Neoplasia
8 cases on [genuine one-line description of what this topic's real clinical territory covers] — choose a case below to open its full multi-voice debate.
A single patient, nineteen months into a good response to osimertinib, now progressing with a MET-amplified liquid biopsy. The disagreement is whether that single circulating-DNA finding is the whole resistance story or one clue in a tumor no one has re-biopsied yet.
A single patient progressing after eleven months on sotorasib. The real disagreement isn't which regimen is better in the abstract — it's whether committing to either one before an already-collected pleural fluid sample gets tested is responsible.
A single patient responding well to osimertinib, whose co-occurring TP53 mutation predicts an earlier-than-average resistance. The disagreement is whether her own baseline lung vulnerability makes her exactly the wrong candidate for a combination strategy meant to delay that resistance.
A single patient with a technically resectable, EGFR-mutant lung cancer. The disagreement isn't whether he needs osimertinib — it's whether giving it before an operation that was never in question buys anything the proven adjuvant approach doesn't already deliver afterward.
A single patient whose PD-L1 score cleanly qualifies him for immunotherapy monotherapy. The disagreement is whether a liver trending toward organ-threatening tumor burden can afford to wait for a slower-onset response.
A single patient with a new, minimally symptomatic hepatic lesion five years after curative lung surgery. The disagreement is whether to treat a real growth signal now, or wait for symptoms to justify a therapy whose evidence base was built in a different disease.
A single patient newly diagnosed with small-cell lung cancer and paraneoplastic Lambert-Eaton syndrome. The disagreement isn't whether chemotherapy will eventually help his weakness — it's whether his airway and his balance can safely wait for it to.
A single patient with severe, chronic SIADH-driven hyponatremia ahead of urgent small-cell lung cancer chemotherapy. The disagreement turns out to be less about which drug to use than about how tightly its use gets monitored.