CRC | Age 58 | R/R

58 y.o healthy female. rectal cancer w/ large liver and lung mets. pMMR, Her-2. Muncinous. NRAS mutated. Tempus has no suggestions. Seen FOLFOX and FOLFIRI+bev with no meaningful response. Now starting Lonsurf+bev. I don't have an NRAS mutation trial near me, but I don't know how helpful that would be anyway. Other suggestions for effective tx?

Hodgkin Lymphoma

With many options, interested to hear about your approach to unfavorable risk, localized HL?

AML | Age 45 | New Dx

45 y/o F with AML, inv16, with NGS +FLT3 TKD and +NRAS mutations, and biopsy-proven leukemia cutis (right leg). Received 7+3 (without midostaurin as the rapid AML panel was initially negative, but final myeloid NGS panel showed the FLT3 mutation). I consulted with several transplanters and the consensus has been to hold off on transplant in CR1 if she is MRD negative. She is now s/p HiDAC consolidation with midostaurin, although she only took the midostaurin for a few days each cycle and it was held during several admissions for fever/bacteremia. Given she did not receive full intended course of midostaurin during her treatment course, would you consider additional midostaurin as monotherapy maintenance? Or just observe?

Ovarian Cancer | Age 59

59yr female with high grade serous ovarian carcinoma treated with carbo/taxol/bev x 6 then debulking which showed FIGO IIIa residual disease. She did not tolerate maintenance zejula and recurred right at 6 months. I’ve called her platinum sensitive and started carbo/gem/bev. Ca125 went from 157 to 116 after C1 but she developed carbo reaction after C2. My institution does not have desensitization protocol. Tissue NGS: TP53 and NF2+, Her2-. Germline BRCA negative. What would you recommend next?

Breast Cancer | Age 21 | New Dx

21 year old female with a Stage III ER+/PR+, HER2+ FISH (equivocal) that has about 7 cm mass. Genetics with MSH6 VUS. PET showing single breast mass, left axillary LN, and 2 sub centimeter left internal mammary LN, no mets. She's very young and nervous about side effects of anthracyclines in long run which is reasonable. What would you use chemotherapy wise assuming she has oncotype that necessitates chemotherapy?

AML | Age 63

63 yo female with past medical history of triple negative right breast cancer. Bone marrow resulted showing 60-70% blasts, complex cytogenetics, with 2 TP53 mutations, and NF1 mutation. I started patient on Dacogen x 5 days every 28 days, with referral to BMTx evaluation. I want to add venetoclax but can't due to neutropenia. My issue is: how do I give her veneto or even C2 of Dacogen when she's always neutropenic?