Rounds with the Investigators 2012 | Multiple Myeloma

Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: What is the best risk stratification test: cytogenetics, FISH, MyPRS™ GEP70, other GEP tests or “other”?

DR RAFAEL FONSECA: The question is a very pertinent one because I think more and more people have moved away from conventional or classic cytogenetics and I think there’s a good reason for that. Sure enough, if they’re abnormal, you know that the patient has very high-risk disease. But the yield for abnormalities, this is about 8 to 9% of cases that you get informative metaphases. So it’s, for the most part, it’s just wasting money, the other 90% of patients.

Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: Has anybody collated a series of unusual fractures in patients on long-term bisphosphonates?

DR NEIL LOVE: So, Steve, can you comment on the other question you were asking about fractures?

Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: Is there any information on dose intensification of pomalidomide if pt progresses?
        
DR STEVEN HAGER: I have a patient who is on pomalidomide. It’s compassionate access. And she just recently progressed on 2 milligrams. And we spoke about it. She’s a physician, so she knows the literature just almost as well as I do, if not better. And so she asked: Why not go up? And there is literature, I know, from the Europeans, looking at 4 milligrams versus 2. What role is there for dose intensification?

Rounds with Investigators 2012 | Multiple Myeloma

QUESTION: Are there biomarkers to indicate who should be treated and whom we can observe in MGUS or smoldering myeloma?      

Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: I'm excited about denosumab in MM, but for now is there any recommendation for bone remineralization for patients with renal insufficiency who are not candidates for bisphosphonates?

DR CHARLES FARBER: Many patients with myeloma have renal insufficiency. For patients with renal insufficiency currently, who aren’t candidates for bisphosphonates, do you have any suggestions for managing bone health?

DR NEIL LOVE: And Jeff Wolf, I mean, specifically the question, I guess, you’re asking, denosumab?

DR FARBER: Right.

Rounds with the Investigators 2012 | Multiple Myeloma

QUESTION: How would you treat a patient who has plasma cell neoplasm in the lung and soft tissue and monoclonal spike and negative bone marrow? Initially responded to bortezomib and doxorubicin and dexamethasone for a very short time, then treated with RT with near complete response. Now after about 16 months recurrence in the rib cage and soft tissue and positive IgG.

Rounds with the Investigators 2012 | Lung

QUESTION: I have a 72 yo male with a non-small cell lung cancer with squamous differentiation who presented with metastatic disease to lung and liver. After 4 cycles of carbo/paclitaxel he has had an excellent response with complete disappearance of disease in neck and on CT of liver. If this were nonsquamous I would employ a maintenance strategy probably with pemetrexed, but erlotinib would also be a consideration. Would there be any suggestion for use of maintenance in this patient?

Rounds with the Investigators 2012 | Lung

QUESTION: I would like to know from the lung cancer investigators what is the incidence of EGFR or EML4-ALK mutations if a tumor tests positive for K-ras mutation. I have a patient who was diagnosed in 2010 and tested positive for K-ras mutation and negative for EGFR mutation. EML4-ALK testing was not performed at that time, and there is insufficient material to perform the testing from the original specimen. She has now recurred, and I wonder if there is a high enough probability of EML4-ALK mutation to perform a repeat biopsy.

DR NEIL LOVE: Steve, can you kind of present the case that was behind your question?

Rounds with the Investigators 2012 | Lung

QUESTION: My second case is a 67 y/o F with an incidental finding of an RUL mass on CXR with enlargement on CT at a 3-month follow-up scan. PET only slightly hypermetabolic. Bronch showed question of bronchoalveolar carcinoma. She underwent RUL resection and was found to have a 3.0-cm adenocarcinoma with some areas of poorly differentiated disease and areas of lymphovascular invasion. Three out of 6 peribronchial LNs were positive. She was EGFR positive. What is the “preferred” adjuvant regimen for this patient? I have treated her with cisplatin and vinorelbine, and it has been relatively poorly tolerated. Is there any role for adjuvant erlotinib?

Rounds with the Investigators 2012 | Lung

QUESTION: My case is a 58 y/o F with limited small cell lung cancer, mediastinal LN involvement at dx with tumor invasion of the SVC and a very large R supraclavicular mass. Tx with carbo/VP16 and RT with CR and followed by PCI. At first follow-up CT at 3 months pt was found to have no disease recurrence in chest but a mass in the transverse colon. Colonoscopy with biopsy showed recurrent small cell lung cancer. For limited small cell lung cancer is cisplatin superior to carboplatin? Should this patient have received cisplatin?

Rounds with the Investigators 2012 | Lung