Head and Neck | Age 68

68 YO lady with multiple recurrences of lateral tongue SCC removed surgically with initial right neck dissection. Most recently I was involved giving adjuvant cis/RT for high risk features. She had recurrence in the left neck and tongue 5 months later. Had surgery and left neck dissection. Tried to give cetuximab with RT but had grade 3/4 reaction so she only give RT to left neck. I started on pembro and a surveillance CT now shows new small lung nodules 2 weeks into starting Pembro but also gas URTI and port wound infection. What would you do next?

Lymphoma | Age 75

75 year old male with ECOG PS: 1 who had chronic persistent leukocytosis since 10 years, initially with negative work up for MPN, including bone marrow biopsy. Since early 2023 his leukocytosis has been progressive with development of generalized lymphadenopathy. Bone marrow is hypercellular and consistent with CMML. Ki-67 35 to 40%, overall favoring histiocytic sarcoma. My questions are is there a relation between CMML and histiocytic sarcoma? How would you approach this case?

Breast Cancer | Age 53

My typical practice is to recommend upfront surgery for T1c lesions but I know some institutions do neoadjuvant for these lesions with TH or THP. How do you decide on these cases and what data would be best to discuss?

HL | Age 27 | New Dx

We were unable to obtain vinblastine for cycle IIIA, and we are still awaiting availability. He is due for cycle IIIB. Should I just continue his current treatment without vinblastine until anticipated availability of vinblastine later this month?

Hodgkin Lymphoma | Age 72 | New Dx

72 M with a new diagnosis of stage III Hodgkin's lymphoma with good functional status and no significant past medical history. Do you prefer ABVD? or consider switching out bleomycin due to pulmonary toxicities with higher risk in old age?

GU Cancer | Age 71 | New Dx

71 yr old male with de novo castrate sensitive metastatic prostate cancer with diffuse adenopathy [bx proven] and bone marrow involvement [s/p BM Biopsy]. He is status post orchiectomy. I have requested NGS and genetic testing. I plan to start an oral anti-androgen agent. In such situations is there a specific agent you prefer that would be less myelosuppressive?