Breast | Age 60 | R/R

60 year female with history of an inflammatory Stage IIIb ER+/HER2 neg breast cancer in 2020. She presented to my clinic a couple of weeks ago with new diffuse hepatic mets and left supraclavicular metastases. Given her extent of new disease, I am consider starting chemotherapy due to visceral crisis (diffuse liver involvement and dysfunction). If she has a good response, is it appropriate to switch her back to endocrine therapy after she receives chemo?

Multiple Myeloma

In a patient w/ IgG Lambda standard risk MM who is not a suitable transplant candidate due to cardiac status and has maintained VGPR on Dara-Revlimid for the past 2 years (not currently on steroids due to issues with volume overload from heart failure), when do you consider de-escalating treatment? Or would you continue DR until no longer able to tolerate?

CLL

I have a refractory CLL patient that I am starting on Venetoclax+Rituximab, and I've been told that CLL patients have an increased risk of TLS compared to AML when initiating venetoclax. Is it recommended to do the slow, weekly Venetoclax ramp-up for CLL patients or can an accelerated ramp-up be safely used?

GU Cancer

73 y/o F who was diagnosed in 2016 s/p L nephrectomy for 8.5cm RCC with rhabdoid features, invading renal vein. She had recurred in lung 2018 and underwent resection RML for oligometastatic site 2018. We have been following with her q6 month with labs and CT TAP and she has been NED for 5 years now. My question is when you would stop Imaging and surveillance in such patients?

Lung | Age 63 | R/R

63 yo man w/ stage IV lung adeno EGFR+ who was on osimertinib 80 mg w/ progressive brain + hilar LN mets. Looks like he is BRAF V600E + now and also has a BRCA2 mutation. Would you see how he responds to the increased osimertinib dosing or switch him to dabrafenib/trametinib?

AML

Our group is worried about giving full dose ATO to newly diagnosed APL patient due to obesity. Her height is 172.7. weight is 181.3 and BSA is 3 and BMI is 60.8. So ATO dose should be 27 mg and we are doing 20 mg. I was just curious what would be your take on it?