GI Cancer

56 year old gentleman with metastatic BRAF V600E mutant colorectal cancer who received frontline mFOLFOX+avastin with 5FU/avastin maintenance. Progressive disease so placed on therapy with cetuximab+braftovi. Based on the trial, it seems this therapy requires ongoing weekly cetuximab infusions until progression. Is there an alternative infusion schedule or approach that is logistically easier on the patient?

AML

75-year-old man with new diagnosis of AML, with 80% blast on bone marrow. He has past medical history of CKD, suspected hypertensive/diabetic nephropathy, progressive renal function decline in the past month with creatinine increasing into the low threes. He is currently day 7 of azacytidine and venetoclax. On day 1, his creatinine was 4 and now it is 3.65 He has BUN of 100 since day 1. Nephrology noted he has proteinuria, 3g in urine now. Admission labs showed possible TLS (Uric acid 5.7, K 6, Ca 8, Phos 5.7, creatiine of 4) for which he got rasburicase and decrease in UA but renal function did not improve. Would you have recommended dose adjustment to Aza or Ven?

Multiple Myeloma | Age 89+

Over 89 year old female with kappa light chain multiple myeloma, diagnosis based on marrow involvement of 10-15% clonal population with light chain involved:uninvolved ratio >100, and biopsy proven amyloidosis in the bone marrow with suspected cardiac and nervous system involvement. Blood counts, electrolytes, and renal function have remained stable as well. She has never been interested in receiving therapies given her age and that she feels well overall. However, as she is having some progression of cardiac symptoms and fatigue, she would be willing to try therapies that are minimally toxic and do not require any time at an infusion center. What potential regimens would you recommend?

Lung Cancer | Age 66

66 F never smoker presented last year with NSCLC, extensive bone and brain mets.Bx adnoca, NGS EGFR L858R and EGFR T79M both high VAF, EGFR amplification and RET V804M (confirmed to be germline by genetic testing). Treated with osi with initial response but progression after just 6 months. Re biopsy and repeat NGS; Same variant plus MET amplification and DCC deep deletion. Would you rec to target MET ampl, or RET or just chemo?

Non-Hodgkin Lymphoma | Age 44 | New Dx

44 y/o male with recent hx of worsening abdominal pain, fullness, and fatigue. Labs show mild lymphocytosis (wbc 11.3), mild anemia and thrombocytopenia (hgb 12.3, plt 92k). Iron studies showed ferritin 700, iron 30, transferrin sat 9. CT CAP showed severe splenomegaly with spleen size 24cm. I am concerned about HCL/SMZL/MPN/CLL. I needed help with the initial workup. I ordered... Anything else? What labs would you order on the marrow? Any special NGS orders?

Lung Cancer | Age 71 | New Dx

Newly diagnosed stage IVB NSCLC (adeno) with primarily skeletal and lung disease. Her biopsy has returned as a poorly differentiated adenocarcinoma. Molecular data include PD-L1 TPS <1%, EGFR G719A, ERBB2 p.S310F. No other actionable mutations. She is still post operative from her spinal decompression and ECOG 2. Should I target her uncommon EGFR mutation or Her2 mutation up front?