diagnosis was 15+ years ago
Does your practice vary based on risk status (low vs high risk) or specific mutation status (BRCA+ vs HRD+) given PAOLA subset analyses?
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 ...
What specific platforms for determining somatic BRCA and HRD status do you use for a patient who does not carry a germline BRCA mutation?
If yes, what type of testing platform would you use?
Are there clinical factors which help stratify? Does your practice vary based on mutation status (BRCA+ vs HRD+?)
How do the 5 year results of SOLO-1 at ESMO 2020 impact your recommendations?
How many cycles do you prefer before and after? How long do you tend to wait before starting radiation after initial chemo and after radiation to resu...
Is MDS/AML risk increased with longer duration of therapy? Does your approach differ for patients who are BRCA+/HRD vs wild type/HRP?
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
Do you use specific tools or take into account certain factors when considering treatment options for older adults?
Patient has tolerated combination therapy well to date.
Given recent approval of niraparib (Zejula) for the maintenance treatment of adult patients with advanced epithelial ovarian, fallopian tube, or prima...
Patient is 34yo and G0 referred from surgical oncology. Laparoscopic specimens of myoma and what appeared to be adhesions were significant for maligna...
If patient meets high intermediate risk criteria, would you consider chemotherapy in addition to radiation?
Does not technically meet high intermediate risk criteria.
Tolerated first line, however now with rising Beta-HCG, new mass in uterus, and pulmonary metastases.
Does your strategy differ if the patient is on maintenance PARP inhibitor, bevacizumab, both, or neither?
There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.
Would you consider adjuvant chemotherapy, radiation therapy, hormone therapy, or surveillance?
The patient has a history of pelvic radiation and progressed through first line carboplatin/taxol. She has had a partial response to pembro/lenvatinib...
After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...
Does residual grade 1-2 neuropathy from Taxol/ carbo 10 years ago affect your recommendation?
Ie for patients who are inoperable due to comorbidities?
Since no data exists or is pending, and the two disease processes are similar, should we consider PARP inhibition in this setting? This is assumi...
E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?
I care deeply about clinical trials but have always struggled on how to approach this topic. I would really appreciate tips from those of you who have...
This has been a common practice in the community. Is there a benefit for certain patients?
Can it be prevented? How do you evaluate patients? What non-pharmacologic or pharmacologic interventions do you use for treatment?
Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...
How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...
When a physical exam is important and telehealth is not a good option, should we be proactive and reschedule or should we continue to see them as sche...
No adjuvant treatment was given upfront
SOLO1 trial studied stage 3/4 patients.
RP node with treatment related changes and surgical specimen from TAH/BSO no other foci of malignancy found.
Would you be more or less likely to use a cisplatin-containing regimen if a patient had previously responded to chemoradiation with concurrent cisplat...
https://www.nejm.org/doi/full/10.1056/NEJMoa1813181
Does the phase II KN-158 provide sufficient evidence to change management?
Should this be done at the time of recurrence or after failure of 1st line therapy for recurrence?
The NCCN recommends either systemic therapy + brachytherapy or pelvic RT + brachy or brachy alone or observation. How do you decide among these option...
Given the recent press release regarding the update on the phase 3 soft tissue sarcoma study of LARTRUVO (olaratumab) showing no benefit to the combin...
Should this be the new standard of care based on the results from the recently published SOLO-1 trial?
Two new phase 2 studies this year with apatinib/oral etoposide (AEROC) and sorafenib/topotecan (TRIAS) were released, and NCCN also lists many single ...
Or do you wait for platinum resistance?
Certainly ovarian cancer will respond to carboplatin and paclitaxel and it sounds like a reasonable chemotherapy to give to a stage IV NSCLC, however ...
Is it reasonable to use single agent carboplatin for elderly patients?
In a patient who underwent laparoscopy for endometriosis and was found to have a 1mm focus of neuroendocrine tumor, would you recommend further surger...
She has metastatic disease beyond the pelvis (lungs).
Would you approach this situation as synchronous primaries (eg. FIGO IA in both) or as a locally advanced endometrial cancer (FIGO IIIA)?
What adjuva...
Would you add chemotherapy if there was gross residual disease, pN+ and/or ECE?
Can the classic indications for post-hysterectomy radiation (eg. "Sedlis" and "Peter's" criteria) be applied? Does the histology change radiation dose...
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