Pulmonology&nbsp;&nbsp;&nbsp;

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

At what age do you stop LDCT chest for lung cancer screening?

USPTF and CMS guidelines differ in age criteria, and NCCN guidelines do not have an upper age limit.

Do you perform EBUS-TBNA for staging in patients with biopsy proven malignant lung nodules with no lymphadenopathy on CT chest and PET scan?

Al-Ibraheem et al., PMID 33731050

In which cases would you consider early transition to DOAC (within 72 hours) for hospitalized patients with intermediate or high risk PE?

Assume thrombolytics are not indicated. Do you favor early DOAC transition after 24-48 hours of heparin gtt or do you favor LMWH for 10-14 days follow...

What is your approach to radiographically suspicious lung nodules for which initial biopsy was negative for malignancy?

How do you decide between neoadjuvant or perioperative chemoimmunotherapy, as per Checkmate 816 or KEYNOTE-671, for early-stage NSCLC?

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

Do you perform routine interval lung cancer screening in non-smokers who are 1st degree relatives of patients with non-smoking related lung cancers with known EGFR mutations?

How do you manage concurrent nonlife-threatening hemoptysis and acute pulmonary embolism?

Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...

Is there a role for nintedanib in the management of patients with radiation-induced pulmonary fibrosis?

How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?

Is dyspnea without radiation pneumonitis a side effect of lung radiation?

Is this acute or long-term, and does it matter whether this is SBRT vs fractionated?

Would you give T-DXd to patients with resolved drug-induced ILD from other agents such as prior chemo/targeted therapy/immunotherapy?

How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?

How do you define an adequate EBUS when staging NSCLC?

Is there a minimum standard for which stations to sample? Does lymph node size affect your recommendations?

What is your next step in management for a patient with immunotherapy induced pneumonitis that does not improve on high dose steroids for 48 hours?

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

What is the optimal frequency and duration of post-operative radiological surveillance following resection of a solitary fibrous tumor?

For NSCLC patients with limited diagnostic tissue that is insufficient for genetic testing, do you offer repeat biopsy (of accessible site), blood based testing, or both to evaluate for actionable driver mutations?

What is the role for "liquid biopsy" for patients with newly diagnosed metastatic NSCLC?

Do you consider the duration of lung/lobar atelectasis in your decision making while offering airway stents for malignant central airway obstruction?

Are patients with long standing malignant central airway obstruction poor candidates for central airway stents? What is considered to be an acceptable...

Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?

Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...

What is your preferred management for diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH)?

Does your management change if symptomatic or asymptomatic?

Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?

6 Answers available

Is there a role of everolimus or capecitabine and temozolomide in diffuse idiopathic pulmonary neuroendocrine cell hyperplasia in patients already on octreotide?

How do you monitor for pulmonary toxicity for patients on trastuzumab deruxtecan?

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

How do you approach management of limited stage SCLC in a patient with idiopathic pulmonary fibrosis?

Are there known biomarkers predictive of IRAEs?

How do you manage steroid-refractory immune checkpoint inhibitor induced pneumonitis?

What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?

What are your top takeaways in Thoracic Cancers from ASCO 2022?

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

6 Answers available

Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?

What are best practices for engaging with multidisciplinary colleagues to ensure patients with earlier stage NSCLC are being appropriately considered for novel adjuvant therapies?

How are your teams effectively evaluating and counseling patients to ensure they are prepared for potential extended adjuvant treatment approaches? Is...

Would you offer adjuvant chemotherapy, osimertinib, or both to a patient with Stage IB EGFR mutated lung adenocarcinoma found in the lung explant pathology after bilateral lung transplant?

Would you consider the immune suppressed status of the patient as a high risk factor to offer adjuvant therapy?

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

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...

How do you evaluate a suspicious, but negative pleural effusion when working up NSCLC and SCLC?

Are two negative pleurocentesis' adequate to conclude that the patient does not have metastatic disease? Do you routinely recommend VATS and pleural b...

How do you manage end-organ toxicity such as hepatotoxicity or pulmonary toxicity in a patient receiving RET-inhibitors for NSCLC?

What is the optimal management of patients with stage II lung cancer without nodal metastasis, but unresectable due to poor pulmonary reserve?

For T2bN0 or T3N0 disease, you consider radiation alone, sequential radiation followed by chemotherapy, or concurrent chemoradiation?

How would you manage a patient with newly diagnosed locally advanced NSCLC and concurrent, active tuberculosis on anti-TB therapy?

After initiation of anti-TB treatment and 3 negative AFB smears, would you initiate concurrent chemoRT? Would you give sequential RT then chemo to giv...

Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?

How do you treat extensive stage small cell lung cancer in the very elderly (more than 80 yrs)?

How has COVID-19 altered your recommendations for invasive mediastinal staging for NSCLC?

Should staging and treatment decisions be made based on imaging alone?

How would you treat a patient with extensive-stage small cell carcinoma and severe end-stage COPD on home oxygen?

Would you treat with chemotherapy (carboplatin/etoposide) vs anti-pd-1 monotherapy vs combination chemoimmunotherapy vs supportive care?

In a patient with ILD and metastatic NSCLC with positive PD-L1, would you give chemo/pembrolizumab, chemotherapy alone, or pembrolizumab alone?

Does the degree of PD-L1 expression weigh into your decision?

How do you approach elderly patients with stage III NSCLC who have a reasonable performance status?

Do you recommend or make any modifications in the PACIFIC regimen for patients > 75 years of age?

How do you identify immunotherapy-related pneumonitis vs. radiation pneumonitis in a patient status post chemoradiation receiving consolidation immunotherapy?

Is IO related pneumonitis in the radiation field or more diffuse?

How are you using liquid biopsy in the routine management of your patients with metastatic NSCLC?

Are you using ctDNA blood tests for targetable mutations at the time of diagnosis, at the time of disease progression, or not at all?

How do you approach the workup of subcentimeter contralateral nodules in cases of locally advanced NSCLC?

When there is biopsy proven mediastinal disease, do you offer definitive chemoradiation and monitor, or do you try to prove the presence/absence ...

What factors do you consider to help guide treatment for patients with high grade large cell neuroendocrine cancers of the lung?

Do you incoprate Ki67% or mitotic rate into your treatment decision, and is there any use for somatostatin based imaging such as octreoscan or gallium...

Do you use anti-PD-1/anti-PD-L1 therapies in lung cancer patients with a prior history of radiation pneumonitis?

What about patients who are still on steroids for radiation pneumonitis?