Lung | Age 80

80yr female, ECOG 0 with stage IV EGFR exon 21 L 858R lung adeno, PDL1 5%. Just completed palliative RT for painful right chest wall lesion. Would you use osimertinib alone or with carbo/Pem?

H&N | Age 58 | R/R

58 year old female with SCC of supraglottic larynx, initially diagnosed as T2N0M0 received RT, total laryngectomy, then concurrent cisplatin+RT on local recurrence. Patient then progressed so started pembro but patient is experiencing clinical and radiographic progression. Is cetuximab my next best option?

GI Cancer | Age 43

43 M with Cirrhosis and a newly diagnosed rectal adenocarcinoma. Rectal cancer is locally advanced. He was evaluted by surgical team and mass was thought to be unresectable. Planned for total neoadjuvant therapy with 5FU continuous chemoradiation. For TNT, does the sequence matter?

Breast Cancer | Age 71 | New Dx

71 year old female with cT1 cN0 cM0 IDC of the right breast, grade 2, ER 5%, PR negative, HER2 negative, Ki 67 24% being referred to medical oncology. MammaPrint and BluePrint results: Basal-type, high risk 1 (index -0.324), probability of pCR 34%. Would you offer neoadjuvant chemotherapy given the low ER expression and high risk genomic score that would warrant chemo anyway?

AML

70 year old man who was diagnosed with high risk AML [JAK2 mutated, complex karyotype with 5 q., 20 q] He was given 7+3 [100 and 60]. He is day 15 today. His day 14 BM shows persistent AML. The overall cellularity appears slightly decreased at 30%. The majority of the cells present consist of blasts. These blasts account for over 90% of the biopsy cellularity. He is clinically doing well. NCCN has listed many options to do reinduction. How would you decide which regimen to offer?

GU | Age 70 | New Dx

70 year old male with borderline renal function, CrCl 50, locally advanced urothelial ca of bladder, T4N0, s/p 1 cycle of neoadjuvant Gem+ Cisplatin (split dose), developed worsening AKI after 1 dose of cisplatin, no recovery in renal function despite aggressive IV hydration and withholding cisplatin. Would you switch to carbo to complete remainder of the neoadjuvant course? Or move straight to cystectomy?