CLL | Age 74 | New Dx

74yo M w/ newly diagnosed CLL/SLL. Presented with severe R. hip pain and imaging with a 9cm pelvic mass. Biopsy consistent w/ SLL. He has (+) FLOW for CLL in blood, but normal WBC count/lymphocyte count. TP53 negative. FISH and IGHV pending. Given significant symptoms, was considering treatment with BTKi (zanubrutinib) vs. acalabrutinib/obinutuzumab. In what settings do you typically add obinutuzumab rather than just single agent BTKi.

GU Cancer | Age 66 | New Dx

66 y/o M with muscle invasive bladder cancer who underwent radical cystectomy prior to seeing me. He did not receive neoadjuvant therapy. Surgical path showed papillary urothelial carcinoma, high-grade extending into the inner half of the muscularis propria, negative margins -- pT2N0. NCCN mentions adjuvant cisplatin-based chemo if >pT3, and nivo if they had >ypT2 after neoadjuvant therapy. Do you typically offer any adjuvant therapy in this situation?

Pancreas Cancer | Age 75

75 year old female, ECOG PS 1, type 2 DM, remote history of breast cancer with recent diagnosis of pancreatic adenocarcinoma, T3N0M0, elevated CA 19-9, no evidence of distant metastasis. Based on surgical oncology evaluation, she was deemed to have resectable disease, but preference was for neoadjuvant chemotherapy prior to consideration of surgery. What would be your preferred approach and regimen?

Lung Cancer | Age 51

51yo otherwise healthy male who presented with weight loss, dyspnea, chest discomfort. CT with left apical pleural-based mass ~6cm, partially necrotic left AP window mediastinal lymph node mass ~3.5cm, left 3rd and 4th rib cortical destruction. Core needle biopsy of LUL mass, pathology positive for spindle cell neoplasm, favor carcinoma. Would you recommend treating this as oligometastatic disease with RT to ribs, spine and gluteus lesions and concurrent chemoRT to the thoracic disease? Or treat as metastatic disease with systemic therapy? Also, given the spindle cell morphology, what regimen would you recommend using?

MM | Age 69

69 yo male with high risk myeloma (1q gain) in renal failure, GFR 9. He is ill due to myeloma only, excellent health premorbidly. I would say potentially transplant eligible. Would you do cybordD until renal function stabilizes, DaraRD or Dara-VRD?

GU Cancer | Age 64 | New Dx

64 yo M with no significant PMH presents with metastatic SCC of the bladder to the lung. He originally presented with urinary obstruction s/p nephrostomy tube placement with preserved CrCl. He has ECOG 1 and remains fully functional. What would be the best treatment?