Case Based Peer Perspectives

This Case-Based Peer Perspectives program explores contemporary diagnosis, assessment, and treatment sequencing strategies for chronic graft-versus-host disease (cGVHD) following allogeneic stem cell transplantation. Dr. Leyla Shune emphasizes the use of NIH consensus criteria to systematically evaluate organ involvement as well as the continued importance of clinical judgment in the absence of validated biomarkers. Through analysis of a detailed patient case, she illustrates challenges such as steroid dependence, disease progression, and multi-organ involvement, highlighting how objective measures guide therapy escalation. The discussion reviews FDA-approved systemic options across second- and third-line settings, focusing on mechanism-driven selection among JAK, ROCK, BTK, and CSF1 receptor–targeted therapies. Particular attention is given to sclerotic and pulmonary cGVHD, where early intervention may prevent irreversible fibrosis. Real-world experience, safety considerations, patient preference, and combination strategies are integrated throughout. Dr. Shune also presents a forward-looking perspective on clinical trials, earlier-line use of targeted agents, and future innovations to reduce treatment burden and improve long-term outcomes.

This Targeted Oncology Case-Based Peer Perspective program, led by Dr. Zachariah DeFilipp of Massachusetts General Hospital, focuses on optimizing treatment sequencing in chronic graft-versus-host disease (cGVHD) following allogeneic stem cell transplantation. The discussion emphasizes practical, real-world decision-making across lines of therapy, integrating NIH diagnostic criteria, patient-reported symptoms, and evolving clinical trial data. Dr. DeFilipp reviews the limitations of corticosteroids as first-line therapy, the central role of ruxolitinib in steroid-refractory disease, and emerging targeted agents such as belumosudil and axatilimab in later lines. Through a longitudinal patient case, the program highlights challenges with durability of response, fibrotic and pulmonary involvement, and timing of therapy escalation. He also explores discrepancies between clinical trial outcomes and real-world experience, logistical considerations influencing oral versus IV therapy selection, and the growing interest in combination strategies and earlier use of targeted agents to alter the long-term trajectory of cGVHD.

Presentation focusing on advances in the first-line treatment of EGFR-mutated advanced or metastatic non-small-cell lung cancer.

Presentation focusing on advances in the first-line treatment of EGFR-mutated advanced or metastatic non-small-cell lung cancer.

A panelist discuss how emerging treatments such as tarlatamab and lurbinectedin are reshaping the management of relapsed extensive-stage small cell lung cancer, emphasizing efficacy, safety, and accessibility. They highlight that future advances depend on addressing real-world barriers while integrating novel agents such as bispecifics and antibody-drug conjugates into clinical practice.

An expert discusses how adding lurbinectedin to maintenance atezolizumab therapy after standard induction treatment significantly improves progression-free survival and overall survival in patients with extensive-stage small cell lung cancer, with manageable toxicity profiles and the rationale for moving treatment earlier to prevent disease progression in a patient population where many never receive subsequent therapies.

Raji Shameem, MD, discusses how to approach treatment decisions for patients with metastatic pancreatic adenocarcinoma, covering first-line therapy options including NALIRIFOX and modified FOLFIRINOX based on performance status, the importance of genetic testing, clinical trial evidence supporting 3-drug vs 2-drug regimens, and proactive adverse event management strategies.

Farshid Dayyani, MD discusses how the NALIRIFOX regimen (nanoliposomal irinotecan, oxaliplatin, leucovorin, and 5-FU) has emerged as a promising frontline treatment option for locally advanced pancreatic adenocarcinoma based on the NAPOLI-3 trial results, with manageable toxicities including diarrhea and cytopenia that can be effectively addressed through dose modifications and supportive care.

An expert discusses how CAR T-cell therapy and bispecific antibodies are transforming relapsed/refractory large B-cell lymphoma treatment by providing durable remissions and personalized care options, while emphasizing the importance of timely referral, multidisciplinary coordination, patient access, and ongoing management to optimize outcomes.

An expert explains that for this 60-year-old man with primary refractory DLBCL, early referral to CAR T-cell therapy is critical—supported by trials like ZUMA-7 showing superior survival and faster recovery compared to traditional treatments—while overcoming eligibility misjudgments, logistical barriers, and balancing safety profiles of different CAR T products through coordinated, patient-centered care optimizes outcomes in this high-risk population.

Raji Shameem, MD discusses how luspatercept has become his preferred frontline treatment for lower-risk MDS patients with anemia due to its superior efficacy compared to ESAs in the COMMANDS trial, showing 60% of patients achieving transfusion independence versus 30% with ESAs, along with impressive durability of response and a promising trend toward improved overall survival.

A panelist discusses how luspatercept has become a convenient and effective treatment for anemia in lower-risk MDS, providing durable transfusion independence and quality-of-life improvements across diverse patients, while emphasizing the importance of personalized therapy, regular dose adjustments, and ongoing development of novel agents to improve long-term outcomes.

An expert discusses first-line treatment options for EGFR-mutated advanced/metastatic non-small-cell lung cancer in a 55-year-old man.

An expert discusses how the case of a 74-year-old woman with newly diagnosed BPDCN underscores the importance of early recognition of skin and blood abnormalities, prompt diagnostic workup, and initiation of tagraxofusp with close monitoring to manage this aggressive hematologic malignancy effectively.

Nelson Chao, MD, MBA,discusses how effective management of GVHD requires comprehensive assessment of symptoms across multiple organ systems, strategic use of steroid therapy as first-line treatment with appropriate supportive care measures, timely recognition of steroid-refractory disease warranting JAK inhibition with ruxolitinib or other emerging therapies as supported by clinical trials like REACH3, vigilant monitoring of treatment-related adverse events through structured protocols, thorough patient education regarding treatment expectations, and a multidisciplinary approach to optimize both disease control and quality of life in transplant survivors.

Nagashree Seetharamu, MD, MBBS, discusses how immunotherapy integration with chemotherapy is transforming nasopharyngeal carcinoma treatment, citing JUPITER-02 and DIPPER study data showing benefits even with low EBV levels, while emphasizing the importance of patient selection factors, multidisciplinary care, and vigilant monitoring for immune-related adverse events in community practice.

An expert discusses the clinical challenges and management strategies for a 48-year-old man with recurrent nasopharyngeal carcinoma and a 53-year-old woman with metastatic nasopharyngeal carcinoma.

An expert discusses the emerging treatment landscape in myeloproliferative neoplasms (MPNs), focusing on the transition from current practices to emerging therapies.

Marlise Rachael Luskin, MD, MSCE, discusses the case of a man aged 62 years who is newly diagnosed with blastic plasmacytoid dendritic cell neoplasm (BPDCN). She provides an overview of the patient’s case and recommended treatment approaches. She discusses the role of CD123 targeted therapy (tagraxofusp) and the evolving landscape of BPDCN treatment options.

Pedro Barata, MD, MSc, FACP, discussessequencing for a relapsed/refractory metastatic renal cell carcinoma patient case. He also discusses how third-line mRCC therapy aims for disease control and symptom palliation with careful toxicity management. Options include cabozantinib, lenvatinib/everolimus, and tivozanib, with selection based on prior therapy, comorbidities, and tolerability.

Amit Mahipal, MD, discusses the patient case of a 57-year-old woman diagnosed with advanced unresectable hepatocellular carcinoma (uHCC). He also discusses how first-line systemic therapy for advanced uHCC focuses on tyrosine kinase inhibitors (lenvatinib, sorafenib), considering patient factors, monitoring response depth, managing adverse events, and balancing efficacy with quality of life.

Amit G. Singal, MD, MS discusses the case of a 60-year-old man with intermediate/advanced unresectable hepatocellular carcinoma that requires careful treatment planning because of his age, disease stage, and potential therapeutic approaches, including systemic therapies and locoregional interventions.

An expert discusses the latest advancements in the use of androgen receptor inhibitors (ARIs) and radium-223 (Ra-223) for the treatment of metastatic castration-resistant prostate cancer, highlighting their evolving roles in improving patient outcomes.

Sumanta K. Pal, MD, provides comprehensive insights into second-line RCC treatment approaches, discussing the evolution from first-line therapy goals, analyzing key clinical trial data (including CONTACT-03 and TiNivo-2), evaluating patient-reported outcomes, explaining individualized therapy selection factors, addressing sequencing strategies across multiple lines of treatment, offering practical guidance on adverse event management, and highlighting promising future research directions in the field.

Misako Nagasaka, MD, PhD discusses a patient case involving a 47-Year-Old Woman with EGFR-mutated Advanced/Metastatic NSCLC and discusses optimizing 1L EGFR-mutant NSCLC care requires balancing efficacy and toxicity in combination therapies. She also reviews MARIPOSA/FLAURA2 data inform sequencing, AE management, resistance testing, and future innovations.

Amrita Krishnan, MD, discusses the evolving treatment landscape for early relapsed/refractory multiple myeloma, focusing on CAR T-cell therapy selection, sequencing, and management. Key areas covered include KarMMa-3 trial data for ide-cel, real-world evidence, toxicity management, community practice strategies, and emerging therapeutic approaches. Emphasis is placed on optimal patient care from selection through long-term monitoring, with consideration of novel combinations and future directions.

Aimee Merino, MD, discusses the management of a 60-year-old patient with early relapse/refractory multiple myeloma and highlights the importance of identifying high-risk disease, the referral process for chimeric antigen receptor T-cell therapy, and the latest efficacy outcomes from the CARTITUDE-4 trial while also addressing emerging treatment strategies and challenges in managing relapsed/refractory multiple myeloma.