IASLC Academy's Amazing Case Race

IASLC's Amazing Case Race

Welcome to the 2024 Amazing Case Race!

Explore each case below by clicking the title of the case, then vote for your top 5 cases! The winners will be announced at the end of WCLC 2024. 

Explore The 2024 Cases

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Pamela Abdayem

Pamela Abdayem

CASE 01

France

Successfully Navigating the Minefield of Immune Checkpoint Inhibitor Treatment in an Older Patient with Multiple Comorbidities and a History of Allogeneic Hematopoietic Cell Transplantation | CASE 01

This case focuses on the management of advanced NSCLC in older patients with multiple comorbidities and relative contraindications to treatments. The main conclusion from this case is that with multidisciplinary decision-making and effective communication/collaboration between teams (thoracic oncology, hematology, geriatrics, palliative care, hepatology…), elderly patients with multiple comorbidities can benefit from innovative treatments such as immunotherapy and can have prolonged survival with a preserved quality of life. Key areas addressed:

  1. Describing the recommended, evidence-based approaches to personalize immune checkpoint inhibitor (ICI) treatment for patients with advanced NSCLC and multiple comorbidities.
  2. Diagnosing and managing immune-related adverse events ([irAEs]) in patients undergoing ICI treatment.
  3. Managing pain and skeletal-related events in NSCLC patients.
Click here to vote for CASE 01
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Fawzi Abu Rous

Fawzi Abu Rous

CASE 02

United States

Managing Stage III Adenocarcinoma of the Lung with Atypical EGFR Mutations:
The Role of Biomarker Testing and Evidence-Based
Consolidation Treatment Strategies | CASE 02

This case focuses on the management of stage III adenocarcinoma of the lung with atypical EGFR mutation. Key areas addressed:

  1. Importance of biomarker testing.
  2. Interpretation of biomarker testing.
  3. Appropriate staging mechanisms for patients with NSCLC.
  4. Reviewing the data on consolidation treatment.
  5. Decision-making regarding consolidation treatment per the available evidence.
Click here to vote for CASE 02
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Lorenzo Belluomini

Lorenzo Belluomini

CASE 03

Italy

How to Manage a Melanoma-Like Advanced NSCLC with BRAF V600E Mutation in Elderly Patient | CASE 03

This case focuses on the management of a patient with BRAF p.V600E mutant NSCLC with metastatic skin lesions. Key areas addressed:

  1. Recognizing the currently approved target therapies and the significance of biomarker testing in advanced NSCLC.
  2. Describing the recommended, evidence-based approaches to personalized treatment for patients with oncogene-addicted advanced NSCLC.
  3. Managing a treatment path in elderly and frail patients with oncogene-addicted NSCLC.
Click here to vote for CASE 03
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Lauren J. Brown

Lauren J. Brown

CASE 04

Australia

Metastatic Large Cell Neuroendocrine Tumour of the Lung | CASE 04

This case focuses on:

  1. The management of a rare and difficult tumour, a large cell neuroendocrine tumour of the lung with metastatic disease to the brain. The patient had a poor response to upfront chemotherapy with carboplatin and etoposide. With a high tumour mutation burden, access to immunotherapy with ipilimumab and nivolumab was granted. The patient had initial intracranial progression and was treated with SRS to the new cranial lesions.
  2. The management of symptomatic brain metastases in lung cancer. Urgent neurosurgical intervention followed by cavity radiation and systemic therapy is generally recommended. On progression, small new cranial lesions were managed with SRS.
  3. The management of multiple immune-related endocrinopathies, dermatitis and hepatitis experienced by the patient. Prompt steroid use and delay of immune checkpoint inhibitors should occur.

This case demonstrates a complete response to immunotherapy in patients with metastatic neuroendocrine tumour, typically a malignancy with a poor prognosis.

Click here to vote for CASE 04

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David Dai-Wee Lee

David Dai-Wee Lee

CASE 05

Malaysia

Navigating Adjuvant Therapy in EGFR Lung Cancer | CASE 05

This case focuses on the management of patients with early-stage NSCLC. Key areas addressed include:

  1. Understanding the impact of molecular testing in early-stage lung cancer.
  2. Deciding on the appropriate adjuvant therapy for EGFR-mutant NSCLC.
  3. Managing patients with suspicion of EGFR-TKI-induced pneumonitis or lung infection.

Click here to vote for CASE 05

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Aakash Desai

Aakash Desai

CASE 06

United States

Comprehensive Care in Advanced NSCLC: Integrating ICIs, Biomarker Testing and Management of KRAS Inhibitor Toxicities | CASE 06

This case focuses on the management of care for patients with advanced non-small cell lung cancer (NSCLC). Key areas addressed:

  1. Recognizing the currently approved immune checkpoint inhibitors (ICIs) and the significance of biomarker testing in advanced NSCLC.
  2. Describing the recommended, evidence-based approaches to personalize treatment for patients with advanced NSCLC.
  3. Implementing effective techniques for identifying and managing adverse events (irAEs) in patients undergoing KRAS inhibitor treatment.
  4. Managing hepatotoxicity with KRASG12C inhibitors.
Click here to vote for CASE 06
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Sora Ely

Sora Ely

CASE 07

United States

Considerations in Sublobar Resection for NSCLC | CASE 07

This case focuses on the surgical and oncologic management of early-stage NSCLC with respect to sublobar resection. Key areas addressed:

  1. Complications of percutaneous biopsy.
  2. Management of biopsy complications in the setting of confirmed NSCLC.
  3. Assessing the need for preoperative biopsy with high clinical pre-test probability.
  4. Criteria for sublobar resection candidacy.
  5. Technical aspects of an oncologically adequate sublobar resection.
  6. Evaluating the oncologic adequacy of an NSCLC sublobar resection case/specimen.
  7. Pathology considerations for a sublobar NSCLC resection specimen.
Click here to vote for CASE 07
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Isabella Favato Barcelos

Isabella Favato Barcelos

CASE 08

Brazil

Treatment Options for Locally-Advanced NSCLC and Their Particularities | CASE 08

This case focuses on the management of locally advanced NSCLC. He presents clinically well, with few symptoms, and a good performance status (ECOG 1), with a diagnosis of stage IIIA lung adenocarcinoma (AJCC 8th edition). Several key points that are important include:

  1. Molecular testing
  2. Invasive mediastinal staging
  3. Multidisciplinary discussion
  4. Need for adaptation
  5. Ongoing multidisciplinary review
  6. Consideration of new data
  7. The ADAURA study demonstrated significant benefits in progression-free survival and overall survival with three years of adjuvant osimertinib treatment.

Click here to vote for CASE 08

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Maria Gemelli

Maria Gemelli

CASE 09

Italy

Management of Histological Transformation from ALKRearranged Adenocarcinoma
to Small Cell Lung Cancer | CASE 09

This clinical case highlights the importance of recognizing histological transformation as a resistance mechanism to tyrosine kinase inhibitors (TKIs) in oncogene-addicted patients, especially those with ALK rearrangements. Along with liquid biopsy, re-biopsy at disease progression helps identify off-target mechanisms and detect histological changes. Transformation to small cell lung cancer (SCLC) is rare, and treatment strategies are not well defined, with these cancers often showing limited response to standard chemotherapy with platinum and etoposide. Some reports suggest sensitivity to third-generation ALK inhibitors, which have shown responses in certain cases, including ours. More data is needed to determine the best treatment strategy for these patients.

Click here to vote for CASE 09

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Robert Hsu

Robert Hsu

CASE 10

United States

NSCLC in a Young Adult Patient | CASE 10

Young adults with lung cancer often are found to be never or light smokers and subsequently also have biomarkers notable for actionable mutations such as EGFR, ALK, and ROS1. Early incorporation of palliative care in metastatic NSCLC patients can be helpful in controlling pain.

Click here to vote for CASE 10

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Long Jiang

Long Jiang

CASE 11

China

Navigating the Intricacies of Checkpoint Inhibitor Pneumonitis in NSCLC: A Real-World Tale of Neoadjuvant Immunotherapy | CASE 11

This case focuses on the management of Checkpoint Inhibitor Pneumonitis (CIP) in patients with Non-Small Cell Lung Cancer (NSCLC) following neoadjuvant immunotherapy. The case aims to improve the learner’s ability to recognize, diagnose, and manage CIP, following evidence-based guidelines. Key areas addressed include:

  1. Recognizing and Diagnosing CIP: Identifying symptoms and interpreting imaging findings to diagnose CIP in NSCLC patients after immunotherapy.
  2. Performing Workup and Referrals: Conducting appropriate workup, including ordering high-resolution CT (HRCT) scans and lab tests.
  3. Differentiating CIP from Other Pneumonitis Causes: Distinguishing CIP from other potential causes of pneumonitis in the clinical setting.
  4. Monitoring and Evaluating Treatment Effectiveness: Assessing patient response to treatment through clinical improvement and imaging results.

Click here to vote for CASE 11

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Sally Lau

Sally Lau

CASE 12

United States

Relapsed Refractory SCLC | CASE 12

This case focuses on the management of care for patients with advanced non-small cell lung cancer (NSCLC) with no molecular alterations and PD-L1 ≥50%. Key areas addressed include:

  1. Choosing between several first-line immunotherapy-based regimens currently approved in this setting.
  2. Recognizing the need for validated biomarkers to prioritize the addition of chemotherapy to anti PD-(L)1 immune checkpoint inhibitors (ICIs) in this setting.
  3. Managing oligo-progression during ICI with a multidisciplinary approach after adequate diagnostic workup.
  4. Choosing appropriate evidence-based strategies to treat oligo-progressive disease during first-line immunotherapy.
  5. Local ablative therapy to the oligo-progressive sites on ICI therapy may extend the duration of benefit of the current systemic treatment.
  6. Deciding the optimal duration of first-line ICI based on literature data.

Click here to vote for CASE 12

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Matthew Lee

Matthew Lee

CASE 13

United States

A Pathology Chimera: Management of Mixed-Histology NSCLC | CASE 13

This case highlights the importance of a multidisciplinary approach to resectable lung cancer patients from the pulmonologist, pathologist, radiology, cardiothoracic (CT) surgery, and medical oncology. Furthermore, it highlights unique aspects of managing mixed histology NSCLC patients and treatment decisions to best manage the patient’s cancer, such as choosing a more histologic-agnostic systemic treatment plan. Lastly, it’s important to include biomarker testing for these patients, as targetable actionable mutations are still possible in these mixed histologies. 

Click here to vote for CASE 13

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Rita Leporati

Rita Leporati

CASE 14

Italy

Challenges and Pitfalls in the Treatment of
Locally Advanced Non-Small Cell Lung Cancer (NSCLC) | CASE 14

This case focuses on the multidisciplinary management of patients with locally advanced NSCLC. Key areas addressed include:

  1. Choosing the appropriate workup for diagnosis of Stage III lung cancer.
  2. Implementing shared decision-making in lung cancer management.
  3. Identifying and managing immune-related toxicities.
  4. Recognizing the significance of biomarker testing in the context of locally advanced NSCLC.

Click here to vote for CASE 14

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Yufei Liu

Yufei Liu

CASE 15

United States

Synchronous Lung Adenocarcinoma | CASE 15

This case focuses on the management of patients with synchronous lung adenocarcinomas. Molecular testing is important to establish the relationship between the separate lung adenocarcinomas to determine if they represent metastatic disease or separate primaries.

Click here to vote for CASE 15
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Laura Moliner

Laura Moliner

CASE 16

Spain

Identifying and Managing Uncommon Toxicities of Immunotherapy in NSCLC: A Focus on Neurologic and Severe Multisystem irAEs | CASE 16

This case focuses on identifying uncommon toxicities of immunotherapy in patients with NSCLC. Key areas addressed include:

  1. Choosing the appropiate workup and initial management for patients that develop a neurologic irAE.
  2. Choosing appropriate workup and initial management for patients with severe irAEs.
  3. Recognizing multisystem irAEs.
  4. Recognizing signs and symptoms requiring acute care.

Click here to vote for CASE 16

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Ivy Ng Weishan

Ivy Ng Weishan

CASE 17

Singapore

Oligoprogressive Lung AdenoCa in a Patient on Maintenance Pemetrexed
for at Least 3 Years | CASE 17

Highlights from this case include: 
1. This patient has had stable disease with maintenance chemotherapy for more than three years
2. Would you have referred the patient for radiotherapy or switched his systemic treatment upfront?
3. For Rad Oncs: What dose and technique would you have ordered to treat this oligoprogressive site of disease?

Click here to vote for CASE 17
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Eziafa Oduah

Eziafa Oduah

CASE 18

United States

A Patient’s Value for Quality of Life in Stage IV
ALK-Rearranged Adenocarcinoma | CASE 18

This case focuses on:
1. Recognizing the management of solitary, symptomatic brain metastasis in NSCLC.
2. The role of NGS in the initial management of metastatic Stage IV NSCLC.
3. Recognizing the role of the patient’s perspective and values in guiding treatment considerations.

Click here to vote for CASE 18

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Jayson Paragas

Jayson Paragas

CASE 19

Philippines

Optimizing Treatment Sequencing for Locally Advanced
Thymic Epithelial Tumors | CASE 19

This case focuses on the treatment of locally advanced thymic epithelial tumors with emphasis on the appropriate sequencing of treatment options as backed up by international clinical practice guidelines tailored to the patient’s clinical presentation. The audience should have increased vigilance on presenting symptoms or have a high index of suspension to address emergent concerns.

Click here to vote for CASE 19

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Kaushal Parikh

Kaushal Parikh

CASE 20

United States

EGFR Lung Adenocarcinoma | CASE 20

This case focuses on the appropriate management of patients with metastatic lung adenocarcinoma whose tumors harbor EGFR mutations.

  1. Importance of biomarker testing in NSCLC.
  2. Local treatment approaches in metastatic NSCLC with symptomatic bone disease and oligoprogression.
  3. Systemic second-line option for EGFR-positive mNSCLC.
  4. Appropriate supportive care regimen for skin toxicity.

Click here to vote for CASE 20

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Evangelos Sarris

Evangelos Sarris

CASE 21

Greece

Complete Response (CR) Maintained at 5 Years in a Patient with Extensive Stage Small Cell Lung Cancer (SCLC)
Treated with Immunotherapy | CASE 21

This case focuses on the management of patients with extensive stage small cell lung cancer. Key areas addressed include:

  1. Recognizing and effectively treating paraneoplastic syndromes.
  2. Recognizing the potential benefit and long-term survival from the implementation of currently approved immune checkpoint inhibitors (ICIs) in the frontline setting of patients with extensive-stage SCLC.
  3. Identifying and managing immune-related adverse events (irAEs) in patients undergoing ICI treatment.
  4. Considerations for immunotherapy treatment duration in responders to ICIs.

Click here to vote for CASE 21

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Ramila Shilpakar

Ramila Shilpakar

CASE 22

Nepal

Low Dose Immunotherapy in an Elderly Patient with Advanced NSCLC with Complex Health Co-Morbidities: Navigating Complexities with Tailored Approaches for Optimizing Outcomes | CASE 22

This case focuses on the practical aspect of the presence of multiple complex health conditions in patients diagnosed with advanced NSCLC. We need to tailor our approach in managing these patients according to their health status so that we do no harm, like we avoided contrast Ct in this patient who already had CKD secondary to her existing medical condition. In addition to navigating the complexities in elderly with advanced NSCLC, we have to adapt our management approach according to local resources like we did a diffusion-weighted MRI of the body due to the unavailability of PET CT scan for metastatic workup and adopted low-dose immunotherapy to avoid financial toxicity. 

Click here to vote for CASE 22

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Eric Singhi and Soo-Ryum Yang

Eric Singhi and Soo-Ryum Yang

CASE 23

United States

Navigating the Nuances of Combined Histology: A Case Study of Advanced-Stage De Novo Small Cell Carcinoma and
Adenocarcinoma of the Lung | CASE 23

Our case focuses on the management of a patient with metastatic combined histology lung cancer, specifically featuring both adenocarcinoma and small cell lung cancer (SCLC). The primary objective is to provide insights into the nuanced diagnosis and treatment approaches required for managing lung cancer with combined histology.

Key Areas Addressed:

  1. Diagnosis of Combined Histology Lung Cancer: The case highlights the challenges of accurately diagnosing de novo combined histology lung cancer, which includes both adenocarcinoma and small cell lung cancer (SCLC) components, using biopsies and molecular profiling.
  2. Management of Combined Histology Lung Cancer: Emphasizes the need for a tailored treatment approach combining chemotherapy and targeted therapy, with adjustments based on disease progression and response.
  3. Importance of Biomarker Testing: Highlights the crucial role of biomarker and molecular testing, including liquid biopsy when tissue is insufficient, to guide personalized treatment. Somatic mutations like EGFR p.L858R influence therapy choices and effectiveness.
  4. Multidisciplinary and Palliative Care: Underlines the importance of a multidisciplinary approach and palliative care integration for advanced-stage lung cancer patients, focusing on symptom management, goals of care discussions, and improving quality of life through supportive care services.
Click here to vote for CASE 23
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Marco Tagliamento

Marco Tagliamento

CASE 24

Italy

A Case of Oligo-Progression During First-Line Immunotherapy
for Non-Oncogene-Addicted Metastatic NSCLC
with High PD-L1 Expression | CASE 24

This case focuses on the management of care for patients with advanced non-small cell lung cancer (NSCLC) with no molecular alterations and PD-L1 ≥50%. Key areas addressed:

  1. Choosing between several first-line immunotherapy-based regimens currently approved in this setting.
  2. Recognizing the need for validated biomarkers to prioritize the addition of chemotherapy to anti-PD-(L)1 immune checkpoint inhibitors (ICIs) in this setting.
  3. Managing oligo-progression during ICI with a multidisciplinary approach after adequate diagnostic workup.
  4. Choosing appropriate evidence-based strategies to treat oligo-progressive disease during first-line immunotherapy.
  5. Local ablative therapy to the oligo-progressive sites on ICI therapy may extend the duration of benefit of the current systemic treatment.
  6. Deciding the optimal duration of first-line ICI based on literature data.

Click here to vote for CASE 24

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Sofia Vidaurre

Sofia Vidaurre

CASE 25

Brazil

Oligometastatic EGFR-Mutated NSCLC:
Is There a Role for Surgical Treatment? | CASE 25

This case focuses on the management of care for patients with oligometastatic EGFR mutated Non-Small Cell lung cancer (NSCLC). Key areas addressed:

  1. Recognizing the importance of molecular testing and systemic staging with brain MRI.
  2. Implementing multidisciplinary discussion.
  3. Understanding the complexity of an oligometastatic disease and the possibility of different treatment approaches.

Click here to vote for CASE 25

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Alison Wallace

Alison Wallace

CASE 26

Canada

ALK Positive Resectable Lung Cancer | CASE 26

This is a case of resectable clinical Stage IIIA ALK-positive adenocarcinoma treated with upfront surgery followed by adjuvant treatment. The patient was diagnosed with clinical Stage IIIA adenocarcinoma originating in the left lower lobe with station 11L lymph node positive on EBUS-TBNA. The patient was discussed at Tumour Board Rounds and deemed a good candidate for neoadjuvant chemotherapy + immunotherapy as per the Checkmate 816 protocol. However, molecular testing revealed the tumour to be ALK+, therefore, the patient underwent upfront resection (VATS left lower lobectomy with mediastinal lymph node dissection) followed by adjuvant treatment. Surgical pathology poorly differentiated solid predominant adenocarcinoma, pT4N2.

Click here to vote for CASE 26

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Duo Xu

Duo Xu

CASE 27

China

One Gene, Two Kinds of Tumors: BAP1 Related Pleural
Mesothelioma and Adenocarcinoma In Situ | CASE 27

This case was chosen as a representative of the management of a patient with pleural mesothelioma combined with adenocarcinoma in situ of the lung.

Key areas addressed:

  1. Recognizing the diagnosis and treatment process of lung AIS and pleural mesothelioma according to NCCN.
  2. Comprehend the surgical indications for lung adenocarcinoma and pleural mesothelioma.
  3. Choosing appropriate systemic therapies for pleural mesothelioma based on histologic subtype and genomic profiling.
  4. Genetic mutations in family members of patients with germline BAP1 mutation should be monitored for the possibility of developing BAP1 cancer syndrome.

Click here to vote for CASE 27

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Mei-Mei Zheng

Mei-Mei Zheng

CASE 28

China

Leptomeningeal Disease Arising from Direct Spread of Brain Parenchyma Lesion: Diagnosis and Multi-Modality Treatment | CASE 28

This case focused on the diagnosis and treatment of leptomeningeal and brain metastasis from EGFR-mutated advanced NSCLC.

Key areas addressed:

  1. Understanding the route of leptomeningeal spread based on clinical evidence
  2. Recognizing the diagnosis of leptomeningeal metastasis as an oligometastatic disease, which used to be defined as multi-focal and deadly
  3. Recognizing the role of liquid biopsy, including cerebrospinal fluid and plasma, in the management of leptomeningeal and brain metastasis
  4. Implementing multi-modality treatments for effective control of leptomeningeal and brain metastasis.

Click here to vote for CASE 28

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Lodovica Zullo

Lodovica Zullo

CASE 29

France

Managing Progression During Durvalumab Consolidation in Unresectable, Locally Advanced Non-Small Cell Lung Cancer | CASE 29

This case focuses on the management of progressive disease during durvalumab consolidation in unresectable, locally advanced NSCLC treated with curative intent.

Keypoints are:

  1. Durvalumab is recommended after curative chemoradiation in unresectable, locally advanced NSCLC.
  2. Suspected progression during durvalumab consolidation should be reviewed by a multidisciplinary team for further work-up and management.
  3. Recommended evaluations include FDG-PET and brain MRI, with histological confirmation if needed.
  4. Oligometastatic disease may be treated with locoregional therapy, while systemic treatment is recommended for metastatic disease.
  5. Choosing the most appropriate treatment during durvalumab consolidation is challenging, as immune checkpoint inhibitors, alone or with platinum doublet chemotherapy, are the standard frontline approach in non-oncogene-addicted, advanced NSCLC.
  6. Subsequent systemic treatment for metastatic disease should consider tumor biology (histology, molecular profile) and the patient’s clinical condition at progression.
  7. Enrollment in a clinical trial should be considered.

Click here to vote for CASE 29