NEJM Journal Club   

What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

Definitions for "high risk" differ by whether patients receive neoadjuvant chemo and across other contemporary studies. Does the change in AJCC stagin...

The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TD...

Recent articles regarding the use of JAK-Inhibition in RA have suggested to avoid in patients with increased CV risk.  However, RA itself is cons...

Given OlympiA trial with olaparib benefit for gBRCA+ patients?What are barriers that you foresee? In your practice who performs mutation testing and w...

For example, would it be appropriate to consider JAK inhibitor therapy as preferable to TNF-alpha inhibitor in patients with heart failure with reduce...

Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?    

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

The OncotypeDx score was 51 in this scenario. 

Given strong TDXd efficacy in these patients is there a role to use it earlier than 2nd line? How does prior Her2-directed and/or taxane therapy...

Does this raise concerns about the efficacy of adjuvant immune checkpoint inhibition? Are any preliminary results from AMBASSADOR (adjuvant pembrolizu...

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...

In subset analyses of OlympiA there seems to be smaller magnitude of benefit among HR+ patients. In your opinion, should adjuvant olabarib be offered ...

Do you think adjuvant nivolumab should be the new standard of care based on current CM274 DFS data? If OS turns out to be no different, will you still...

Would you continue pembrolizumab? Would you introduce olaparib? If using both, how would you sequence? 

How does prior chemotherapy, site of disease, and pathological staging inform your decision? How about molecular markers (PD-L1, ctDNA)?

Is a 3 month delay too long in someone who had postoperative complications?

NCCN recommends perioperative FLOT or FOLFOX vs. neoadjuvant chemoRT with Carboplatin/Paclitaxel or FOLFOX.Does CM-577 and the approval of nivolumab p...

What about for a patient with complete radiographic response who declines surgical management?

How and when do you plan to perform HER2 testing in patients with NSCLC?

Many of the patients on ASCENT trial were heavily pre-treated and require growth factors. With the day 1,8 treatment cycle, is there a way to minimize...

Based on CheckMate 577?Is DFS endpoint sufficient to establish SOC or is OS benefit needed?

How does trastuzumab deruxtecan compare to other HER2 targeted strategies?

What factors would influence your approach?

Are there other treatment variations by clinical subsets (eg tumor location, histology, stage II vs III, other biomarkers) seen in CM577 or other data...

CheckMate 577 only included patients with R0 resection.For R1 resections, guidelines suggest observation vs re-resection only.  

How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

Given seemingly improved efficacy in ASCENT patients who had less prior treatment, would you consider use after only one prior agent rather than two? ...

Are there specific patient cohorts in whom you will more preferentially use sacituzumab govitecan? Can data from ASCENT be applied to patients with C...

Are there differences in outcome among the BRCA mutated subgroup, or others?

To what degree do you factor in patient preference when choosing among available treatments? Are there features of each regimen that you emphasize in ...

ADVOCATE trial

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

In the ADVOCATE trial, patients were not re-dosed with rituximab.

Conversely: In a patient with N2 EGFR+ NSCLC receiving radiation, would you still consider use of osimertinib?

What was the magnitude of benefit for patients with EGFRm NSCLC by stage?  Are you still considering adjuvant osimertinib for patients with earl...

If patients do recur, do you perform these tests on the initial surgical specimen or on tissue from a fresh biopsy (or both?)

Is data available regarding the percentages of patients in each arm who underwent staging PET or the breakdown of CNS imaging modalities?

Are the rates of adjuvant chemotherapy used in ADAURA consistent with real-world practice?

For example in a patient with a history of PE?

i.e. EGD surveillance for varices?

What parameters do you use to decide to treat beyond progression? Is there any efficacy data from this specific study subgroup in IMbrave150?

ex. VEGFR2 expression, inflammatory signature, PDL1, etc.

Do you continue atezolizumab alone? Would you avoid anticoagulation?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

Do you screen even asymptomatic patients?