Medical Oncology

In a patient who would be otherwise fit for surgery +/- adjuvant RT, and the delay is caused by COVID-related OR staffing issues, what would be your a...

1 Answer available

How do you recommend differentiating between localized cutaneous melanoma of the perianal skin versus mucosal melanoma of anal canal?

This question arises from a case of a patient with multifocal nodular melanoma with circumferential involvement of the perianal region.

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What is your preferred first-line treatment for metastatic melanoma in a patient with a class 2/non-V600 BRAF mutation?

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What is your preferred adjuvant treatment option for a patient with stage III BRAF-mutated melanoma and a history of a solid organ transplantation on immunosuppressants?

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What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?

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Would you offer adjuvant immunotherapy for a melanoma patient with lymphocytic colitis?

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How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?

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What surveillance imaging do you obtain for stage III melanoma patients after completing systemic adjuvant therapy?

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Are there circumstances where you would recommend every 6 week dosing schedule for pembrolizumab monotherapy?

I am considering every 6 week pembrolizumab dosing in patients >70 years old in whom I want to reduce clinic visits for, especially in the context ...

3 Answers available

Would you pursue adjuvant immunotherapy for a resected stage IIIC or IIID, BRAF wild type, melanoma patient with pre-existing ulcerative colitis that is well managed on maintenance infliximab?

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Would you change systemic therapy for metastatic melanoma on BRAF/MEK targeted therapy with excellent extracranial response, but with CNS-only progression?

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What is your preferred adjuvant systemic treatment for resected stage IV melanoma with a BRAF mutation?

Based on available results from the IMMUNED trial, which evaluated the role of adjuvant nivolumab/ipilimumab or nivolumab monotherapy vs placebo in re...

2 Answers available

What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?

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Would you continue cemiplimab or pembrolizumab following resection of initially unresectable cutaneous squamous cell carcinoma?

What if pathology showed NED?

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How would you approach a BRAF negative metastatic melanoma patient on immune checkpoint inhibitor therapy with enlarging, symptomatic brain lesions that had previously been treated with SRS?

If on pembrolizumab or nivolumab, when would you escalate to ipilimumab/nivolumab?

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How do you manage MEK inhibitor induced ocular adverse events?

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When, if ever, would you consider using encorafenib/binimetinib or vemurafenib/cobimetinib instead of dabrafenib/trametinib for adjuvant treatment of BRAF mutated melanoma?

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Is there benefit in switching between sonedegib to vismodegib or vice versa for patients with unresectable basal cell carcinoma of the face that progresses on first line hedgehog inhibitor?

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Would you start neoadjuvant treatment with immunotherapy or BRAF/MEK inhibitors in a patient with a large regional inoperable BRAF V600E positive melanoma (IIIC)?

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Is there a role for adjuvant therapy, either radiation (+/- chemo), or systemic therapies (immunotherapy, targeted agents or chemotherapy) after resection of anorectal mucosal melanoma?

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Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?

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How do you decide between initial radiotherapy vs systemic therapy in patients with metastatic melanoma and brain metastases?

If neurologic symptoms are absent or controlled, does that affect your treatment decision?

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Would you consider starting immunotherapy concurrently with whole brain radiation for newly diagnosed metastatic (BRAF negative) melanoma with multifocal symptomatic brain metastases?

If so, would you consider it with monotherapy only or also with combined checkpoint blockade?

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Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?

What dose of radiation, what type of chemo, and what indications?

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When do you change treatment for an asymptomatic metastatic melanoma with a mixed response after at least 3 months of treatment with a PD-L1 inhibitor?

1 Answer available

Is there any contraindication to concurrent administration of radioactive iodine in a patient on immunotherapy?

A patient with stage 3 melanoma on adjuvant nivolumab needs radioactive iodine for papillary thyroid cancer.

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Would you offer concurrent chemoradiotherapy and/or adjuvant systemic therapy (chemo or immunotherapy) or for a completely resected stage III Merkel cell after WLE and ALND?

Patient is a 67yo with a pT1 (2.5mm) pN1a merkel cell of the chest, 1 mm deep, widely clear margins, SLN with 1.5mm met, 11 additional axillary ...

2 Answers available

For a patient with limited/resectable metastatic melanoma and no evidence of disease after resection, when would you consider doublet immunotherapy rather than nivolumab or pembrolizumab monotherapy?

For instance, in a patient with isolated distant nodal involvement who had the lymph node resected but did not have a lymph node dissection?

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How do you manage local recurrence of a resected stage III BRAF WT melanoma occurring during or shortly after completion of adjuvant nivolumab?

Would you offer nodal dissection and/or additional adjuvant immunotherapy in addition to wide local excision?

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How do you decide whether or not to give immunotherapy in patients with a history of an isolated, severe autoimmune event?

For instance, not chronic autoimmune diseases (eg RA, IBD) that may relapse/remit but events like Guillan Barre syndrome that is not likely to recur b...

1 Answer available

What therapy would you offer a young BRAF wild type patient with metastatic melanoma, who progressed on single agent pembrolizumab?

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How do your adjuvant treatment recommendations change, if at all, for clinically node positive Stage III desmoplastic melanoma?

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How would you treat a patient with BRAF mutated Metastatic Melanoma who has progressed on targeted therapy (Encorafenib + Binimetinib) and Immuotherapy (Nivolumab/Ipilimumab), but yet maintain an excellent performance status?

2 Answers available

Can you use immunotherapy in patients with liver transplants?

With increasing utility of immunotherapy across cancer types, patients with history of solid organ transplants may face need for cancer IO. How do you...

1 Answer available

When do you consider employing the 4-week dosing schedule for nivolumab?

The FDA has approved the new dosing schedule of Nivolumab 480 mg every 4 weeks for multiple disease sites (melanoma, RCC, urothelial carcinoma, SCC of...

5 Answers available

What are your recommendation for vaccines in patients while on immunotherapy?

Do you recommend or withhold influenza and pneumonia vaccines while on treatment with checkpoint inhibitors?

1 Answer available

How often are you recommending adjuvant pembrolizumab for resected stage IIB/C melanoma patients?

Based on the KEYNOTE-716 study and Dec 2021 FDA approval

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Would you give adjuvant nivolumab for IIIA melanoma?

Patients with T3aN1a( stage IIIA per AJCC7) were excluded from nivolumab adjuvant trial. Would you consider nivolumab in these patients?

1 Answer available

How would you approach a patient who progressed on immunotherapy for merkel cell carcinoma?

Checkpoint inhibitors have demonstrated durable responses in clinical trials, which was never seen with cytotoxic chemotherapy in the past. What are t...

1 Answer available

What is your approach to metastatic choroidal melanoma with systemic metastases outside of a clinical trial?

NCCN guidelines recommend both single agent Pembro and/or Ipi/Nivo as first line options. How would you choose between the two? In case of the latter,...

1 Answer available

What is the role of Braftovi (encorafenib) and Mektovi (binimetinib) in combination for unresectable or metastatic melanoma?

The FDA recently approved Braftovi (encorafenib) and Mektovi (binimetinib) in combination for unresectable or metastatic melanoma. When would they be ...

1 Answer available

How would you treat a patient with aggressive metastatic cutaneous squamous cell carcinoma, which is not amenable to surgery or radiation?

2 Answers available

When would you consider neoadjuvant immunotherapy for advanced melanoma?

For example, would you consider this in a patient that would otherwise be eligible for adjuvant treatment (stage III or stage IV with oligometastatic ...

1 Answer available

Would you hold immunotherapy if a patient with metastatic melanoma has stable disease for 6 months?

If so, after what duration?

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Would you consider stopping nivo/ipi combination after a CR in a patient with metastatic melanoma?

Can you extrapolate the data on Durable Complete Response After Discontinuation of Pembrolizumab in Patients With Metastatic Melanoma to patients on a...

1 Answer available

What is the your choice of treatment after progression or AE following pembrolizumab in metastatic melanoma?

Patient does not have BRAF mutation.

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Is there a difference in the durability of CR based on the dosage of pembrolizumab used in metastatic melanoma?

In this study, doses of 2mg/kg Q3wks, 10mg/kg Q3wks and 10mg/kg Q2wks were used. What did the majority of these patients in CR receive?

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What is your approach to the initial treatment of metastatic melanoma patients with NRAS mutations?

How do you treat these patients if they progress after immune checkpoint inhibitors?

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What systemic therapy, if any, would you recommend for a patient with oligometastatic melanoma who is rendered NED after resection?

Would your recommendation change at all depending on time to relapse or original stage of melanoma?

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What would you recommend as adjuvant treatment for a patient with Stage III melanoma?

If staged so due to satellite lesion and negative nodes? How do you decide between adjuvant PD-1 inhibitor or BRAF/MEK inhibition in BRAF-mutated pati...

1 Answer available

What treatment would you offer to a patient after resection of a solitary metastatic melanoma from the brain without evidence of other sites of disease?

Assuming SRS to the resection cavity is advised, would you recommend early immunotherapy to improve outcomes/enhance a possible abscopal eff...

1 Answer available

Is there a role for PD-1 inhibitors for metastatic or locally recurrent cutaneous squamous cell carcinomas after failure of first line therapy, EGFR inhibitors?

Is it commonly used if no clinical trials are available?

1 Answer available

Would you treat a patient with HIV or hepatitis C with an anti-PD-1 agent?

These patients have been largely excluded from these trials. What if the infection is well controlled?

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Is it necessary to hold immunotherapy during a 4-6wk steroid taper after resolution of immunotherapy related toxicity?

Would you ever considering re-starting immunotherapy before completing the taper? According to the new guildelines on managing immunotherapy related ...

1 Answer available

How do you approach treatment for metastatic cutaneous squamous cell carcinoma after standard chemotherapy failure?

Is the use of immunotherapy being considered, and if so, is the data extrapolated from treatment of mNSCLC and head and neck SCC?

1 Answer available

How do you approach the managment of basal cell carcinoma with only lymph node involvement?

No skin lesion was apparent on exam and extracapsular extension was seen on the excised lymph node. Is radiation therapy sufficient and is there a rol...

3 Answers available

Do you consider alternate therapy with a different anti-PD1 agent after a patient responds to an anti-CTLA4 +/- anti-PD1 agent but develops serious side effects?

Is there data for switching from nivolumab/ipilimumab to pembrolizumab if a patient develops significant pneumonitis but also had a significant radiog...

1 Answer available

What is your next step in management for a patient with immunotherapy induced pneumonitis that does not improve on high dose steroids for 48 hours?

How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...

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Does anaphylactoid reaction to one immunotherapy agent exclude the possibility of using other immunotherapy agents?

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Do you resume immunotherapy (such as nivolumab) for metastatic melanoma after therapy-induced grade 4 hyperglycemia that has resolved?

Can immune check point inhibitor be restarted if grade 4 hyperglycemia (with acidosis and insulin drip requirement) has resolved?

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Is there an effective treatment for multiple appearances of cutaneous Kaposi's lesions besides radiation?

In a patient who already received 13 courses of radiation (with complete response), is there any other effective treatment?

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Would you start immunotherapy in a patient with metastatic melanoma who is on steroids (e.g. dexamethasone for cerebral edema)?

Or would you try to wait and get the steroids off first?

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How do you approach the management of surgically resected conjunctival melanoma that has recurred locally?

What, if any, is the role of immunotherapy in this situation ?

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How do you choose between single agent versus combination checkpoint inhibitors for BRAF Wildtype metastatic melanoma?

1 Answer available

How do you manage anticoagulation for patients with DVT/PE who have brain metastases?

Some medical oncologists tend to hold anticoagulation in patients who develop brain metastases for fear of causing intracranial hemorrhage. Is t...

3 Answers available

Would you ever consider stopping immunotherapy in a patient with metastatic melanoma after achieving a good response?

Would your recommendations change if it was a partial vs complete radiographic response?

1 Answer available

How do you manage immune-related toxicity from checkpoint inhibitors that is refractory to initial steroid therapy?

What immunosuppressive agents are used and in what order? Does your approach differ depending on the organ involved, e.g. colitis vs. pneumoniti...

1 Answer available

For newly diagnosed BRAF mutated melanoma with brain metastases, do you prefer to start with targeted therapy or with immunotherapy?

1 Answer available

Would you use immune checkpoint inhibitors in patients with well-compensated liver cirrhosis?

Does the risk of severe inflammation of the liver lead you to choose other therapies in in this population? What about in patients with mild liv...

1 Answer available

How do you manage patients with BRAF V600E-mutated metastatic melanoma who have a mixed radiographic response after several months of therapy with dabrafenib/trametinib?

Does the site of progression or response matter? What if there is progression in the lungs but response in lymphadenopathy, for example?

1 Answer available

How do you manage hematologic toxicities in solid tumor patients treated with immune checkpoint inhibitors?

If these are presumed to be immune-mediated (e.g. immune neutropenia or immune thrombocytopenia), do you treat with steroids?

1 Answer available

When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies (i.e. TSH and ACTH) or only when a patient has symptoms?

If so, how often do you check these labs?

1 Answer available

How should RT be combined with immunotherapy to generate an abscopal response?

Is there any consensus regarding the optimal RT dose, fractionation, and timing to the best abscopal response? What is the optimal metastatic site to ...

1 Answer available

What should be the first line treatment for metastatic uveal melanoma?

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What is your approach to patients with stage III melanoma now that the FDA has approved adjuvant ipilimumab for high risk stage III melanoma patients?

1 Answer available

How do you manage dabrafenib fever?

Decrease the dose? Treatment break? Steroids?

1 Answer available

When should patients with metastatic melanoma be referred for treatment at an academic center?

With novel therapies quickly evolving, it's becoming more difficult to discern the proper sequence of therapies and the point at which a clinical tria...

1 Answer available