Oncology Peer Review On-The-Go

In a conversation with CancerNetwork®, Oluwadamilola “Lola” Fayanju, MD, MA, MPHS, FACS, discussed the key findings from a study she published in JAMA Network Open, which demonstrated that most patients with inflammatory breast cancer do not receive all available types of guideline-concordant care they are eligible for. Additionally, data showed disparities regarding receipt of modality-specific therapy among patients who were Black, Asian, Hispanic, or other racial minority populations. Based on these findings, Fayanju highlighted potential next steps for mitigating these gaps in care for certain patients with breast cancer. These strategies included revising stringent inclusion criteria for clinical trial enrollment, which may disproportionately exclude racial minority populations who have higher rates of diabetes or other medical conditions. Fayanju also emphasized educating clinicians across different oncology specialties to recognize how different populations present with inflammatory breast cancer and better understand the context in which patients receive treatment. “I hope [the study] makes some people angry…Frustration can be a wonderful fuel,” Fayanju stated regarding her research. “[By] recognizing that there isn't as much guideline-concordant care receipt amongst all people as there should be and the hope that's provided when we achieve concordant care, we can mitigate and eliminate racial disparities. I hope [that] will motivate people to think about how we can get more guideline-concordant care to more people and how we can incorporate diverse populations in the development of guidelines for concordant care at the beginning. Then, how can we also develop treatments that achieve efficacious results across diverse populations?” Fayanju is the Helen O. Dickens Presidential Associate Professor, chief in the Division of Breast Surgery at Penn Medicine, surgical director of Rena Rowan Breast Center, director of Health Equity Innovation at Penn Center for Cancer Care Innovation (PC3I), and senior fellow at Leonard Davis Institute of Health Economics (LDI), Perelman School of Medicine at the University of Pennsylvania. Reference Tadros A, Diskin B, Sevilimedu V, et al. Trends in guideline-concordant care for inflammatory breast cancer. JAMA Netw Open. 2025;8(2):e2454506. doi:10.1001/jamanetworkopen.2024.54506

The International Psycho-Oncology Society (IPOS) deemed April 9th, 2025, the first-ever World Psycho-Oncology Day (WPOD). This day was meant to spread awareness of the importance of prioritizing psychosocial care for patients with all types of cancer as well as to honor Jimmie C. Holland, MD. Prior to WPOD, CancerNetwork® spoke with Cristiane Decat Bergerot, PhD, BS, MS, a psychologist and the head of supportive care at Grupo Oncoclinicas in Brazil, and a member of IPOS, about the importance of psychosocial care and the impact it has on patients with cancer. As stated by Bergerot and listed on the official IPOS website, the primary goals of WPOD are as follows: raise awareness, honor Jimmie Holland, engage stakeholders, promote action, and support fundraising efforts.1 These goals are geared towards paying homage to the history of psycho-oncology and pushing for a more advanced future. “We aim to empower patients, caregivers, and healthcare professionals, fostering a future where psychosocial support is an integral part of oncology worldwide,” Bergerot said.  Psycho-oncology has become more prevalent as a cancer care field since Jimmie C. Holland, MD, worked to help found it in the 1970s. Holland, a “pioneer” of psycho-oncology, was the first ever Chief of Psychiatry Services—a department that was the first of its kind anywhere in the world—at Memorial Sloan Kettering Cancer Center, and a founding member of IPOS.  Bergerot stated that, in her work, she sees that patients who receive psychological support exhibit improved pain management and quality of life. Trials now focus more on end points such as quality of life and patient-reported outcomes, and guidelines have emerged to create standards of care. The National Comprehensive Cancer Network and the American Society of Clinical Oncology each offer guidelines that detail how to manage patient distress as they progress through cancer therapy.2,3 Distress screenings and earlier recommendations for palliative care have also become more standard in treatment.  As for the future, Bergerot highlighted that psychosocial care needs to be more integrated into care as a necessary, rather than optional, component. New developments around the world, however, have created a landscape where telehealth and new research demonstrate the potential to help psycho-oncology grow rapidly.  References 1.        World Psycho-Oncology Day (WPOD). IPOS. Accessed April 2, 2025. https://tinyurl.com/43c9rr2c 2.        Distress during cancer care. NCCN. 2024. Accessed April 2, 2025. https://tinyurl.com/ycxxvnmt 3.        Andersen BL, Lacchetti C, Ashing K, et al. Management of anxiety and depression in adult survivors of cancer: ASCO guideline update. J Clin Oncol. 2023;41(18):3426-3453. doi:10.1200/JCO.23.00293

CancerNetwork® visited Sibley Memorial Hospital of Johns Hopkins Medicine to speak with a variety of experts about therapeutic advancements and ongoing research initiatives across several different cancer fields. As part of each discussion, clinicians highlighted how collaboration across different departments has positively impacted treatment planning, decision-making, and outcomes at their institution. These experts included the following: ·      Rachit Kumar, MD, an assistant professor of Radiation Oncology and Molecular Radiation Sciences at Johns Hopkins School of Medicine and a radiation oncologist specializing in genitourinary and gastrointestinal cancers at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center for Sibley Memorial Hospital and Suburban Hospital; ·      Michael J. Pishvaian, MD, PhD, director of Gastrointestinal, Developmental Therapeutics, and Clinical Research Programs, and associate professor of Oncology at Johns Hopkins School of Medicine; ·      Nina Wagner-Johnston, MD, a professor of Oncology and the director of Lymphoma Drug Development at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, director of Hematologic Malignancies National Capital Region, and co-director of Clinical Research for Hematologic Malignancies; ·      Valerie Lee, MD, an assistant professor of Oncology at Johns Hopkins University School of Medicine and a medical oncologist at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital; ·      Armine Smith, MD, the director of urologic oncology at the Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital, and an assistant clinical professor of Urology at the Brady Urological Institute of Johns Hopkins University School of Medicine; ·      Pouneh Razavi, MD, the director for Breast Imaging in the National Capital Region and an instructor in Radiology and Radiological Science; ·      and Curtiland Deville Jr., MD, medical director of the Johns Hopkins Proton Therapy Center and clinical director of Radiation Oncology at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center at Sibley Memorial Hospital. Altogether, their insights demonstrated how multidisciplinary teamwork has improved outcomes ranging from patient survival to healthcare resource utilization across a wide range of diseases including breast cancer, gastrointestinal cancer, genitourinary cancer, hematologic malignancies, and others.

In a conversation with CancerNetwork®, Leticia Nogueira, PhD, MPH, highlighted the findings and implications of a study she published that evaluated how exposure to wildfires affected post-operative length of stay (LOS) among patients who were recovering from surgery for non–small cell lung cancer (NSCLC). Data from this study showed that patients who underwent curative-intent surgery at facilities exposed to a wildfire disaster experienced a longer LOS compared with similar patients who received treatment during times when no disasters occurred. According to data published in Journal of the National Cancer Institute, the LOS was 7.45 days (SE, 0.22) for patients treated at facilities without wildfire exposure vs 9.42 days (SE, 0.25) among those who underwent surgery at facilities with exposure (P

In the second edition of a special podcast series, CancerNetwork® spoke with Daniel Morgensztern, MD; Mary Ellen Flanagan, NP; and Janelle Mann, PharmD, BCOP, about the best practices for incorporating recently approved bispecific antibodies into cancer care. This discussion focused on clinical trial results, administration protocols, and adverse effect (AE) management strategies related to the use of tarlatamab-dlle (Imdelltra) for patients with small cell lung cancer (SCLC). Morgensztern is a professor of Medicine and the clinical director of Thoracic Oncology in the Division of Oncology at Washington University School of Medicine in St. Louis. Flanagan is a nurse practitioner in the Division of Thoracic Oncology at Washington University. Mann is a clinical oncology pharmacist at Siteman Cancer Center of Washington University School of Medicine and manager of Clinical Pharmacy Services at Barnes-Jewish Hospital. The conversation opened with Morgensztern highlighting tarlatamab's mechanism of action as an agent that targets DLL3. He then reviewed prior efficacy data that the therapy demonstrated in the phase 1 DeLLphi-300 trial (NCT03319940) and the phase 2 DeLLphi-301 trial (NCT05060016). Of note, the FDA approved tarlatamab as the first available T-cell engager immunotherapy for patients with extensive-stage SCLC who have progressed on prior platinum-containing chemotherapy in May 2024 based on data from the DeLLphi-301 trial. Additionally, Flanagan detailed strategies for monitoring and mitigating the most common AEs associated with tarlatamab in this patient population, which include cytokine release syndrome and immune effector cell–associated neurotoxicity syndrome. Mann then outlined considerations for properly dosing and administering the agent, highlighting factors that clinicians should keep in mind when continuing treatment in an inpatient or outpatient setting. The group also spoke about clinical decision-making related to patients who have brain metastases, which included processes for adjusting the dose of tarlatamab and sequencing the bispecific agent with radiotherapy. Reference FDA grants accelerated approval to tarlatamab-dlle for extensive stage small cell lung cancer. News release. FDA. May 16, 2024. Accessed March 14, 2025. https://tinyurl.com/48k34rw5

Molecular differences in the profiles of low grade serous ovarian cancer (LGSOC) and high-grade SOC substantiate the need to find unique, differentiated treatment options for each epithelial ovarian cancer subtype, according to Kathleen N. Moore, MD, MS. CancerNetwork® spoke with Moore, Virginia Kerley Cade Endowed Chair of Cancer Development, associate director of Clinical Research at the Stephenson Cancer Center, director of the Oklahoma TSET Phase I Program and professor in the Section of Gynecologic Oncology the University of Oklahoma Health Sciences Center, about distinguishing low grade serous ovarian cancer from other types of ovarian cancer, current treatment options and clinical trials evaluating new regimens, as well as managing treatment in younger patients with or those seeking to preserve fertility. Moore began by differentiating LGSOC from high grade SOC, stating that this disease typically occurred in younger patients and was primarily characterized by MAP kinase alterations, specifically KRAS and BRAF mutations. She then discussed the emergence of endocrine therapies in this indication owing to the presence of estrogen receptors. Additionally, first line treatment was discussed, with the standard of care defined by primary cytoreduction followed by paclitaxel and carboplatin. She then highlighted multiple clinical trials assessing alternative treatment in this indication, particularly involving the use of letrozole (Femara). Other clinical trials evaluated the use of CDK4/6 inhibition plus fulvestrant or BRAF and MEK inhibition with letrozole, with Moore emphasizing the potential for these studies to shift the treatment paradigm in the frontline setting. Furthermore, she suggested that CDK4/6 inhibition may help enhance responses in patients with recurrent LGSOC. Moore then highlighted treatment concerns for younger patients and those seeking to preserve fertility, while expressing the importance of understanding a patient's goals, which may help optimize outcomes. She concluded by reiterating the importance of designing trials and tailoring treatment considering the molecular profile of LGSOC.

In a recent episode of Oncology on the Go, several oncologists discussed the impact of the COVID-19 pandemic on oncology care, 5 years later. Each doctor discussed a different aspect of multidisciplinary care, including medical oncology, radiation oncology, and epidemiology. CancerNetwork® spoke with leading clinicians including:  ·      Aditya Bardia, MD, MPH, FSCO, professor in the Department of Medicine, Division of Hematology/Oncology, and director of Translational Research Integration at the University of California Los Angeles Health Jonsson Comprehensive Cancer Center; ·      Ritu Salani, MD, director of Gynecologic Oncology at the University of California Los Angeles, and ONCOLOGY® editorial advisory board member; ·      Scarlett Lin Gomez, PhD, MPH, a professor in the Department of Epidemiology and Biostatistics at the University of California San Francisco (UCSF), and co-leader of the Cancer Control Program at UCSF Helen Diller Family Comprehensive Cancer Center ·      Marwan F. Fakih, MD, professor in the Department of Medical Oncology & Therapeutics Research, associate director for Clinical Sciences, medical director of the Briskin Center for Clinical Research, division chief of GI Medical Oncology, and co-director of the Gastrointestinal Cancer Program at City of Hope Comprehensive Cancer Center; ·      Elizabeth Zhang-Velten, MD, a radiation oncologist at Keck Medicine of University of Southern California;  ·      Frances Elain Chow, MD, neuro-oncologist at the University of Southern California (USC) Norris Comprehensive Cancer Center ·      James Yu, MD, MHS, FASTRO, assistant professor adjunct, Department of Radiation Oncology, Smilow Cancer Hospital at Saint Francis Hospital, and ONCOLOGY® editorial advisory board member.  The COVID-19 pandemic disrupted routine cancer care in a number of ways. Many patients were unable to receive timely screening, diagnosis, and treatment, Fakih noted. Additionally, Bardia stated that the pandemic led to a decrease in the number of patients participating in clinical trials. One of the most significant changes in oncology care, according to Salani, has been the increased use of telehealth. Telehealth has allowed patients to receive care from the comfort of their own homes, which has been especially beneficial for patients who live in rural areas or who have difficulty traveling. Telehealth has also made it easier for patients to connect with their doctors and to receive support from other members of their care team.  For Gomez, the COVID-19 pandemic also highlighted the importance of addressing the structural and social drivers of health. These are the conditions in which people are born, grow, live, work, and age that can affect their health. For example, people who live in poverty or who lack access to healthy food are more likely to develop cancer. The pandemic has led to a renewed focus on addressing these disparities. Overall, the COVID-19 pandemic has had a profound impact on oncology care. However, it has also led to a number of positive changes, such as the increased use of telehealth and the focus on addressing the structural and social drivers of health. In the years to come, it will be important to continue to build on these changes in order to improve the lives of patients with cancer.

CancerNetwork®, in collaboration with The American Society for Transplantation and Cellular Therapy (ASTCT), organized an X Space hosted by Rahul Banerjee, MD, FACP, an assistant Professor in the Clinical Research Division at the Fred Hutchinson Cancer Center in Seattle, Washington, and Shernan Holtan, MD, the chief of Blood and Marrow Transplantation and professor of Medicine at Roswell Park Comprehensive Cancer Center.  The conversation took place during the 2025 Tandem Meeting and highlighted many significant presentations and posters on CAR T-cell therapies and transplantation, Banerjee's and Holtan's respective areas of expertise. The following trials were discussed: LBA1 - Phase II Multicenter Trial of Idecabtagene Vicleucel (Ide-cel) Followed By Lenalidomide Maintenance for Multiple Myeloma Patients with Sub-Optimal Response after an Upfront Autologous Hematopoietic Cell Transplantation: Top Line Results from the BMT CTN 1902 Clinical Trial1 “This [study] is nice because it merges 2 worlds. It's like a tandem—but not really a tandem—because you're not doing 2 transplants back-to-back. You're doing a transplant followed by CAR T-cell therapy,” said Banerjee. Abstract 50 - CAR T Cell Therapy in Early Relapsed/Refractory Large B-Cell Lymphoma: Real World Analysis from the Cell Therapy Consortium2 “In a relatively small cohort, [investigators] found no difference in 9-month survival whether someone got their [CAR T cells] in second-line therapy vs third-line therapy from a statistical perspective. If you look at the curves, it looks like there is a potential benefit to second-line therapy, but there was not enough statistical power to determine a difference,” said Holtan. Poster 340 - CD83 Expression By Human Breast Cancer Mediates Effective Killing By CAR T3 “If there's a way to do [the therapy] armored and have a paracrine delivered in real time—and not given to the whole body—[so] the patient [would] have all the adverse effects and cytokine release syndrome release on their own…that would be awesome,” stated Banerjee.  Poster 317 - Risk Factors for Immune Effector Cell-Associated Enterocolitis (IEC-colitis) in Patients with Relapsed Myeloma Treated with Ciltacabtagene Autoleucel (cilta-cel)4 “From the best that we can tell, ironically, corticosteroids aren't the fix that we want them to be [for immune effector cell-associated colitis]…We were like ‘Diarrhea, whatever. Let's give some steroids and treat it like gut graft-versus-host-disease,' but these patients [didn't] respond as well [to that],” said Banerjee. Poster 572 - Post-CAR-T Driving Restrictions Appear Unnecessary after Week 4: Data from the US Multiple Myeloma Immunotherapy Consortium5 “Patients and their caregivers [who have] put their life aside for 4 weeks just to get through CAR T-cell therapy and the Risk Evaluation and Mitigation Strategies requirements are now being told ‘You're free to go, but you can't drive for 4 weeks, which means you can't get your own groceries or…go to doctor's appointments by yourself.' Basically, we argue…that this [requirement] is not evidence-based,” stated Banerjee.  Presentation 58 - Physical Function Measures Identify Non-Hodgkin Lymphoma Patients at High Risk of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) and 1-Year Mortality after Chimeric Antigen Receptor T (CAR-T) Cell Therapy6 “This [presentation] highlights that even within a high [CAR-HEMATOTOX group], those patients were at extraordinarily high risk of not benefitting from CAR T-cell therapy, and these tests are so simple to do. It's going to be interesting to see if others can reproduce this,” said Holtan. Poster 618 - Comparison of Outcomes after Hematopoietic STEM Cell Transplantation (HCT) for Myelodysplastic Syndrome (MDS) Patients Older or Younger THAN 65 YEARS Old. a Retrospective Analysis of the Latin America Registry7 “My personal hope for this space is that our field can come up with more novel conditioning regimens such that we can ablate the marrow without causing those gastrointestinal toxicities or other organ toxicities [while] doing that so effectively that we don't even need maintenance therapies for a lot of conditions,” stated Holtan. Presentation 39 - Determinants of Immune Suppression Discontinuation in the Modern Era: A CIBMTR Analysis of 18,642 Subjects8 “I'm going to make a provocative prediction for the next paper [approximately 10 years from now]. I predict that steroids won't be the first-line therapy for acute or chronic graft-versus-host-disease,” Holtan said. Poster 516 - Patient Experiences with Chronic Graft-Versus-Host Disease and Its Treatment in the United States: A Retrospective Social Media Listening Study9 “We can still work together to make life as good as we possibly can [for patients], to improve physical function, to take away some of this mental distress, and then work together for advocacy too. [We can] help with peer support, help with resources, and help relieve some of that misunderstanding in the community,” stated Holtan. References 1.        Garfall AL, Pasquini MC, Bai L, et al. Phase II multicenter trial of idecabtagene vicleucel (ide-cel) followed by lenalidomide maintenance for multiple myeloma patients with sub-optimal response after an upfront autologous hematopoietic cell transplantation: top line results from the BMT CTN 1902 clinical trial. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Abstract LBA-1. 2.        Rojek AE, Ahmed N, Gomez-Llobell M, et al. CAR T cell therapy in early relapsed/refractory large B-cell lymphoma: real world analysis from the cell therapy consortium. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Abstract 50. 3.        Betts BC, Davilla ML, Linden AM, et al. CD83 expression by human breast cancer mediates effective killing by CAR T. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Poster ID 340. 4.        Chang Lim KJ, Chhabra S, Corraes ADMS, et al. Risk factors for immune effector cell-associated enterocolitis (IEC-colitis) in patients with relapsed myeloma treated with ciltacabtagene autoleucel (cilta-cel). Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Poster ID 317. 5.        Banerjee R, Richards A, Khouri J, et al. Post-CAR-T driving restrictions appear unnecessary after week 4: data from the US multiple myeloma immunotherapy consortium. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Poster ID 572. 6.        Herr M, McCarthy P, Jacobsen H, et al. Physical function measures identify non-Hodgkin lymphoma patients at high risk of immune effector cell-associated neurotoxicity syndrome (ICANS) and 1-year mortality after chimeric antigen receptor T (CAR-T) cell therapy. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Presentation ID 58. 7.        Duarte FB, Garcia YDO, Funke VAM, et al. Comparison of outcomes after hematopoietic STEM cell transplantation (HCT) for myelodysplastic syndrome (MDS) patients older or younger THAN 65 YEARS Old. A retrospective analysis of the Latin America registry. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Poster ID 618. 8.        Pidala J, DeFlilipp Z, DeVos J, et al. Determinants of immune suppression discontinuation in the modern era: a CIBMTR analysis of 18,642 subjects. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Presentation ID 39. 9.        Cowden M, Derrien-Connors C, Holtan S, et al. Patient experiences with chronic graft-versus-host disease and its treatment in the United States: A retrospective social media listening study. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Poster ID 516.

In a conversation with CancerNetwork®, Marwan G. Fakih, MD, spoke about the FDA approval of sotorasib (Lumakras) plus panitumumab (Vectibix), and how it may affect the treatment paradigm for patients with KRAS G12C-mutant metastatic colorectal cancer (CRC). Fakih is a professor in the Department of Medical Oncology & Therapeutics Research, associate director for Clinical Sciences, medical director of the Briskin Center for Clinical Research, division chief of GI Medical Oncology, and co-director of the Gastrointestinal Cancer Program at City of Hope Comprehensive Cancer Center in Duarte, California. According to Fakih, the approval of this combination regimen is a “welcome step” for those with metastatic CRC harboring KRAS G12C mutations. Based on supporting data from the phase 3 CodeBreaK 300 trial (NCT05198934), sotorasib/panitumumab may prolong progression-free survival (PFS) and reduce disease burden in patients while offering improvements in other outcomes vs prior standards of care (SOC) like trifluridine/tipiracil (Lonsurf) and regorafenib (Stivarga). Topline data at the time of the approval showed a median PFS of 5.6 months (95% CI, 4.2-6.3) with sotorasib at 960 mg plus panitumumab vs 2.0 months (95% CI, 1.9-3.9) in the SOC arm, in which patients were assigned to receive trifluridine/tipiracil or regorafenib (HR, 0.48; 95% CI, 0.30-0.78; P = .005). Additionally, the overall response rate was 26% (95% CI, 15%-40%) vs 0% (95% CI, 0%-7%) in each respective arm. Looking ahead, Fakih highlighted the potential next steps for research associated with the sotorasib combination as well as other novel therapeutic strategies in the gastrointestinal cancer space. For example, he described the phase 3 CodeBreaK 301 study (NCT06252649), which will evaluate sotorasib/panitumumab as frontline therapy when administered in combination with folinic acid, fluorouracil, and irinotecan (FOLFIRI) vs FOLFIRI plus bevacizumab (Avastin) in metastatic KRAS G12C-mutant CRC. Other novel agents under development in the space include RAS inhibitors and immunotherapy regimens combining CTLA-4 inhibitors with anti–PD-L1 agents. References 1. FDA approves sotorasib with panitumumab for KRAS G12C-mutated colorectal cancer. News release. FDA. January 16, 2025. Accessed February 12, 2025. https://shorturl.at/1WviB 2. Kim TW, Price T, Grasselli J, et al. A phase 3 study of first-line sotorasib, panitumumab, and FOLFIRI versus FOLFIRI with or without bevacizumab-awwb for patients with KRAS G12C–mutated metastatic colorectal cancer (CodeBreaK 301). J Clin Oncol. 2025;43(suppl 4):TPS326. doi:10.1200/JCO.2025.43.4_suppl.TPS326

Following the 2024 Marginal Zone Lymphoma (MZL) Workshop, CancerNetwork® spoke with multiple attending clinicians about insights they shared regarding the disease state, covering the significance of the workshop and its contribution to advancing research in areas such as prognostic factors and managing adverse events (AEs) related to the disease. Thomas Habermann, MD, professor of Medicine at the Mayo Clinic in Rochester, Minnesota, member of the Lymphoma Research Foundation's Scientific Advisory Board, and MZL Workshop co-chair, spoke about the significance of the MZL Workshop. He highlighted the complexity of these types of diseases, which he believed warranted the establishment of the group. According to Habermann, MZL is a “heterogenous group of disorders” that most contemporaries in the field “don't quite appreciate.” Next, Julie M. Vose, MD, MBA, George and Peggy Payne chair in oncology and chief of Hematology and Oncology at the University of Nebraska Medical Center, and co-editor-in-chief of ONCOLOGY®, spoke about how the MZL Workshop contributes to advancing research and improving outcomes for patients with MZL. She emphasized a need to be more inclusive when enrolling patients with MZL in clinical trials. Then, James R. Cerhan, MD, PhD, professor of Epidemiology at the Mayo Clinic College of Medicine and Science, and Ralph S. and Beverly Caulkins Professor of Cancer Research, spoke about addressing research questions in MZL epidemiology to further disease understanding. He emphasized a need to further study newly identified risk factors of the disease, as well as identifying new treatment targets for patients with MZL. Additionally, Alexandar Tzankov, MD, surgical pathologist and head of the Department of Histopathology and Autopsy at the Institute of Medical Genetics and Pathology at University Hospital Basel, and chair for the European Bone Marrow Working Group, discussed how prognostic factors for MZL may influence treatment. He described how the limited number of studies done with relatively small subsets of patients makes prognoses challenging, as prognostic factors have not been sufficiently explored. Finally, Andrew D. Zelenetz, MD, PhD, medical director of Quality Informatics at Memorial Sloan Kettering Cancer Center, outlined challenges related to AE management of treatments for MZL. He emphasized that safety management practices for MZL are comparable with other B-cell lymphomas, suggesting that use of bridging therapy for CAR T cells and step-up dosing for bispecific antibodies may help with mitigating AEs.

In the first edition of a special 3-part podcast series, CancerNetwork® spoke with Daniel Morgensztern, MD; Mary Ellen Flanagan, NP; and Janelle Mann, PharmD, BCOP, about best practices for implementing recently approved bispecific antibodies into cancer care. Their initial discussion focused on the clinical trial results, administration protocols, and toxicity management strategies related to the use of amivantamab-vmjw (Rybrevant) for patients with EGFR-mutated non–small cell lung cancer (NSCLC). Morgensztern is a professor of Medicine and clinical director of Thoracic Oncology in the Division of Oncology at Washington University School of Medicine in St. Louis. Flanagan is a nurse practitioner in the Division of Thoracic Oncology at Washington University in St. Louis. Mann is a clinical oncology pharmacist at Siteman Cancer Center of Washington University School of Medicine in St. Louis and manager of Clinical Pharmacy Services at Barnes-Jewish Hospital. Morgensztern began by giving an overview of amivantamab's mechanism of action and highlighting supporting data for the agent when administered alone or in combination with other agents.  The FDA initially approved amivantamab monotherapy for patients with EGFR exon 20 insertion–mutant NSCLC in May 2021 based on data from the phase 1 CHRYSALIS trial (NCT02609776). Furthermore, the agency approved amivantamab/chemotherapy as frontline treatment for patients with NSCLC harboring EGFR exon 20 insertion mutations in March 2024 based on data from the phase 3 PAPILLON trial (NCT04538664). Findings from the phase 3 MARIPOSA trial (NCT04487080) also supported the FDA approval of amivantamab plus lazertinib (Lazcluze) for those with EGFR-mutant NSCLC in August 2024. Additionally, Mann reviewed key dosing considerations as patients receive amivantamab via intravenous infusion. She detailed the use of premedication such as diphenhydramine (Benadryl) to supplement amivantamab while monitoring for toxicities during the initial infusion period, which may necessitate additional dosing adjustments. Flanagan added to the conversation surrounding infusion-related reactions by describing strategies for mitigating the risk of venous thromboembolism, cutaneous toxicities, and other adverse effects. References 1. RYBREVANTTM (amivantamab-vmjw) receives FDA approval as the first targeted treatment for patients with non-small cell lung cancer with EGFR exon 20 insertion mutations. News release. The Janssen Pharmaceutical Companies of Johnson & Johnson. May 21, 2021. Accessed January 29, 2025. https://tinyurl.com/3d8wtu4m 2. FDA approves amivantamab-vmjw for EGFR exon 20 insertion-mutated non-small cell lung cancer indications. News release. FDA. March 1, 2024. Accessed January 29, 2025. https://tinyurl.com/msw4u5yk 3. RYBREVANT® (amivantamab-vmjw) plus LAZCLUZE™ (lazertinib) approved in the U.S. as a first-line chemotherapy-free treatment for patients with EGFR-mutated advanced lung cancer. News release. Johnson & Johnson. August 20, 2024. Accessed January 29, 2025. https://tinyurl.com/yxc8u8t4

In collaboration with KidneyCAN, CancerNetwork® spoke with Eric Jonasch, MD, a professor in the Department of Genitourinary Medical Oncology of the Division of Cancer Medicine, and the director of the von Hippel Lindau Center at the University of Texas MD Anderson Cancer Center in Houston, Texas, about the missions and goals of the Kidney Cancer Research Consortium. Jonasch is the principal investigator of an effort, supported by a Department of Defense (DoD)–funded grant, that aims to improve the treatment of patients with renal cell carcinoma (RCC) by developing a network of clinical trial centers that have expertise in both developing and executing new research efforts.  “We want to do the clinical trials that the industry wouldn't do otherwise and do the trials that are going to allow us to gain knowledge faster,” Jonasch said. “We do this by, number one, using novel agents; number 2, using more efficient and innovative clinical trial designs; and, number 3, incorporating correlative studies, including biopsies and various other circulating biomarkers analyses that allow us to get smarter faster.” Many of the ongoing and recently completed trials in the kidney cancer space focused heavily on immune therapy, utilizing checkpoint-blocking antibodies like nivolumab (Opdivo) and pembrolizumab (Keytruda) or CTLA-4–blocking agents like ipilimumab (Yervoy). Of the studies moving the space forward, Jonasch highlighted an ongoing phase 1b/2 trial (NCT05501054) evaluating ipilimumab, nivolumab, and ciforadenant (CPI-444), an A2A inhibitor, in RCC along with other trials. During the discussion, Jonasch mentioned the initiative to incorporate biopsies in treatment more frequently, particularly through giving a pre- and post-biopsy to see how the results change during therapy. This approach gives investigators an opportunity to see how cancer cells interact with immune cells.  Additionally, Jonasch stated that they wish to expand their efforts to the broader kidney cancer community, as currently, work in the consortium only takes place in 7 “ivory tower” institutions that may be difficult to access for some patients. One of the ways they're combatting this barrier is through working with the Veterans Affairs hospital system. Once that effort is complete, Jonasch hopes the consortium will be able to start helping more patient groups.  KidneyCAN is a nonprofit organization with a mission to accelerate cures for kidney cancer through education, advocacy, and research funding. You can learn more about KidneyCAN's work here: https://kidneycan.org/ Reference Beckermann K, Rini B, Haas N, George D, Jonasch E. Phase 1b/2 trial of ipilimumab, nivolumab, and ciforadenant (INC) (adenosine A2a receptor antagonist) in first-line advanced renal cell carcinoma. Oncologist. 2023;28(suppl 1):S13–4. doi:10.1093/oncolo/oyad216.022.

In a conversation with CancerNetwork®, Shewetal Mehta, PhD, spoke about her research team's focuses in moving novel brain cancer therapies down the pipeline as part of an early phase clinical trials program at the Ivy Brain Tumor Center. Mehta, the deputy director and pre-clinical core leader at the Ivy Brain Tumor Center of Barrow Neurological Institute in Phoenix, Arizona, underscored a scientifically rigorous, patient-driven philosophy that drives her team members to deliver timely answers to those with brain cancer via work in a clinical lab and a pre-clinical arm. This collaboration helps identify therapeutic agents that may demonstrate activity in the brain while determining patient populations who are suitable to enroll on clinical trials. As part of her institution's early phase trial program, Mehta specifically highlighted work associated with a phase 0/1 clinical trial (NCT06072586) evaluating BDTX-1535, a brain-penetrant fourth-generation EGFR inhibitor, for those with recurrent high-grade glioma harboring oncogenic EGFR alterations or fusions.1 Investigators are incorporating liquid biopsy, sampling cerebrospinal fluid from patients on treatment to monitor potential evolutions or changes in brain tumors. Regarding biomarker testing, Mehta described the roles that gene sequencing and immunohistochemistry can play in identifying targetable alterations in patients with brain cancer. She mentioned vorasidenib (Voranigo), which received approval from the FDA in August 2024, as an example of a targeted therapy that may be suitable for use in patients who are found to have actionable IDH mutations. “Over the last year, we've seen that we were capable of not just doing these early phase clinical trials [but of entering] this phase of moving drugs into phase 3 [studies]. That's exciting,” Mehta stated regarding her outlook on the current state of brain cancer treatment. “Right now, we are excited about these new classes of agents that are within the space, like the proteolysis targeting chimeras, protein degraders, and antibody-drug conjugates, which have shown amazing promise in the rest of the oncology space.” References 1.        Study of BDTX-1535 in recurrent high-grade glioma (HGG) participants with EGFR alterations or fusions. ClinicalTrials.gov. Updated January 15, 2025. Accessed January 15, 2025. https://tinyurl.com/m6kwr2b3 2.        FDA approves vorasidenib for grade 2 astrocytoma or oligodendroglioma with a susceptible IDH1 or IDH2 mutation. News release. FDA. August 6, 2024. Accessed January 20, 2025. https://tinyurl.com/25r9fkvy

CancerNetwork® spoke with Michael P. Bogenschutz, MD, director of the NYU Langone Center for Psychedelic Medicine and professor of Psychiatry at NYU Grossman School of Medicine, about psilocybin-assisted psychotherapy (PAP) in managing psychological challenges associated with serious cancer diagnoses following the publication of a pooled analysis of 2 phase 2 trials assessing the regimen in this patient population. In these trials, 87 patients were randomly assigned 1:1 to receive either psilocybin first (n = 45) or control therapy with niacin or low-dose psilocybin first (n = 42) followed by crossover. A total of 79 patients completed at least 1 assessment after the first dose. He began by touching upon the significance of the results, highlighting an improvement in multiple psychiatric symptoms including anxiety (P = .0049), depression (P = .0007), interpersonal sensitivity (P = .0005), obsession-compulsion (P = .0002), hostility (P = .009), and somatization (P < .0001). Then, Bogenschutz discussed the potential for PAP to reduce an unmet need for patients seeking effective medication to mitigate cancer-related psychological challenges, highlighting limitations of both antidepressants and anxiety medication in this population.  Next, Bogenschutz discussed implementing PAP into clinical practice for patients with cancer-related psychological challenges. In particular, he expressed that integration could occur through in-house operation, which may build the capacity to provide PAP within cancer centers, or through a referral system to a licensed practitioner trained to administer psilocybin.  Additionally, he described potential adverse effects associated with psilocybin use, highlighting acute mind-altering and sympathomimetic effects. He then expressed the importance of psychotherapy as a means of supplementing the use of psilocybin, which may help patients better attain positive mental health outcomes than with psilocybin alone.  He concluded by highlighting the lasting effects of psilocybin dosing, which may persist for months after a single dose, as well as areas for future research in assessing PAP. Specifically, he emphasized exploring ideal treatment parameters and the full psychopathological scope of the agent. Reference Petridis PD, Grinband J, Agin-Liebes G, et al. Psilocybin-assisted psychotherapy improves psychiatric symptoms across multiple dimensions in patients with cancer. Nat Mental Health. 2024;2:1408-1414. doi:10.1038/s44220-024-00331-0

Following the 2024 San Antonio Breast Cancer Symposium (SABCS), Paolo Tarantino, MD, and Matteo Lambertini, MD, PhD, co-hosted a live X Space with CancerNetwork® and spoke about updated trial findings that may impact the breast cancer treatment paradigm. Tarantino is a clinical research fellow at Dana-Farber Cancer Institute and Harvard Medical School. Lambertini is an associate professor and consultant in medical oncology at the University of Genova – IRCCS Policlinico San Martino Hospital in Genova, Italy. Tarantino and Lambertini highlighted data from various studies that investigators presented at the Symposium, which included results on the use of treatment modalities such as antibody drug conjugates and CDK4/6 inhibitors. Some presentations of interest included the following: ·      Phase 3 DESTINY-Breast06 Trial (NCT04494425) o   Patients with hormone receptor (HR)–positive, HER2-low or HER2-ultralow metastatic breast cancer were assigned to receive fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) or physician's choice of therapy. o   Treatment with T-DXd improved progression-free survival (PFS) among patients with a time to progression on frontline endocrine therapy of less than 6 months (HR, 0.38; 95% CI, 0.25-0.59), 6 to 12 months (HR, 0.69; 95% CI, 0.43-1.12), and more than 12 months (HR, 0.67; 95% CI, 0.51-0.88). o   PFS improved with T-DXd regardless of disease burden. ·      Phase 3 EMBER-3 Trial (NCT04975308) o   Investigators evaluated 3 treatment arms—imlunestrant (LY3484356) monotherapy, fulvestrant (Faslodex) or exemestane (Aromasin), and imlunestrant in combination with abemaciclib (Verzenio)—among patients with estrogen receptor (ER)–positive, HER2-negative advanced breast cancer. o   Across the overall population, imlunestrant monotherapy improved PFS compared with standard endocrine therapy (HR, 0.87; 95% CI, 0.72-1.04; P = .12). o   Imlunestrant plus abemaciclib also showed a PFS improvement vs endocrine therapy across the overall population (HR, 0.57; 95% CI, 0.44-0.73; P

In a conversation with CancerNetwork®, Rachel A. Millstein, PhD, MHS; Loren Winters, NP; and Amy Comander, MD, discussed their article titled Implementing a Multidisciplinary Lifestyle Medicine Clinic for Cancer Survivorship, which was published in the November 2024 issue of ONCOLOGY®. The authors detailed the implementation of a novel oncology-based multidisciplinary lifestyle medicine clinic that may help enhance the quality of life (QOL) among survivors of cancer. Millstein is a psychologist in the Behavioral Medicine Program and an assistant professor in the Department of Psychiatry at Massachusetts General Hospital. Winters is an oncology nurse practitioner and assistant director of the Lifestyle Medicine Program at Massachusetts General Hospital. Comander is the medical director of Mass General Cancer Center-Waltham, director of the Breast Oncology Program at Newton-Wellesley Hospital, and director of the Lifestyle Medicine Program at Massachusetts General Hospital. Millstein outlined the rationale for this publication on the development of a multidisciplinary lifestyle medicine clinic, highlighting a need to boost general awareness and support for lifestyle medicine consultations and health behavior change in cancer survivor care. Winters then explained how the multidisciplinary clinic works in alignment with 6 key pillars of lifestyle medicine, as team members aim to promote physical activity, plant-predominant diets, restorative sleep, stress management, avoidance of risky substances, and social connections to enhance QOL among cancer survivors. Additionally, Comander highlighted how the lifestyle medicine program optimizes health and well-being by matching patients to the specific services they require, which may include the help of team members such as board-certified physicians, nurse practitioners, registered dietitians, and clinical psychologists. Millstein and Winters then detailed the improvements in health behaviors associated with 2 patient cases at their program, demonstrating the potential benefits of implementing broad and diverse lifestyle medicine tools in oncology-supportive care. Looking ahead, Comander described the importance of addressing gaps in education, a lack of programs focused on areas such as weight management, and other barriers to the implementation of lifestyle medicine in oncology care. Finally, each author expressed her hope to see more colleagues, clinics, and programs incorporate lifestyle medicine as part of elevating QOL among survivors of cancer. The authors invite listeners to contact them if they would like to find ways to implement lifestyle medicine in their respective centers.

CancerNetwork® spoke with Natasha Bahri, MD, MS, and Daneng Li, MD, about their Hot Topics article titled Casting a Wide NET: When Is the Optimal Time for 177Lu-Dotatate Treatment?, which was published in the November 2024 issue of ONCOLOGY®. Their article focused on findings related to the use of 177Lutetium-Dotatate (177Lu-dotatate; Lutathera) in patients with neuroendocrine tumors (NETs) and whether these data supported the use of the novel radioligand therapy for this population. Bahri is a PGY-5 chief fellow in Medical Oncology and Hematology at City of Hope National Medical Center in Duarte, California. Li is an associate professor in the Department of Medical Oncology & Therapeutics Research at City of Hope Comprehensive Cancer Center in Duarte, California, and a gastrointestinal editorial board member of ONCOLOGY. Bahri and Li discussed findings from the phase 3 NETTER-1 trial (NCT01578239) assessing 177Lu-dotatate for those with inoperable, locally advanced or metastatic, grade 1/2 midgut NETs following progression on long-acting repeatable octreotide therapy. Although these findings established a significant efficacy signal with the radioligand therapy, Li noted that questions remained regarding the sequencing of 177Lu-dotatate alongside other therapies in the treatment landscape. The conversation also covered efficacy, safety, and quality-of-life (QOL) data from the phase 3 NETTER-2 trial (NCT03972488), in which investigators assessed high-dose octreotide with or without 177Lu-dotatate among patients with locally advanced or metastatic, well-differentiated, somatostatin receptor–positive gastroenteropancreatic NETs. Although data showed improvements in efficacy with the 177Lu-dotatate combination, there did not appear to be significant differences regarding QOL outcomes between arms. “We're waiting for further long-term follow-up information as there was no difference in the QOL metrics. It's important to think about how these patients' goals align with the therapy that we're giving, and if we're not seeing a difference in the quality of life quite yet, [we need to] look at individual patients, see what their goals are, and match them up to the therapy that we're giving them,” Bahri stated. Although the NETTER-1 and NETTER-2 trials demonstrate “great” results associated with efficacy end points such as progression-free survival, the authors noted that it is crucial to weigh these benefits with the potential toxicities when determining suitable candidates for treatment with 177Lu-dotatate. “There's a lot of nuances in terms of who is the ideal patient that's going to maximally benefit [while] minimizing any risk of serious toxicity in those patients. As a result of that, we're helping to improve their outcomes to the highest bars possible, whether it's quality of life or survival,” Li concluded. References 1.        Strosberg J, El-Haddad G, Wolin E, et al; NETTER-1 Trial Investigators. Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376(2):125-135. doi:10.1056/NEJMoa1607427 2.        Singh S, Halperin D, Myrehaug S, et al; NETTER-2 Trial Investigators. [177Lu]Lu-DOTA-TATE plus long-acting octreotide versus high-dose long-acting octreotide for the treatment of newly diagnosed, advanced grade 2-3, well-differentiated, gastroenteropancreatic neuroendocrine tumours (NETTER-2): an open-label, randomised, phase 3 study. Lancet. 2024;403(10446):2807-2817. doi:10.1016/S0140-6736(24)00701-3

CancerNetwork® spoke with Rachel A. Greenup, MD, MPH, an associate professor of surgery (oncology), section chief of Breast Surgery, and co-director of the Center for Breast Cancer at the Yale School of Medicine, about the rationale behind conducting a study evaluating the lived experiences among women of color following breast cancer mastectomy, as well as data collection strategies employed during the study and key themes outlined in questionnaire responses. First, Greenup, senior author of the study, emphasized that disparities persist for women of color following mastectomy for breast cancer, both in those seeking breast reconstructive surgery and those choosing to forego it, which is an act called “living flat.” She explained that many of the stories behind these disparities were left untold, and this study was seeking to unearth them. She then explained that women of color who underwent a mastectomy for breast cancer were sampled for the study. The patient population included women from her institution and survivors willing to share their experiences. Expressing that her team strove to let the stories of these women speak for themselves, she discovered 2 major findings during her research. The first theme that emerged was a cultural stigma surrounding cancer diagnoses among minority groups, which impact knowledge of family history as well as timely screening, care, and support for their disease. The second major theme that her study revealed was spirituality as a driver for many of the decisions following mastectomy. Greenup further emphasized a need for cultural, racial, and ethnic inclusion during clinical trials, which extends to anticipating differences in cancer developments among diverse populations. She concluded by encouraging all patients to share their family history of cancer, regardless of background, as it can impact screening and prevention measures. “I would encourage all families and all individuals from different cultural backgrounds to share their family history of cancer. It has a critical impact in terms of screening and cancer prevention for other family members,” Greenup said. “It can be difficult to have those conversations, but it is information that can be powerful for future prevention.” Reference Khubchandani JA, Suttiratana SC, Washington R, et al. Living flat: stories from women of color after mastectomy. Ann Surg Oncol. Published online October 15, 2024. doi:10.1245/s10434-024-16337-y

CancerNetwork, in a partnership with KidneyCAN, spoke with 2 genitourinary oncologists, Elizabeth P. Henske, MD, and Jason Muhitch, PhD, about how advocacy and funding through interdisciplinary collaboration between patient advocates, researchers, and physicians have resulted in numerous clinical breakthroughs in kidney cancer.  Henske is a professor of medicine at the Harvard Medical School, an associate member of the Broad Institute of MIT and Harvard, director of the Center for LAM Research and Clinical Care, and a physician at Brigham and Women's Hospital and Dana-Farber Cancer Institute. Muhitch is an associate professor of Oncology, co-chair of the Genitourinary Translational Research Group, deputy director of Graduate Studies, and a member of the Department of Immunology at Roswell Park Comprehensive Cancer Center at Roswell Park Comprehensive Cancer Center. First, the state of kidney cancer advocacy was discussed, with Muhitch emphasizing multidisciplinary collaboration and the role of conferences, such as the Kidney Cancer Research Summit (KCRS) and the International Kidney Cancer Symposium, in bringing these groups together. Henske emphasized the strength of the advocacy network for kidney cancer, particularly as a mechanism for exchanging information, offering patient support and education, and facilitating research. Next, funding was touched upon, with Henske expressing her interest in conveying the importance and urgency of kidney cancer research to Congress. Muhitch agreed, suggesting that the meetings with congressional offices offer opportunities to explain how funding can impact kidney cancer outcomes and scientist training, as well as the strength of patient advocacy in influencing Congress. Muhitch and Henske then discussed the Kidney Cancer Research Program, which has enabled significant increases in funding for kidney cancer research, helped to facilitate clinical breakthroughs for common kidney cancer types, and set a foundation for exploring different kidney cancer variants. The discussion then turned to encouraging research for renal cell carcinoma , which Muhitch expressed can be attributed to partnership award recipients who went on to conduct research evaluating biomarkers predictive of patient responses to immunotherapies.  Regarding additional funding mechanisms, Henske and Muhitch discussed numerous private foundations providing smaller research grants. Henske explained that these smaller grants are instrumental in taking the first steps to explore rarer kidney cancer subtypes, with Muhitch explaining that the earlier funding can formulate research that leads to greater funding from the Kidney Cancer Research Program. KidneyCAN is a nonprofit organization with a mission to accelerate cures for kidney cancer through education, advocacy, and research funding. Learn more about KidneyCAN's mission and work here.

In a conversation with CancerNetwork® at the 2024 Annual Oncology Clinical Practice and Research Summit, Andrew M. Evens, DO, MBA, MSc, spoke about a session he moderated at the meeting, in which he and other panelists highlighted ongoing efforts to improve the quality of care for cancer survivors at his institution.  Evens is the deputy director for Clinical Services at Rutgers Cancer Institute and the system director of Medical Oncology and the oncology lead at RWJBarnabas Health Medical Group. He is also the associate vice chancellor for Clinical Innovation and Data Analytics at Rutgers Biomedical and Health Sciences. Evens contextualized the presentation by describing various gaps in care for survivors of cancer, particularly among adolescent and young adult populations or those who become “lost in transition” as they switch from pediatric to adulthood survivorship. He emphasized a growing effort to mitigate the risks of post-acute or late effects following prior anti-cancer therapy, which can include cardiac disease, lung disease, or increased infections associated with chemotherapy or radiation.  As part of elevating the level of care for cancer survivors, Evens described the collaborative efforts across different departments at his institution, including medical, surgical, and radiation oncologists; pharmacists; nurses; pathologists; and members of the clinical research team. Other international research projects, including those formed in association with the National Cancer Institute, aim to elucidate the granularity of treatment-related toxicity, which may help inform better survivorship care strategies.  “Survivorship includes many factors,” Evens said. “There are physical and emotional factors, and we want to do everything we can as a comprehensive cancer program, and to do what's best for the patient in a holistic manner. [Beyond the] cancer, it also means the emotional factors and health behavior modifications. For the rest of their life, [we want to] help the patient in every way possible so they can live the most fruitful life. A high quality of life is what we strive for.” Reference Evens A, Cole P, Ligresti L, Manne S. Cancer survivorship: scale, scope, and partnerships for patient-centered care. Presented at the 2024 Annual Oncology Clinical Practice and Research Summit; November 15-16, 2024; New Brunswick, NJ.

During Pancreatic Cancer Awareness Month, CancerNetwork® spoke with Kelly A. Rone, DNP, RN, AGNP-c, about the current state of pancreatic cancer, emphasizing risk factors, diagnostic challenges, and treatment planning. Rone is an advanced practice nurse of gastrointestinal oncology at Mayo Clinic in Phoenix, Arizona. Rone initially discussed patient counseling for risk factors, making a distinction between modifiable risk factors—such as smoking, drinking, and obesity—and nonmodifiable risk factors, which primarily include genetic syndromes. Rone then highlighted a need for more effective screening methods, highlighting a lack of screening tools that have been proven to be highly effective, as well as the tendency for pancreatic cancer to be identified at a later stage. Rone then touched upon treatment-emergent adverse effects (AEs), as well as how her practice manages them. She particularly placed emphasis on appetite loss, which may prove difficult for patients attempting to recover from cancer treatment. Additionally, Rone suggested various methods to encourage food consumption in spite of appetite loss. Rone expressed that she connects patients with pancreatic cancer to palliative care frequently, explaining that patients can benefit from involvement in terms of managing AEs and extending life expectancy. Furthermore, she stressed a need to correct misconceptions of palliative care as exclusively entailing pre-hospice care, highlighting benefit in all patients regardless of disease stage. Rone iterated that addressing psychosocial needs for patients varies depending on a patient's circumstances. Rone then suggested that viewing patients as individuals with lives beyond their cancer diagnosis can help humanize them and can help to foster more meaningful discussions regarding cancer treatment than electronic health records alone.  Then, Rone expressed a desire to find ways to detect pancreatic cancers sooner by developing biomarkers, highlighting how pancreatic cancer may be paired with several vague symptoms that make early detection difficult. Rone explained that early detection of pancreatic cancers can be associated with better outcomes. She further expressed a need to elicit better treatment outcomes for pancreatic cancer based on low responsiveness to chemotherapy. Rone concluded by emphasizing a need for education regarding 2 distinct types of pancreatic cancer––pancreatic adenocarcinoma and pancreatic neuroendocrine cancer––to better manage patient expectations.

In a conversation with CancerNetwork® during Pancreatic Cancer Awareness Month, Tanios S. Bekaii-Saab, MD, spoke about various developments in the pancreatic cancer treatment field. Throughout the discussion, Bekaii-Saab weighed the benefits of currently available chemotherapeutic regimens for patients with metastatic disease, discussed research on the potential for precision medicine in those with KRAS wildtype pancreatic ductal adenocarcinoma (PDAC), and detailed ongoing initiatives to improve outcomes among those with RAS mutations and other targetable genomic alterations. Bekaii-Saab is the David F. and Margaret T. Grohne Professor of Novel Therapeutics for Cancer Research, chair and consultant in the Division of Hematology and Medical Oncology at Mayo Clinic in Arizona, and co-leader of Advanced Clinical and Translational Science at Mayo Clinic Cancer Center. Given the prevalence of RAS mutations and other alterations in patients with pancreatic cancer, Bekaii-Saab especially emphasized the use of genomic analysis to inform personalized treatment decision-making in the field. Screening patients to detect aberrations such as microsatellite instability-high tumors, BRAF 600E mutations, KRAS G12C mutations, and NRG1 fusions can open the door for the development and use of targeted agents, which may consequently improve patient outcomes.  Looking ahead, Bekaii-Saab noted the need to adapt the therapies that have shown activity in the later stages of the disease to earlier treatment settings. Although “great work” has been achieved with chemotherapy and surgical techniques, he highlighted the importance of bringing targeted agents to earlier lines of therapy to further increase the likelihood of positive outcomes for patients.  “I have never been more optimistic. I'm always the eternal optimist, but I'm even more optimistic today that we're going to move the needle for our patients with pancreatic cancer and continue to enhance that likelihood of living longer, having a better quality of life, or even increasing the level of a cure for this cancer,” Bekaii-Sabb stated. “Certainly, the future looks bright. We're chipping away, one drug at a time. We can now remove that whole concept of nihilism in pancreatic cancer and look quite optimistically on the future.”

As part of Oncology On the Go, CancerNetwork® spoke with Andrew M. Evens, DO, MBA, MSc, about developments in the treatment landscape for adolescents and young adults (AYA) with lymphoma. He highlighted collaboration between adult and pediatric oncologists that may better standardize treatment for this population.  Evens is the deputy director for clinical services at the Rutgers Cancer Institute and system director of medical oncology and oncology lead at RWJBarnabas Health Medical Group. Of note, Evens discussed an effort to “harmonize” efforts between adult and pediatric oncologists in treating AYA patients who may receive different treatment regimens, despite being similar in age. Furthermore, he highlighted 2 prominent trials that illustrated collaborative efforts from both adult and pediatric oncologists: the phase 3 SWOG S1826 trial (NCT03907488) and the phase 3 AHOD2131 trial (NCT05675410). Regarding the SWOG trial, Evens highlighted the greater efficacy and tolerability of nivolumab (Opdivo) with doxorubicin hydrochloride (Adriamycin), vinblastine sulfate, and dacarbazine (AVD) vs the standard of care brentuximab vedotin (Adcetris) plus AVD.  “You could say it was, generally speaking, a double winner. [The nivolumab combination] was more effective at 2 years; the progression-free survival [PFS] was greater than 90%, [which was] a remarkable output. When I say a double winner, it was also largely better tolerated. There was less neuropathy, [fewer] infections, and less sepsis [vs brentuximab vedotin plus AVD]. Surprisingly, to a certain extent, [there were] not many immune-related adverse events outside of thyroid [events],” Evens said. Furthermore, Evens discussed how collaboration between adult and pediatric oncology has impacted developments in the AYA lymphoma sphere. He placed a particular emphasis on the efforts of the Lymphoma Research Foundation, which convened multiple AYA lymphoma symposiums and established an AYA consortium. He then outlined unmet needs for this patient population, which included mitigating late toxicities following treatment and addressing inconsistencies in guidelines for lymphoma treatment in the AYA group. Evens then discussed mitigating disparities and addressing barriers to care, underscoring a need to navigate the complexities of treatment for a patient population with a myriad of stressors. He concluded by highlighting resources available to AYA lymphoma groups, which include educational, medical, and psychosocial resources to best educate patients and express to them that they are not alone.  “At the end of the day, be an advocate. Be an advocate for yourself. Be an advocate for others and know that there are [many] resources and people out there to help. We want to make sure nobody has to go through this alone, and that they have the medical and other psychosocial resources available to them,” Evens concluded.

CancerNetwork® sat down with Kelley A. Rone, DNP, RN, AGNP-c, to discuss the importance of speaking compassionately and ensuring patient awareness when leading end-of-life discussions among those with gastrointestinal (GI) cancers. The discussion also focused on combating burnout in the clinic, using opioids to help manage pain and other symptoms, and educating all members of a multidisciplinary team on initiating end-of-life conversations with their patients. Rone is an advanced practice nurse (APN) in GI oncology at the Mayo Clinic in Phoenix, Arizona. As part of leading these end-of-life conversations, Rone emphasized the necessity of addressing the discomfort patients tend to feel when talking about the fact that they may die from their cancer. Speaking with these patients may involve being open about the possibility of terminating therapy early if treatment-related toxicity such as fevers, diarrhea, and pain outweigh any potential efficacy or diminish quality of life. Additionally, Rone highlighted how APNs may be more comfortable with speaking about death than other team members. Rone also discussed the importance of managing fatigue and pain as patients near the end of their lives. In her role, she initiates education on pain management early in end-of-life care discussions to make patients feel more comfortable about receiving opioids for symptoms. When working with other members of a multidisciplinary care team, Rone illustrated the challenge of having physicians understand that their treatments may fail in younger patients and helping other oncologists become more experienced in speaking about death with patients. Regarding the idea of mitigating burnout and maintaining one's mental well-being, Rone described how her role has given her perspective on what is truly important about life. “This [role] helps you appreciate the finality of life. You don't get upset about [minor] things after you see a 39-year-old with metastatic cancer,” Rone stated. “You learn to have an appreciation for the good things and not dwell so much on the bad things.”

CancerNetwork® spoke with John Paul Diaz, MD, about uterine transposition, a surgical technique aiming to preserve fertility in women undergoing radiotherapy for pelvic tumors. Diaz is the chief of gynecologic oncology, director of robotic surgery, director of the Center of Excellence in Minimally Invasive Gynecologic Surgery at Baptist Health, and lead physician for Clinical Trials in Gynecologic Oncology at Miami Cancer Institute.  Of note, Diaz discussed the outcomes associated with 2 procedures conducted at his practice, as well as challenges associated with the development and implementation of the procedure. Additionally, he spoke about the next steps in developing and raising awareness of the procedure. Diaz foregrounded the discussion by highlighting the simplicity of the procedure, which he stated was similar to a hysterectomy. Unlike a hysterectomy, uterine transposition entails a temporary relocation of the uterus to the anterior abdominal wall, which preserves it for fertility while removing it from the radiation field. Furthermore, Diaz described the collaboration between Baptist Health and Memorial Sloan Kettering Cancer Center, including a partnership with Mario M. Leitao, Jr., MD, FACOG, FACS, who holds the largest series in the United States in performing uterine transpositions. He explained that the collaboration was conducive for expanding patient populations that may benefit from this surgery. Diaz then underlined outcomes related to 2 uterine transposition procedures he conducted at Baptist Health. He described a favorable outcome with one patient who had completed the procedure 3 months prior who may be able to become pregnant in the future. The second patient was undergoing radiotherapy, with plans to undergo the second stage of the surgery in following months. Diaz then highlighted a distinction between uterine transposition and other fertility preservation measures in that it preserves the entire uterus so patients can still carry a child, whereas other radiation therapy techniques do not. He then highlighted patients who are eligible for this procedure, particularly among women who want to preserve their fertility with pelvic tumors requiring radiation that might otherwise sterilize the uterus. Challenges related to the development and implementation of the procedure were discussed, with particular emphasis placed upon quality of life following treatment. Additionally, he emphasized the idea of patient-driven improvements in treatment outcomes, which he hoped could be applied to help more women preserve their fertility. Diaz continued by emphasizing the novelty of the procedure, explaining that experiences with it are growing while surgery success rates increase with global collaboration and technique sharing. He followed by underscoring the primary goal of cancer eradication, stressing that treatment for progressing disease takes precedence over fertility, and in those situations, fertility may be compromised. He further outlined key short-term outcomes in patients undergoing uterine transposition, particularly as they related to maintaining uterine perfusion and mitigating post-operative complications. For long-term outcomes, he highlighted the goal for patients to be disease-free and capable of carrying a live birth. Additionally, Diaz underscored a challenge related to raising awareness for this procedure, highlighting efforts he has undertaken to inform surgeons in the colorectal cancer field about the availability of this procedure as an option for this patient population. He suggested that colleague identification of eligible patients, effective referral, and increased proliferation of procedure knowledge may be effective in overcoming this challenge. Diaz concluded by highlighting next steps for the procedure as they relate to expanding access for patients, increasing knowledge of the procedure among physicians, and developing novel techniques for uterine preservation during radiotherapy. He highlighted the “exciting” development of this procedure, which he suggested might have been inconceivable a few years ago, in achieving better outcomes for young women diagnosed with pelvic tumors.

In a conversation with CancerNetwork®, Ginger J. Gardner, MD, FACOG, spoke about current research and advocacy efforts to improve clinical outcomes among patients with gynecological cancers. With diagnoses of gynecologic malignancies on the rise around the world, Gardner also highlighted the next steps for raising awareness in the field and addressing gaps in care. Gardner is a gynecologic surgeon at Memorial Sloan Kettering Cancer Center, as well as the chair of the board for the Foundation for Women's Cancer (FWC). According to Gardner, approximately 115,000 of those in the United States and 1 million patients across the world are diagnosed with gynecologic cancer. Additionally, she highlighted a growing incidence of uterine cancers, which included a 2-fold increase in mortality among patients who are Black in the United States compared with other populations. As part of raising awareness in this patient population and advancing potential therapeutic solutions, Gardner described ongoing initiatives at FWC to facilitate collaboration among scientists, researchers, and gynecologic oncology providers to help improve outcomes. Regarding potential treatment innovations, she also highlighted clinical trials designed to assess various disease prevention methods and other therapies like targeted agents, PARP inhibitors, and antiangiogenic treatments. Looking ahead, Gardner detailed other potential developments in the gynecologic cancer space that she is excited about. For example, she spoke about future efforts to further uncover the tumor biology and molecular heterogeneity associated with these malignancies, which may help providers optimize treatment plans for patients. “We are seeing some impact in improvement for gynecologic cancers with innovation in many of our disciplines; that includes disease prevention and innovative modalities related to treatment, inclusive of surgical innovation, new targeted therapies, refining radiation treatment, and ultimately patient-reported outcomes. We need to keep our eye on the ball for where we're going next,” Gardner stated. “It is hard to dial it into just 1 or 2 snapshots, but I am so thankful that we have this time together to talk about the importance of gynecologic health awareness and research because it is important that we raise this conversation.”

In a special co-branded episode between Oncology On the Go hosted by CancerNetwork® and the American Society for Transplantation and Cellular Therapy (ASTCT)'s program ASTCT Talks, Alexis K. Kuhn, PharmD, BCOP, spoke with Katie Bruce, PharmD, BCPPS, and Susie Long, PharmD, about the use of approved cell-based gene therapies for patients with sickle cell disease, beta thalassemia, adrenoleukodystrophy (ALD), and metachromatic leukodystrophy (MLD). These panelists shared the pharmacist's perspective on ensuring quality care with these ex vivo gene therapies across all treatment phases, including mobilization, conditioning, and infection prophylaxis. Kuhn is an ambulatory Pediatric Hematology/Oncology/BMT Pharmacist at the Mayo Clinic in Rochester, Minnesota, and an assistant professor of Pharmacy at the Mayo Clinic College of Medicine. Bruce is a pediatric clinical pharmacy specialist at the Sarah Cannon Pediatric Hematology/Oncology & Cellular Therapy program of Tristar Centennial Medical Center in Nashville, Tennessee. Long is a pediatric clinical pharmacist in the Blood and Marrow Team at the University of Minnesota Masonic Children's Hospital. Specifically, the panelists spoke about the use of agents like elivaldogene autotemcel (Skysona) and atidarsagene autotemcel (Lenmeldy), which are FDA-approved for ALD and MLD, respectively. They also discussed the use of exagamglogene autotemcel (Casgevy) and lovotibeglogene autotemcel (Lyfgenia), which the FDA approved for treating patients 12 years and older with sickle cell disease in December 2023. The conversation broke down each stage of treatment, detailing optimal strategies for the cell manufacturing and storing processes as well as the management of toxicities like cytopenias. They also reviewed key considerations during the post-infusion period that may help maximize the quality of life for patients after they complete their therapy. “It has been so amazing to be able to be a part of gene therapy and gene editing,” Bruce stated regarding the potential long-term impacts of these treatments. “We have patients who are able to hold full-time jobs they never were able to have before. We have patients who are climbing mountains and backpacking through Europe, which would have never been an option before because their sickle cell disease would have prevented them from [doing] that…. It's not an easy process, and it has a lot of steps for the patient to go through, but the reward at the end of it all is worth it.” References bluebird bio receives FDA accelerated approval for SKYSONA® gene therapy for early, active cerebral adrenoleukodystrophy (CALD). News release. bluebird bio, Inc. September 16, 2022. Accessed October 7, 2024.  https://tinyurl.com/mp8crxes FDA approves first gene therapy for children with metachomatic leukodystrophy. New release. FDA. March 18, 2024. Accessed October 7, 2024. https://tinyurl.com/mrh659yk FDA approves first gene therapies to treat patients with sickle cell disease. News release. FDA. December 8, 2023. Accessed October 7, 2024. https://tinyurl.com/3zbdnf4c

CancerNetwork® collaborated with CURE® to speak with Samantha Shenoy, NP, MSN, a nurse practitioner at the Cancer Immunotherapy Clinic of University of California San Francisco (UCSF) Health, about the role she plays when treating patients with multiple myeloma who are receiving talquetamab-tgvs (Talvey). Of note, emphasis was placed on managing treatment-emergent adverse effects (TRAEs) and toxicities that may impact quality of life. Shenoy foregrounded the discussion by outlining the role of nurses in facilitating the management of toxicities and providing education to patients in both an inpatient and outpatient capacity. She subsequently discussed common skin, oral, and dermatologic toxicities, as well as how they impact patient quality of life.  Furthermore, she touched upon taking an aggressive approach to addressing early-grade cytokine release syndrome (CRS), placing an emphasis on close adherence to UCSF clinical guidelines for treating it. Additionally, Shenoy acknowledged the possibility of neurological effects occurring as a result of treatment with talquetamab, although she stated she has not observed any in her experiences with using the bispecific.  Shenoy disclosed talquetamab-related monitoring parameters, indicating that taste changes and weight loss were notable risks. Particularly for weight loss, she mentioned that she regularly checks in with patients about their eating habits and weight. Furthermore, methods for living with taste changes were discussed, which included recommendations for prophylactics, dietary modifications, and dry mouth remedies. Shenoy continued by suggesting that the efficacy seen with talquetamab, particularly as part of a combination therapy, makes it an impactful agent. Citing her experience as part of the phase 1 TRIMM-2 trial (NCT04108195), where talquetamab was assessed in combination with daratumumab (Darzalex) in relapsed or refractory multiple myeloma, she claimed that combination therapies for bispecifics would become the new standard in this patient population. She concluded by expressing her passion for educating patients about management strategies for multiple myeloma. Additionally, she further illustrated the sentiment through her experience witnessing patients continue treatment for several years while overcoming toxicities associated with talquetamab. “I feel passionately about the fact that we can educate patients who are struggling at the beginning [to] hang in there. It is not going to last forever,” Shenoy stated. “I can imagine how frustrating it is [when you are not] able to taste, your mouth is dry, and your hands are peeling. Just know that it is not forever.” Reference Dholaria, BR, Weisel K, Mateos MV, et al. Talquetamab (tal) + daratumumab (dara) in patients (pts) with relapsed/refractory multiple myeloma (RRMM): updated TRIMM-2 results. J Clin Oncol. 2023;41(suppl 16). doi:10.1200/JCO.2023.41.16_suppl.8003

In a conversation with CancerNetwork®, Yoshie Umemura, MD, offered various perspectives on progressing in the brain cancer treatment field. In addition to detailing institution-level advances in delivering multidisciplinary care, she highlighted her personal growth as she advanced in the neuro-oncology field while giving key advice to aspiring researchers who are in the early stages of their careers. Umemura, the chief medical officer of the Ivy Brain Tumor Center, division chief of Neuro-Oncology, and the William and Joan Shapiro chair of Neuro-Oncology at Barrow Neurological Institute, first described what drew her to studying neurology and eventually specializing in neuro-oncology, emphasizing the potential to form close connections with patients during treatment. Additionally, her collaborative approach to care and her institution's emphasis on multidisciplinary practice have helped in yielding various accomplishments, which included expediting the development of an investigator-initiated trial during the COVID-19 pandemic. The conversation also focused on the personal aspects of Umemura's neuro-oncology career. Delving into her experiences with immigrating to the United States when she was a high school student, she recalled feeling like an outsider as she learned to speak English and began to study neurology. However, she noted how several role models and mentors in the field have offered her guidance, which helped her grow and take on more leadership positions over time. Continuing to build upon the theme of collaboration in brain cancer research, Umemura emphasized the necessity of finding mentors even outside of one's institution to advance in the field. Additionally, as part of paying it forward to a new generation of neuro-oncologists, researchers should also become open to guiding others once they have gained enough experience.  “When you are at a conference and you meet someone you think you might click with, you're intrigued about, or you're impressed with, you can shoot an email and ask them if they would be open to chatting with you about a question or mentoring you,” Umemura said. “[You should also] pay it forward. Always be open to mentoring others; I think that's the only way to move forward….It [speaks] to the collaborative aspect and how to operate as an outsider. You're not an outsider as long as you make the connection; you can just wedge yourself in.”

CancerNetwork® spoke with James R. Berenson, MD, about the potential role that JAK inhibitors may play in the treatment of patients with multiple myeloma. The conversation focused on the rationale for researching this drug class as well as ongoing initiatives to assess the utility of agents like ruxolitinib (Jakafi) for this patient population. Berenson, founder, medical and scientific director, and president and chief executive officer of the Institute for Myeloma and Bone Cancer Research and private practitioner in West Hollywood, California, described the factors associated with the overexpression of JAK in the bone marrow, which may constitute a prime survival factor for multiple myeloma. This overexpression may affect the checkpoint inhibitor proteins in the body, resulting in resistance to standard anti-myeloma therapies such as immunomodulatory drugs.  Additionally, he mentioned a patient case that had involved a scenario in which JAK-mutated multiple myeloma progressed following prior treatment with lenalidomide (Revlimid). According to Berenson, the disease's resistance to lenalidomide was primarily associated with proteins driven by JAK; subsequent treatment involving JAK inhibition proved successful in restoring the efficacy of lenalidomide.  Based on a rationale to target JAK overactivity in the bone marrow and results from this patient case, Berenson and colleagues have focused on researching ruxolitinib as a therapeutic candidate for potentially improving outcomes in multiple myeloma via JAK inhibition. Findings from a phase 1 trial (NCT03110822), for example, have demonstrated that the efficacy and tolerability of ruxolitinib plus methylprednisolone can be extended with lenalidomide in those with multiple myeloma. Additionally, other ongoing trials aim to combine ruxolitinib with agents such as selinexor (Xpovio). “The question is, where will ruxolitinib sit in the sequencing of treatment of [patients with] multiple myeloma? Where will selinexor be?” Berenson stated. “At this point, there's certainly been low use of these drugs, especially ruxolitinib in multiple myeloma. We hope, with a more positive signal, these drugs will move further up in the algorithm of how you treat multiple myeloma.” Reference Berenson JR, Limon A, Rice S, et al. A phase I trial evaluating the addition of lenalidomide to patients with relapsed/refractory multiple myeloma progressing on ruxolitinib and methylprednisolone. Target Oncol. 2024;19(3):343-357. doi:10.1007/s11523-024-01049-w

In a conversation with CancerNetwork®, Nader Sanai, MD discussed the current state of the glioblastoma field, highlighting ongoing research efforts to help improve outcomes among patients with this disease.  Sanai is the director of the Ivy Brain Tumor Center and J.N Harber Professor of Neurological Surgery, Francis and Dionne Najafi chair for Neurosurgical Oncology, and chief of neurological oncology at Barrow Neurological Institute. Specifically, Sanai described plans to assess treatment with niraparib (Zejula) compared with temozolomide (Temodar) in a population of patients with newly diagnosed MGMT unmethylated glioblastoma as part of the phase 3 Gliofocus study (NCT06388733).1 He contextualized the rationale for conducting this study by focusing on findings from a proof-of-concept hybrid study (NCT05076513) and detailing how they supported additional investigation into the utility of niraparib.  According to findings from this proof-of-concept study presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, the median overall survival (OS) was 20.3 months among patients who received niraparib in combination with radiotherapy.2 Additionally, data showed that niraparib reached drug concentrations in Gadolinium-nonenhancing newly diagnosed glioblastoma tissue exceeding those of any other evaluated PARP inhibitors; investigators identified no new safety signals after combining niraparib with radiotherapy in this population. With the Gliofocus trial, Sanai and co-investigators aim to provide a clinically meaningful quality of life benefit with niraparib-based therapy beyond a marginally valuable statistical advantage. By evaluating treatment with niraparib, investigators look to improve historical survival rates reported with standard-of-care options among patients with unmethylated disease. “What we're looking to do with this trial is set a benchmark that's clinically relevant for patients and providers. The [OS] target for the study is 18 months, which is to effectively convert [a] 12-month natural history to a natural history closer to the methylated glioblastoma population,” Sanai said. “We think that is a meaningful transformation of a difficult patient population, a significant chunk of survival time that would be beneficial to patients, providers, and caregivers. Importantly, [it may also mean] an advantage for quality of life, which is of paramount importance for this patient population.” References 1.        A study comparing niraparib with temozolomide in adult participants with newly-diagnosed, MGMT unmethylated glioblastoma. ClinicalTrials.gov. Updated June 24, 2024. Accessed September 16, 2024. https://tinyurl.com/y25er8p9 2.        Sanai N, Umemura Y, Margaryan T, et al. Niraparib efficacy in patients with newly-diagnosed glioblastoma: Clinical readout of a phase 0/2 "trigger" trial. J Clin Oncol. 2024;42(suppl 16):2002. doi:10.1200/JCO.2024.42.16_suppl.2002

In a conversation with CancerNetwork®, Georgios Evangelou, MD, MSc spoke about his manuscript titled Neoadjuvant Capecitabine Plus Temozolomide in Atypical Lung NETs, which he and his coauthors published in the July issue of ONCOLOGY®. Evangelou, a medical oncologist and consultant in the 3rd Department of Medicine at Sotiria General Hospital in Athens, Greece, reviewed the results of a case study involving the use of neoadjuvant capecitabine (Xeloda) plus temozolomide (Temodar; CAPTEM) for a 62-year-old woman with well-differentiated atypical carcinoid. The patient was asymptomatic at diagnosis, with imaging revealing an atypical bronchial neuroendocrine tumor (NET) as well as a pancreatic mass indicating another NET.  This patient subsequently underwent treatment with CAPTEM, which resulted in minor volume reductions of masses in the left lower lobe and subcarinal lymph node after 6 months of therapy. Although the pancreatic mass increased in size, Evangelou and colleagues excised it via central pancreatectomy, allowing the patient to resume treatment with CAPTEM for 6 additional months and undergo lobectomy with lymph node dissection. Further use of CAPTEM produced a partial response in the mediastinal lymph nodes and a 21% reduction in the size of the primary tumor. Following treatment, the patient was able to recover without any significant complications. Additionally, follow-up scans revealed no avid lesions, and there were no signs of disease recurrence at 24 months after the lobectomy. Based on the results of this case study, the authors noted how neoadjuvant therapy may significantly impact the management of patients with atypical carcinoids, although larger clinical trials may be necessary to affirm the potential survival benefit of CAPTEM. “I hope that others will recognize the potential value of CAPTEM as a neoadjuvant treatment in similar cases. Sometimes, these cases are very difficult to manage; you need the neoadjuvant treatment because it can offer tumor shrinkage. Eventually, it can lead to radical excision of the disease,” Evangelou said. “We need larger studies to better understand the effectiveness of the regimen as a neoadjuvant treatment.”

In a conversation with CancerNetwork®, Jessica Cheng, MD, spoke about her work in the growing field of physical medicine and rehabilitation (PMR) and how it may improve quality of life outcomes among patients with cancer. Above all else, Cheng, an assistant clinical professor in the Department of Supportive Care Medicine at City of Hope, emphasized how supportive care through PMR aims to ensure patient function. By developing a whole-person approach that focuses on the musculoskeletal and nervous systems, those involved in the field may minimize adverse effects and help patients participate in day-to-day activities more easily. Additionally, Cheng highlighted how this modality can involve the efforts of a comprehensive multidisciplinary team including physical therapists, occupational therapists, and speech therapists as well as those involved in disciplines such as integrative medicine, neurology, and orthopedics. As part of ensuring function in patients who undergo therapy for cancer, Cheng discussed the importance of integrating exercise into their care routines. She highlighted how exercise in preparation for surgery, stem cell transplantation, or other treatment modalities may help patients recover from their treatment more quickly and yield improvements in the pathologic complete responses and other outcomes. In terms of the next steps for aiding the growth of PMR across the country, Cheng detailed ongoing plans for a trial assessing the utility of cancer rehabilitation in patients with breast cancer and gynecologic cancer undergoing chemotherapy before surgery. Adopting a catchphrase of “prehab for all,” Cheng said that she wants all patients to be armed with the knowledge of PMR so that they can gain control over their lives and be able to pursue meaningful activities during their treatment courses. “I hope that oncologists and rehabilitation physicians alike will see that there's an opportunity with cancer prehabilitation to enable [patients] to get their cancer treatment, get through it better, and recover better,” Cheng said. “That's my hope: that this [field] will spread even more like wildfire than it already is.”

In a special co-branded episode between Oncology On the Go and the American Society for Transplantation and Cellular Therapy (ASTCT)'s program ASTCT Talks, Rahul Banerjee, MD, FACP, and Noopur Raje, MD, discussed the risk of secondary malignancies in patients with multiple myeloma who receive CAR T-cell therapy. Banerjee is an assistant professor in the Clinical Research Division of Fred Hutchinson Cancer Center and an assistant professor in the Division of Hematology and Oncology at the University of Washington. Raje is the director of the Center for Multiple Myeloma at Massachusetts General Hospital Cancer Center and a professor of medicine at Harvard Medical School. Banerjee and Raje spoke in the context of prior advisories from the FDA on the potential development of secondary T-cell malignancies in patients who receive CAR T-cell therapy for hematologic cancers. Specifically, the agency required a boxed warning for secondary T-cell malignancy risks for BCMA- or CD19-targeting therapies in April 2024.1 The conversation also touched upon reports of secondary malignancies in cases and trials such as CARTITUDE-1 (NCT04181827), in which second primary cancers were highlighted in 9 patients who received treatment with ciltacabtagene autoleucel (Carvykti).2  Considering these reports and warnings, Banerjee and Raje emphasized shared treatment decision-making with patients after assessing the risks and benefits of CAR T-cell therapy compared with other agents like bispecific antibodies. They also reviewed optimal strategies for monitoring and referring patients based on the incidence of certain toxicities. “[Treatment with] CAR T cells requires planning, and we need to have good control of the disease. We need to have 4 to 6 weeks of a lead time to get these effective treatments to our patients, so early referral is a good idea,” Raje said. “[For example], if you see chronic diarrhea in someone that is way out of the window of what you would expect, referring back to the CAR T-cell center is important so that we don't miss some of these toxicities.”  References 1. FDA requires boxed warning for T cell malignancies following treatment with BCMA-directed or CD19-directed autologous chimeric antigen receptor (CAR) T cell immunotherapies. News release. FDA. April 18, 2024. Accessed August 22, 2024. https://tinyurl.com/5n8pm5ca  2. San-Miguel J, Dhakal B, Yong K, et al. CIlta-cel or standard care in lenalidomide-refractory multiple myeloma. N Engl J Med. 2023;389(4):335-347. doi:10.1056/NEJMoa2303379 

In a conversation with CancerNetwork®, Brian A. Van Tine, MD, PhD, spoke about the FDA accelerated approval of afamitresgene autoleucel (afami-cel; Tecelra) for patients with metastatic or unresectable synovial sarcoma expressing MAGE-A4. He discussed the data from the phase 2 SPEARHEAD-1 trial (NCT04044768) supporting the agent's use in this patient population and highlighted how this approval might pave the way for other potential developments in the sarcoma landscape. Van Tine, a professor of medicine and pediatrics and a medical oncologist at Siteman Cancer Center of Washington University in St. Louis, detailed results from SPEARHEAD-1 leading to the FDA's approval of afami-cel. Based on these findings and the agent's potential availability as a one-time intravenous fusion, afami-cel may offer improvements in quality of life to patients with synovial sarcoma compared with standard treatment options such as chemotherapy. Topline data from cohort 1 of the SPEARHEAD-1 trial showed that treatment with afami-cel produced an objective response rate of 43% among 44 evaluable patients, which included a complete response rate of 4.5%. Additionally, the median duration of response was 6 months (95% CI, 4.6-not reached). Of patients with a response, durable responses lasting for 12 months or longer occurred in 39%.  In terms of other potential benefits following the accelerated approval of afami-cel, Van Tine said that the T-cell therapy may increase treatment access to specific subsets of patients. For those who are unable to relocate and live near certain treatment centers during their therapy, afami-cel may offer a more readily accessible alternative that can allow patients to undergo treatment at home. Van Tine also described how this accelerated approval may “open the gateway” for other advancements related to the use of afami-cel and similar agents in solid tumors.  “We're all working hard to get these therapies open at our institutions,” Van Tine said regarding the next steps for increasing access to afami-cel following the accelerated approval. “Knowing who [has] HLA-A*02–positive [disease], knowing who has synovial sarcoma, and being ready to trigger the screening for MAGE-A4 is in every patient's best interest. If you're one of the patients who have synovial sarcoma, you need to know your status [to determine] how we're going to integrate this into your care plan.” Reference Adaptimmune receives U.S. FDA accelerated approval of TECELRA® (afamitresgene autoleucel), the first approved engineered cell therapy for a solid tumor. News release. Adaptimmune Therapeutics. August 2, 2024. Accessed August 14, 2024. https://tinyurl.com/mw6k4hjh

CancerNetwork® spoke with Ritu Salani, MD, about the expanded FDA approval of dostarlimab-gxly (Jemperli) in combination with carboplatin/paclitaxel for patients with primary advanced or recurrent endometrial cancer.1  Salani, a board-certified gynecologic oncologist and director of Gynecologic Oncology at the University of California, Los Angeles Health, discussed the clinical benefit the dostarlimab combination showed for patients with endometrial cancer, particularly those with mismatch repair-deficient (dMMR) tumors, in the phase 3 RUBY trial (NCT03981796). Data leading to the approval showed a statically significant progression-free survival (PFS) and overall survival (OS) benefit in patients with dMMR or microsatellite-instability high (MSI-H) endometrial cancer, as well as for those across the overall population. Noting the significant impact dostarlimab had on survival benefit without significant added toxicity, which investigators reported as early as March 2023, Salani said it was “wonderful” to have a relatively short turnaround time in making the combination therapy available for patients with primary advanced or recurrent endometrial cancer. Beyond the particular benefit among patients with dMMR tumors, she expressed the need to improve outcomes for patients with mismatch repair-proficient (pMMR) or microsatellite stable (MSS) tumors, who did not experience as much of a pronounced benefit from treatment with dostarlimab. Salani also addressed the role of immunotherapy in subsequent lines of treatment following frontline therapy. Being thoughtful about sequencing agents in this setting may be an optimal strategy to give patients the greatest survivability and quality of life. She also considered alternative treatment strategies for certain patients, such as those with pMMR tumors.  “The thing that is interesting is the study highlighted patients who had residual disease or measurable disease present when they were getting this therapy, and that seems to be where the most significant impact [is],” Salani said. “Seeing more data on the right selection of patients will be really important. There are other avenues of treatment for these patient populations, particularly the pMMR population, where you might see some other therapies that may have an equally profound impact as immunotherapy. Maybe that will lend itself to leading immunotherapy for second-line treatment, if needed.” Reference FDA expands endometrial cancer indication for dostarlimab-gxly with chemotherapy. News release. FDA. August 1, 2024. Accessed August 15, 2024. https://tinyurl.com/mtr6tpyp

In a conversation with CancerNetwork®, Catherine J. Wu, MD, spoke about the ongoing development of cancer vaccines as a potentially “cross-cutting” therapeutic strategy for treating patients with cancer. Wu, chief of the Division of Stem Cell Transplantation and Cellular Therapies and a Lavine Family Chair for Preventative Cancer Therapies at Dana-Farber Cancer Institute, and also a professor of medicine at Harvard Medical School, discussed how neoantigens may show promise as possible targets for immunotherapy, which may make it feasible to treat broad swaths of patient populations through vaccination. Specifically, she highlighted the KRAS mutation as a potential area of focus based on its frequent expression in diseases such as gastrointestinal cancers, myeloma, and other solid tumors. Findings from previous studies published in recent years also appear to support further research on the use of vaccines to manage cancer. For example, Wu brought up a study conducted by Memorial Sloan Kettering Cancer Center, in which investigators evaluated the potential utility of a personalized RNA neoantigen for those with pancreatic cancer. Data from this study indicated that the median recurrence-free survival was not reached in patients with vaccine-expanded T cells compared with 13.4 months in those without vaccine-expanded T cells (P = .003). “There have been very promising studies,” Wu said. “There are many conceptual reasons for why cancer vaccines would partner well with other forms of immunotherapy such as immune checkpoint blockade. Increasingly, one can envision how it can be coupled together with cellular therapy.” In terms of other research, Wu described how ongoing efforts aim to meet various time and cost considerations as vaccine-based therapy becomes more widely adopted in the cancer field. She underscored the necessity of developing a rapid manufacturing process and deploying vaccines to patients as quickly as possible. Additionally, she highlighted the progress in developing mRNA-based vaccines in light of the COVID-19 pandemic, suggesting that this modality may hold promise in the management of cancer. Reference Rojas LA, Sethna Z, Soares KC, et al. Personalized RNA neoantigen vaccines stimulate T cells in pancreatic cancer. Nature. 2023;618(7963):144-150. doi:10.1038/s41586-023-06063-y

CancerNetwork® spoke with Kamran Idrees, MD, MSCI, MMHC, FACS; Natalie A. Lockney, MD; and Milad Baradaran, PhD, DABR, about the potential utility of intraoperative radiation therapy (IORT) among patients with pancreatic cancer. The group detailed the design and mechanism, gradual technical advancements, and trial data supporting the application of this radiotherapy modality for this patient population.  Idrees is the chief in the Division of Surgical Oncology & Endocrine Surgery, an associate professor of surgery, an Ingram Associate Professor of Cancer Research, and director of Pancreatic and Gastro-Intestinal Surgical Oncology at Vanderbilt University Medical Center. Lockney is an assistant professor in radiation oncology and the program director for the radiation oncology medical residency at Vanderbilt University Medical Center. Baradaran is the head of quality assurance operations and assistant professor in the Department of Radiation Oncology at Vanderbilt University Medical Center. As part of this discussion revolving around IORT, the group outlined the optimal conditions for using this technique depending on the extent of disease resectability in patients. Specifically, Idrees categorized patients as belonging to one of 3 major groups: those with metastatic disease, those with resectable disease, and those with borderline resectable or locally advanced disease. When considering these factors, patients with borderline resectable disease may be suitable to undergo IORT in combination with chemotherapy, radiotherapy, and surgery.  The conversation also focused on a particular case involving a patient with pancreatic cancer who received IORT at their institution. Based on the outcome of this case, they highlighted how multidisciplinary collaboration in combination with careful patient selection may offer surgical resection through IORT. “[There] has to be a multidisciplinary team approach to carefully select these patients and [determine] who can benefit from this procedure,” Idrees said. “For the families and the physicians who are taking care of [patients with] pancreatic cancer, it's valuable to obtain a second opinion, even if [the tumor is] initially deemed unresectable. What's unresectable in one surgeon's hands may be resectable in a different team,” he added.

In a conversation with CancerNetwork®, Nausheen Ahmed, MD, spoke about optimizing monitoring strategies for patients with B-cell non-Hodgkin lymphoma who undergo treatment with CAR T-cell therapy. Ahmed, an associate professor in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Medical Center, discussed the possibility of offering more flexible monitoring periods for patients in the context of findings from a real-world study published in Blood Advances.1 Data from her study showed that the occurrence of new onset cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) was rare at more than 2 weeks following CAR T-cell therapy infusion. Additionally, late non-relapse mortality generally resulted from infectious complications. The FDA implemented a Risk Evaluation and Mitigation Strategy (REMS) to help manage the risk of severe CRS and ICANS by requiring patients to reside within 2 hours of an authorized treatment center for 4 weeks following CAR T-cell therapy infusion.2 According to the study authors, this mitigation strategy may create significant barriers to CAR T-cell therapy access among certain patients and caregivers who need to relocate as part of a treatment plan.  Findings from Ahmed's study supported the development of individualized monitoring strategies depending on the stability of the patient. She and her coauthors proposed a 2-week monitoring period for patients while allowing for an optional increase to 4 weeks based on factors such as physician comfort and availability of local community oncology support. As Ahmed emphasized during the discussion, having flexibility in these monitoring periods could help mitigate financial and geographic obstacles preventing adequate access to CAR T-cell therapy among patients. “There has to be more of a hybrid model of care. There has to be more involvement of our referring doctors or community doctors in detecting and managing these infections or working with the specialized center in order to bypass the [emergency room] and other strategies to help these patients,” Ahmed said. “If there is enough data to say that the patients do not need extra restrictions beyond 2 weeks, which is what our studies show, then reconsidering the requirements will be one step towards decreasing disparities in access.” References 1.        Ahmed N, Wesson W, Lutfi F, et al. Optimizing the post-CAR T monitoring period in recipients of axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel. Blood Advances. Published online July 24, 2024. doi:10.1182/bloodadvances.2023012549 2.        Risk Evaluation and Mitigation Strategies (REMS) for autologous chimeric antigen receptor (CAR) T cell immunotherapies modified to minimize burden on healthcare delivery system. FDA. June 26, 2024. Accessed July 23, 2024. https://tinyurl.com/2m284rjy

At the 2024 Kidney Cancer Research Summit (KCRS), CancerNetwork® spoke with various experts in the kidney cancer field about potential advancements in disease detection and updated efficacy data on immunotherapy and other treatment strategies in patients with renal cell carcinoma (RCC). Karl Semaan, MD, MSc, a postdoctoral oncology research fellow at Dana-Farber Cancer Institute, discussed the implications of findings related to the use of an investigational tissue-informed liquid biopsy epigenomic profiling tool for detecting sarcomatoid differentiation in RCC.1 According to Semaan, this method may avoid the sampling errors and spatial heterogeneity challenges associated with traditional biopsy strategies. Additionally, Neil J. Shah, MBBS, an assistant attending physician from Memorial Sloan Kettering Cancer Center, spoke about data from a real-world study evaluating treatment patterns and outcomes in those with metastatic RCC following prior receipt of immunotherapy and tyrosine kinase inhibitors (TKIs).2 Data showed no differences in overall survival (OS) outcomes across different immunotherapy- and TKI-containing regimens. Based on these findings, Shah emphasized a need for additional novel therapeutic approaches to help improve outcomes in later-line settings of treatment. Bradley A. McGregor, MD, director of Clinical Research for the Lank Center of Genitourinary Oncology and medical oncologist specializing in genitourinary malignancies at Dana-Farber Cancer Institute, highlighted findings from his presentation on a phase 1b study (NCT04627064) evaluating treatment with abemaciclib (Verzenio) in a pretreated metastatic clear cell RCC population.3 Among 11 patients who received abemaciclib, 1 had stable disease, 8 had progressive disease, and 2 were not evaluable for response. Additionally, the median progression-free survival (PFS) and overall survival (OS), respectively, was 1.8 months (95% CI, 1.5-1.9) and 9.1 months (95% CI, 2.1-15.3). Although abemaciclib monotherapy yielded no responses in the study, McGregor highlighted the potential clinical utility of administering the agent in combination with other therapies. Findings from his presentation suggested that CDK4/6 inhibitors may demonstrate a synergistic effect when combined with HIF-2α inhibitors, which is a potential strategy that investigators are evaluating with belzutifan (Welireg) and palbociclib (Ibrance) combination therapy as part of the phase 1/2 LITESPARK-024 trial (NCT05468697). References 1.        Semaan K, Zarif TE, Eid M, et al. Liquid biopsy epigenomic profiling for the detection of sarcomatoid renal cell carcinoma. Presented at the 2024 Kidney Cancer Research Summit; July 11-12, 2023; Boston, MA. Abstract 44. 2.        Shah N, Sura S, Shinde R, et al. Real-world treatment patterns and clinical outcomes of metastatic renal cell carcinoma patients post immune-oncology (IO) and Vascular Endothelial Growth Factor (VEGF) receptor targeted therapies. Presented at the 2024 Kidney Cancer Research Summit; July 11-12, 2023; Boston, MA. Abstract 36. 3.        McGregor BA, Xie W, Xu W, et al. Phase IB trial of abemaciclib in advanced renal cell carcinoma. Presented at: 2024 Kidney Cancer Research Summit; July 11-12, 2024. Boston, MA.

As part of the Breaking Barriers: Women in Oncology program, CancerNetwork® spoke with Julie M. Vose, MD, MBA, and Avyakta Kallam, MD, about the evolution of their careers in the hematology-oncology space, including some of the critical advances and challenges associated with their work in the lymphoma field. Vose is division chief, Neumann M. and Mildred E. Harris Professor at the University of Nebraska Medical Center, and co-editor-in-chief of ONCOLOGY®. Kallam is an assistant professor in the Division of Lymphoma and Department of Hematology & Hematopoietic Cell Transplantation from City of Hope in Duarte, California. Vose and Kallam discussed how they first developed a passion for researching lymphoma, which led them to become involved in various breakthroughs related to the use of treatment strategies such as autologous stem cell transplantation, bispecific antibodies, and CAR T-cell therapy. The conversation highlighted how this evolution of therapy options has helped improve patient outcomes while reducing hospitalization periods and minimizing toxicity. The discussion also extended to the topic of overcoming various physical and social barriers while trying to advance in the lymphoma field. For example, Kallam described her experience with moving to the United States from India to complete her medical training, which involved adapting to a new culture and a new style of approaching treatment.  In the early stages of Vose's career, there were far fewer women involved in oncology and medicine in general, contributing to the challenge of needing to work extremely hard to prove that she was equal to her male colleagues. Vose noted in the early days, she was considered a rarity in the field as one of very few women.  Vose and Kallam also brought up how their mentors have given them key pieces of advice from mentors that have stuck with them throughout their careers. They, in turn, offered wisdom to any woman looking to advance in the hematology-oncology space.  “The biggest piece of advice [I received] is to see the patient as a person—not just as a patient—to be able to get to know them and their families understand some of their struggles so that you can relate to them as a person,” Vose said. The conversation also focused on the challenge of achieving work/life balance while making advances in the lymphoma space. Dedicating time to hobbies and finding support from friends and family members emerged as potential strategies for balancing professional responsibilities with one's personal life. “Life is too unpredictable to not do things that you enjoy doing,” Kallam said, recounting a bit of advice she had received from one of her mentors. “What we're doing is important; we are impacting lives. We're doing a lot of research, but at the same time, keep in mind to have fun along the way.”

Tycel Phillips, MD, spoke with CancerNetwork® ahead of the FDA's accelerated approval of epcoritamab-bysp (Epkinly) for patients with relapsed/refractory follicular lymphoma to discuss how this agent may impact the treatment paradigm. Phillips, an associate professor in the Division of Lymphoma and Department of Hematology & Hematopoietic Stem Cell Transplantation at City of Hope in Duarte, California, reviewed data from the phase 1/2 EPCORE NHL-1 trial (NCT03625037), which ultimately supported the approval of epcoritamab in the aforementioned population. Topline results reported at the time of the agent's approval showed an overall response rate (ORR) of 82% (95% CI, 74.1%-88.2%), with 60% of patients experiencing a complete response. Additionally, the median duration of response was not reached (NR; 95% CI, 13.7-NR).  Beyond the supporting data, Phillips highlighted how this approval may increase availability of treatment options for patients with follicular lymphoma, especially those who lack access to alternative therapies. He stated that readily available off-the-shelf bispecific antibodies like epcoritamab may bridge the gap for patients who are unable to access CAR T-cell therapies or travel to a major academic center for treatment.  Phillips also detailed strategies for mitigating some of the common toxicities that may occur following treatment with epcoritamab, which include cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Although Phillips said that epcoritamab is usable in the third-line setting, he noted that bispecific antibodies like it “have a lot of potential for upward mobility,” as he anticipates further assessment of these treatments in the first or second line. “As community oncologists get more and more comfortable with these drugs and have the structure to set up to safely administer [them] for the first month when most of the complications happen, more and more patients will be able to be treated, which will be a great benefit based on what we've seen in early response rates for these drugs,” Phillips said regarding the utility of bispecific antibodies like epcoritamab. “There'll be a big benefit for the patient population in the long term as more community settings implement these drugs into their clinical practice.” Reference FDA grants accelerated approval to epcoritamab-bysp for relapsed or refractory follicular lymphoma. News release. FDA. June 26, 2024. Accessed June 26, 2024. https://tinyurl.com/26s9myey

In a conversation with CancerNetwork®, James B. Yu, MD, MHS, FASTRO, and Julian C. Hong, MD, MS, spoke about their study titled AI Use in Prostate Cancer: Potential Improvements in Treatments and Patient Care, which was published in the May issue of the journal ONCOLOGY®. Yu is a radiation oncologist in the Department of Radiation Oncology at Smilow Cancer Center Hospital at Saint Francis Hospital and an adjunct assistant professor of Medical Oncology at Yale School of Medicine. Hong is an assistant professor in the Department of Radiation Oncology of Bakar Computational Health Sciences Institute at the University of California, San Francisco (UCSF). Yu and Hong focused on the growing overlap between the advancement of artificial intelligence (AI)–based tools and the prostate cancer treatment field. In their study, they detailed AI-based developments related to diagnostic image analysis, the ability to “predict” prostate cancer outcomes, evaluating prostate cancer histopathology, and defining tumors and normal tissue to help plan radiation oncology treatment strategies. Additionally, they reviewed how these tools make use of machine learning algorithms, a subset of AI in which computers can assess data and interact with users without explicit instructions.  “We're trying to incorporate AI and machine learning into more trials to make these types of predictions because, at the end of the day, we're trying to deliver better care and improve outcomes for patients…. It takes trials to figure those things out, so it's a little bit of a work in progress.” Hong said, regarding potential next steps for improving the utility of these tools in the prostate cancer field. According to the authors, pushing the boundaries of AI would need to involve building upon prior retrospective data with additional sources of information to affirm that such tools can impact patient care. Additionally, the discussion highlighted potential future implications related to data ownership or privacy and how patients and physicians interact with these programs as AI becomes more prevalent in medical practice.  “We're not going to be replaced [by AI]. There will always be the need for the human connection any time there's disease or cancer,” Yu said. “It's a super exciting area, and the more people understand the limitations of AI rather than thinking of it as a panacea, the more the field will move forward.”

At the 2024 European Hematology Association (EHA) Congress, CancerNetwork® spoke with a variety of experts in the hematologic oncology space about optimizing outcomes across different patient populations and subgroups based on updated research they presented at the meeting.  Manali Kamdar, MD, an associate professor of medicine-hematology and clinical director of Lymphoma Services at the University of Colorado Anschutz Medical Campus, in Colorado, spoke about data from the phase 1 TRANSCEND NHL 001 trial (NCT02631044) supporting the use of lisocabtagene maraleucel (liso-cel; Breyanzi) in earlier lines of therapy for patients with relapsed/refractory mantle cell lymphoma (MCL).1  Specifically, Kamdar highlighted how research should continue to focus on the potential utility of liso-cel in MCL subgroups such as those with TP53 mutations or blastoid morphology. Additionally, she stated that liso-cel may need to be further tested in earlier lines of therapy for patients with diffuse large B-cell lymphoma, including those with double-hit lymphoma. Michael R. Grunwald, MD, chief of the Leukemia Division and director of the Transplantation and Cellular Therapy Program at Atrium Health's Levine Cancer Institute, in North Carolina, discussed findings from the Prospective Observational Study of Patients With Polycythemia Vera (PV) in US Clinical Practices Trial (REVEAL) exploring risk factors for disease progression in patients with polycythemia vera (PV).2 According to Grunwald, a history of thromboembolic events, elevated white blood cell counts, and higher variant allele frequencies may contribute to a patient's likelihood of experiencing progression to myelofibrosis or acute myeloid leukemia (AML). Additionally, he highlighted ongoing research into the potential molecular factors that may prognosticate disease transformation in PV among a small cohort of patients enrolled on the REVEAL trial.3 Harry P. Erba, MD, PhD, a professor of medicine in the Division of Hematologic Malignancies and Cellular Therapy and the director of the Leukemia Program and Phase I Development in Hematologic Malignancies at Duke Cancer Institute, in North Carolina, discussed the clinical implications of data from the phase 3 QuANTUM-First study (NCT02668653).4  Specifically, findings demonstrated that continuation therapy with quizartinib (Vanflyta) elicited a more pronounced survival benefit vs placebo in patients with newly diagnosed FLT3-ITD–positive AML who did not undergo allogeneic hematopoietic stem cell transplant (allo-HSCT). However, Erba noted that survival outcomes were not significantly different in the quizartinib and placebo arms among patients who received allo-HSCT. References 1.        Palomba ML, Siddiqi T, Gordon LI, et al. Subgroup analyses in patients with R/R MCL treated with lisocabtagene maraleucel by prior lines of therapy and response to Bruton tyrosine kinase inhibitor from the TRANSCEND NHL 001 MCL cohort. Presented at the European Hematology Association (EHA) 2024 Congress; Madrid, Spain; June 13-16, 2024. P1126. 2.        Grunwald M, Zwicker J, Gerds A, et al. A real-world evaluation of risk factors for disease progression in patients with polycythemia vera (PV) enrolled in REVEAL. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract P1047. 3.        Crowgey E, Timmers C, Xue Z, et al. Analysis of molecular mechanisms and predictive biomarkers of disease transformation in polycythemia vera. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract S217. 4.        Sekeres MA, Erba H, Montesinos P, et al. QuANTUM-First: efficacy in newly diagnosed patients with FMS-like tyrosine kinase 3-internal tandem duplication–positive (FLT3-ITD+) acute myeloid leukemia (AML) who received continuation therapy. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract S142.

Following the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, Neil M. Iyengar, MD, and Paolo Tarantino, MD, co-hosted a live X Space with CancerNetwork® and discussed the latest trial updates that may impact clinical practice in the breast cancer field. Iyengar is an associate attending physician at Memorial Sloan Kettering Cancer Center and a co-editor-in-chief of ONCOLOGY®. Tarantino is a clinical research fellow at Dana-Farber Cancer Institute and Harvard Medical School.  Iyengar and Tarantino discussed data regarding several trials and studies presented at the meeting. These presentations included:  ·      Phase 3 DESTINY-Breast06 Trial (NCT04494425)1 o   Investigators evaluated treatment with trastuzumab deruxtecan (T-DXd; Enhertu) compared with investigator's choice of chemotherapy among patients with hormone receptor (HR)–positive, HER2-low or HER2-ultralow metastatic breast cancer. o   The median progression-free survival (PFS) was 13.2 months with T-DXd compared with 8.1 months in patients who received chemotherapy across the HER2-low population (HR, 0.62; 95% CI, 0.51-0.74; P

In a conversation with CancerNetwork®, Jagoda Misniakiewicz, PharmD, a clinical pharmacy specialist in the Clinical Pharmacy and Outcomes Sciences Department at Hollings Cancer Center of the Medical University of South Carolina, spoke about the use of fruquintinib (Fruzaqla) as a treatment option for those with metastatic colorectal cancer (CRC). The FDA previously approved fruquintinib as a treatment for those with metastatic CRC and prior treatment with fluoropyrimidine-, oxaliplatin-, and irinotecan-based chemotherapy and anti-VEGF therapy in November 2023.1 Misniakiewicz detailed the agent's mechanism of action as a potent, orally available small molecule kinase inhibitor and its potential to inhibit blood vessel growth, thereby yielding vascular regression, normalization, and construction. Additionally, the clinical benefit of switching from intravenous therapy to this oral treatment appears to extend to any patient who has progressed on prior therapy, although she noted that there are currently no specific biomarkers or tumor characteristics that would make patients suitable candidates for fruquintinib. The discussion also focused on the efficacy and safety data supporting the clinical utility of fruquintinib in this patient population. Specifically, Misniakiewicz highlighted the “exciting” progression-free survival (PFS) findings from the phase 3 FRESCO-2 trial (NCT04322539), which may affirm fruquintinib as a “promising treatment option” for those with refractory disease.  According to previous findings from the FRESCO-2 trial published in Lancet Oncology, the median PFS was 3.7 months (95% CI, 3.5-3.8) with fruquintinib plus best supportive care vs 1.8 months (95% CI, 1.8-1.9) with placebo plus best supportive care (HR, 0.32; 95% CI, 0.27-0.39; P

In a conversation with CancerNetwork®, Terence T. Sio, MD, MS, discussed how technological advancements in radiation oncology have impacted the modern treatment landscape for patients with non–small cell lung cancer (NSCLC). Sio, a professor of radiation oncology at Mayo Clinic in Phoenix, Arizona, first outlined the use of immunotherapy and other systemic treatment options for this patient population. He detailed how the use of these modalities and other factors such as the risk of radiation-induced pneumonitis often inform the extent of subsequent radiotherapy. Treatment decision making may also involve collaboration with surgeons and medical oncologists as part of a multidisciplinary tumor board, which meets regularly at his institution to determine suitable strategies for those who require more than 1 course of therapy.  Additionally, Sio spoke about currently prevalent radiotherapy treatment strategies for patients with NSCLC as well as possible toxicities that may be associated with these modalities. In terms of novel technology in the field, he highlighted the development of proton beam radiotherapy and the potential advantages it may offer over other therapies.  According to Sio, use of proton beam radiotherapy may reduce excess radiation that usually extends beyond the targeted tumor, effectively lowering the risk of adverse effects (AEs) during treatment. Specifically, proton beam radiotherapy may benefit patient subgroups including those who have previously experienced a heart attack or those who are older and frailer. With an adequate treatment plan that encompasses the use of proton beam radiation, Sio stated that it may be possible to treat these subgroups with fewer AEs than those observed in patients who undergo standard radiotherapy.  “We can actually be helping some of the patients who otherwise may not be able to stand as intensive of a method of combining radiation and chemotherapy for their lung cancer treatments,” Sio said regarding the use of proton beam radiotherapy in this population. “Right now, we have shown that proton [beam radiotherapy] has a role in lung cancer treatments.”

Through elaborate multidisciplinary collaboration, institutions with National Accreditation Program for Rectal Cancer (NAPRC) standards can deliver a “high level of care” in the surgical treatment of patients with rectal cancer, according to Steven Wexner, MD, PhD, and Arielle Kanters, MD. In a conversation with CancerNetwork®, Wexner and Kanters detailed the history and advancement of the NAPRC as an interdisciplinary initiative to improve the outcomes of those undergoing surgery for rectal cancer. Wexner is the chair in the Department of Colorectal Surgery and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic, Florida, the founding chair of the NAPRC for the American College of Surgeons Commission on Cancer, and part of the executive committee of the Commission on Cancer. Kanters is a colorectal surgeon, associate fellowship program director, and surgeon leader of the NAPRC program at Cleveland Clinic Main Campus. Wexner spoke about the inspiration for developing the NAPRC as a mission to elevate the level of surgical outcomes in patients with rectal cancer across the United States to those he observed in European countries such as the United Kingdom and Scandinavia. He enlisted leaders from organizations including the Society of Surgical Oncology and the College of American Pathologists to outline and apply appropriate standards for surgical care in rectal cancer. Additionally, Kanters highlighted how enforcing precise guidelines and compliance measures through the NAPRC program facilitates multidisciplinary efforts with colleagues who specialize in radiology and pathology. She stated that these principles help individuals develop their skills across each department, thereby maintaining a high level of treatment for patients with rectal cancer.  Findings from a study published in the Journal of the American College of Surgeons indicated that mortality and complication rates appeared to be lower for patients who received surgery for rectal cancer at NAPRC-accredited institutions compared with those who were treated at non-accredited practices. Wexner and Kanters also discussed how potential advancements related to the use of neoadjuvant or adjuvant therapy may further improve patient outcomes in the field. Additionally, they spoke about updated research on immunotherapy and other modalities that they anticipate at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. Reference Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. J Amer College Surg. Published March 28, 2024. doi:10.1097/XCS.0000000000001064

In a conversation with CancerNetwork® at Memorial Sloan Kettering Cancer Center (MSKCC), Neil M. Iyengar, MD, spoke about developments and challenges in his career as a medical oncologist and clinical investigator as well as ongoing research efforts in improving outcomes among patients with breast cancer.  Iyengar, a breast oncologist in in the Department of Medicine at MSKCC and Weill Cornell Medicine in New York City, New York, as well as the co–editor-in-chief of the journal ONCOLOGY®, detailed his work in the emerging field of exercise oncology. Based on preclinical data supporting the potential anti-tumor effects of exercise, he and his colleagues are organizing several clinical trials to validate whether exercise intervention can improve cancer-specific end points. Although some findings may support implementing exercise as part of a cancer treatment plan, Iyengar noted the observational and self-reported nature of the prior data and said that it would be necessary to test exercise intervention in the same way “you would develop any new drug for treating cancer.” Additionally, Iyengar discussed the fulfillment of ensuring patient care, a passion that has fueled his interest in lifestyle interventions such as exercise oncology. He highlighted how his cancer treatment philosophy extends beyond the goal of reducing tumor volumes to safeguarding the patient's physical and emotional well-being. “You can certainly hammer away at a tumor and give all kinds of chemotherapy and anti-cancer therapies, but if that [patient] is feeling miserable and has no quality of life and a short duration of response to that therapy, that's not necessarily the type of outcome that I would consider to be successful,” Iyengar said. “If you're able to either control or cure a cancer while also improving a [patient's] quality of life and general well-being, that's the kind of outcome that I strive for. When I see that in my patients and in the patients of my colleagues, that certainly brings a lot of fulfillment.” Iyengar also highlighted how he found excitement and passion in off-hours responsibilities to help achieve work-life balance. Looking ahead, he spoke about data on anti-estrogen agents, antibody drug conjugates, and other breast cancer treatment strategies that he is looking forward to hearing at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

In a discussion with CancerNetwork® at John Theurer Cancer Center, Gregory Charak, MD, highlighted advancements in surgical treatment strategies for patients with colorectal cancer (CRC) as well as other ongoing challenges in the field. Specifically, Charak, a board-certified colorectal surgeon at Palisades Medical Center and Hackensack University Medical Center of Hackensack Meridian Health, described how minimally invasive strategies such as laparoscopic and robotic surgery have become more prevalent in the field, which have appeared to confer improvements in pain and length of hospital stay for patients. Although these minimally invasive techniques are typically preferred in this population compared with open surgery, Charak stated that he would still employ the latter depending on factors such as tumor size. Charak also discussed the rise in CRC incidence among younger populations, which has impacted how practices conduct screening. He highlighted that patients who are in their late 20s or 30s receive recommendations to undergo colonoscopy in the event of weight changes or blood appearing in their stool, noting that he would not hesitate to perform screening even if there's a small but real possibility of disease. Regarding other treatment modalities in this population, Charak emphasized the potential benefits of neoadjuvant therapy. Administering neoadjuvant treatment with agents including cytotoxic chemotherapy and immunotherapy, for example, may help achieve negative-margin resections, thereby yielding less morbidity for patients. “It's a very exciting time to be a surgical oncologist. [There are] tremendous new treatment modalities coming down the pike. Immunotherapy, in particular, is extremely exciting because it's such an elegant way to treat cancer: to harness and augment the body's own defense system to eliminate a cancer rather than using cytotoxic chemicals or invasive surgery,” Charak said. “It's a beautiful thing. If we can get it to apply to more and more tumors and figure out how to make it work, it couldn't be more exciting.” 

During the 2024 Oncology Nursing Society Congress, CancerNetwork® spoke with multiple registered nurses about research they presented on safely administering treatment options such as CAR T-cell therapy and bispecific T-cell engager (BiTE) therapy in patients with multiple myeloma and other malignancies. Ishmael Applewhite, BSN, RN-BC, OCN, a registered nurse at the University of Rochester Medical Center, highlighted the management of adverse effects including peripheral neuropathy in patients with multiple myeloma undergoing treatment with ciltacabtagene autoleucel (cilta-cel; Carvykti). He discussed these treatment strategies in the context of a presentation he gave on findings from the phase 3 CARDITUDE-4 trial (NCT04181827), in which investigators assessed treatment with cilta-cel in those who were refractory to lenalidomide (Revlimid).1 According to Applewhite, cilta-cel may offer “another path” aside from standard treatment options such as chemotherapy and give “more time” to patients with multiple myeloma. Additionally, Leslie Bennett, MSN, RN, a nurse coordinator at Stanford Healthcare, highlighted the importance of identifying and mitigating cranial nerve palsy (CNP) in patients with multiple myeloma who are treated with cilta-cel. At the conference, Bennett presented data on CNP outcomes across various studies, which included the phase 1/2 CARTITUDE-1 trial (NCT03548207), phase 2 CARTITUDE-2 trial (NCT04133636), and phase 3 CARTITUDE-4 trial (NCT04181827).2 According to findings from this presentation, patients had CNP onset at a median of approximately 3 weeks after beginning treatment with cilta-cel. Most cases of CNP tended to occur in male patients. Kathy Mooney, MSN, RN, ACNS-BC, BMTCN®, OCN®,clinical program director at Johns Hopkins Hospital and Johns Hopkins Health System, spoke about a study designed to evaluate the feasibility and safety of using BiTE therapy to treat those with cancer in an outpatient setting.3 Mooney emphasized multidisciplinary collaboration among nurses, pharmacy providers, and social workers as part of monitoring patients for toxicity as they undergo treatment with BiTE agents. References 1.        Applewhite I, Elfrink G, Esselmann J, Lonardi C, Florendo E, Sidiqi MH. Efficacy and adverse events after ciltacabtagene autoleucel treatment in the CARTITUDE-4 as-treated population consisting of patients with lenalidomide-refractory multiple myeloma who received 1-3 prior lines of therapy. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC. 2.        Bennett L, Kruyswijk S, Sidana S, et al. Incidence and management of cranial nerve impairments in patients with multiple myeloma treated with ciltacabtagene autoleucel in CARTITUDE studies. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC. 3.        Mooney K, Allen N, Anderson K, Zukas A. Taking a BiTE out of hospital admission days using a team approach to managing patients at risk for treatment related toxicities. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.