Breast | Age 72 | New Dx

72-year-old patient with numerous comorbidities including cardiac valvular disease with a normal LVEF in fairly poor health (ECOG1-2) recently diagnosed with locally advanced left breast carcinoma. Her biopsy has revealed an ER/PR positive HER2/neu positive invasive carcinoma with a Ki67 score of 49%. She was referred to me for neoadjuvant therapy. I am skeptical that she will tolerate TCHP. Do you generally use an alternate chemotherapy + anti-HER2/neu combination in less fit patients requiring neoadjuvant therapy?

AML

What would your approach be to a patient with AML who is s/p induction with D30+ marrow demonstrating low blast percentage, say <5%, but otherwise hypoplastic with peripheral counts having persistent neutropenia and thrombocytopenia?

GI Cancer | Age 84

84yr female who was found to have a 4.5cm right liver mass, bx positive for gr 2. NET, Ki 10-20%. Octreotide scan: right liver, left neck and vague central abdomen uptake. Treated her as metastatic and started octreotide. 3 months later, slight weight loss and right liver mass up to 6.8cm on CT, no other sites. Would you rpt functional imaging (not sure if we could get approved) and refer to Surg Onc or change therapy, if so what?

MM | Age 77 | New Dx

77 yo man with solitary plasmacytoma with flow cytometry showing monoclonal kappa restricted plasma cells. Bone marrow biopsy had <5% polyclonal plasma cells. I saw him last week for f/u earlier than planned because he started to notice subcutaneous nodules on his scalp that were increasing in size and number. I ordered a PET and he now has extensive bony and soft tissue nodules with several fractures. Is this considered extramedullary disease? a combination of numerous plasmacytomas AND extramedullary disease?

MDS

88 yo male with LGL and bone marrow features consistant with VEXAS syndrome. Does he require a rheumatology work up or treatment?

AML | Age 67 | New Dx

67 yo woman who is pancytopenic and marrow shows AML. She is feeling well at the moment and scheduled to close on her house soon and move out of state. She is transplant eligible and needs induction. The closest transplant center where she is moving is over an hour away. Is there any treatment I can give safely outpatient while she tries to figure out where she wants to be treated?