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FEATURED COMMENTARY
15 Mar 2015 02:43 PM
Every March, the ASCO Board of Directors meets for its Strategic Planning Retreat. Although we always have...   
24 Apr 2015 08:10 PM
Dear Colleagues: For many of us, the ASCO Annual Meeting is simply known as “ASCO.” It’s when we can count on learning about new scientific advances—some that will be truly practice changing. It’s...
23 Apr 2015 08:39 AM
She had come to my office looking to transfer her care—she and her family were relocating from the South to New England.. . .
16 Apr 2015 05:17 PM
One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day.
16 Apr 2015 03:12 PM
Recognizing the needs of patients as well as doctors is essential to healthcare. We may have ideas about what those needs are, but how do we include them in decisions about healthcare reform?
13 Apr 2015 04:08 PM
ASCO is the most important oncology meeting in the world, with more than 30,000 attendees and hundreds of presentations. Over the last few years, we posted tips on how to navigate the ASCO Annual...
07 Apr 2015 11:52 AM
It has long been held that testosterone is the root of all evil—probably true for most wars, and possibly true for the development of prostate cancer....

Latest Comments


Heather Marie Hylton, PA-C
24 Apr 2015 09:30 AM
Thank you for posting this interesting case.  For this patient, who has no comorbidities and relatively preserved organ function but a poor performance status and notable frailty, I'm curious know more about his goals of care at this point. 

Ben J. Slotman, MD, PhD
22 Apr 2015 11:49 AM
The patient is a 70 year old gentleman with ES-SCLC with two liver metastases who has completed chemotherapy two week ago. ECOG PS 1.  Restaging shows a partial remission in the thorax and liver without any new sites. Would you advise prophylacatic cranial irradiation and/or thoracic radiotherapy? Log in to answer here. For more information, return to the Small Cell Lung Cancer Tumor Board on ASCO University

David S. Ettinger, MD
22 Apr 2015 11:47 AM
The patient is a 70 year old gentleman with ES-SCLC with liver metastases and an ECOG PS 2 and normal LFTs as well as a serum creatinine of 1.6 due to chronic renal disease.  What initial chemotherapy would you treat this patient? Log in to answer here. For more information, return to the Small Cell Lung Cancer Tumor Board on ASCO University

Jay Kallio
21 Apr 2015 02:04 PM
Dear Dr Dizon, Perhaps one of the reasons patients are uncomfortable going without surveillance is because of the many stories like mine. I went through a year and a half of treatment for aggressive breast cancer in 2008, and as an overly well educated paramedic I believe in evidence based medicine and took seriously the evidence that surveillance sans symptoms does not contribute value. I ignored and overrode the uneasy feelings and intuitive concerns I felt that I was still very sick, not wanting to be a hypochondriac, or one who keeps demanding services that are not indicated. When I... more

ASCO University
20 Apr 2015 02:56 PM
Discussion Questions What is the differential diagnosis for this patient’s presentation? Was the evaluation adequate for planning management? What would be the optimal therapy for progressive CLL in this patient?   

ASCO University
20 Apr 2015 02:55 PM
Patient Case Update Physical examination and imaging:  The patient was evaluated at a referral center in December 2013.  At that time, he was not able to walk and had a performance status of 4.  He reported drenching night sweats, more than 10% weight loss over the past 6 months, anorexia, and profound fatigue.  On physical examination, the patient was a pale, frail and wasted elderly man with extensive palpable lymphadenopathy (maximum 2 x 2 cm in the axilla).  His abdomen was mildly distended by a vague central mass.  There was no palpable enlargement of the... more

Clive S. Zent, MD
20 Apr 2015 02:51 PM
Do you consider fludarabine monotherapy to be a suitable therapy for this patient in 2015?  Course Faculty Response Management of previously untreated CLL patients with progressive disease requiring therapy should be based on patient fitness and the results of TP53 testing as detailed above.  This patient would be considered to be fit based on performance status and renal function. A more sophisticated functional test (e.g. CIRS) could be of additional value in determining fitness. Although age alone should not be used to determine fitness, a 79 year-old man could have serious... more

Steven Schichman
20 Apr 2015 02:49 PM
What genetic tests were indicated prior to initial treatment of the patients CLL? Course Faculty Response Testing for defects in TP53, the gene coding for the tumor suppressor protein p53, should be considered standard of care for patients prior to initiation of therapy for CLL. Interphase fluorescent in situ hybridization (FISH) testing of CLL cells can detect 17p13 deletion that results in loss of one allele of TP53. This deletion is detected in ~5% of patients requiring initial treatment for CLL and is usually monoallelic. The consequences of loss of one allele of TP53 are determined... more

Clive S. Zent, MD
20 Apr 2015 02:36 PM
Did this patient meet the standard criteria for initiation of therapy for his CLL? Course Faculty Response Criteria defining “active CLL” requiring treatment are described in the 2008 International Workshop on Chronic Lymphocytic Leukemia (IWCLL) revision of the National Cancer Institute Working Group criteria of 1996 (IWCLL 2008). The criteria for initiation of therapy include cytopenia (hemoglobin <11 g/dL or platelets <100 x 109/L) caused by progressive CLL. This patient had a hemoglobin <11 g/dL but there was no evidence to support a diagnosis of bone marrow failure.... more

Grzegorz S. Nowakowski, MD
19 Apr 2015 01:11 PM
1. Treatment might be required in next 12 months, however at the time is not mandatory. Careful observation would be OK. Considering progression so far, not it is unreasonable to consider treatment soon, provided other causes of progressive cytopenias are excluded (autoimmune) after discussion with the patient. .  2. One would consider testing for 17p/p53 alterations. Purine analogues have limited activity in this setting, however, there is limited evidence if treatment with other agents in upfront setting, including ibrutinib.  If 17p del... more

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One day in clinic, recently, I reviewed my daily schedule with the oncology fellows who were working with me that day.
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