Podcasts about abramson cancer center

“A lot of other disease sites, they have some targeted therapies, they have some immunotherapies [IO]. In lung cancer, we have it all. We have chemo. We have IO. We have targeted therapies. We have bispecific T-cell engagers. We have orals, IVs. I think it's just so important now that, particularly for lung cancer, you have to be well versed on all of these,” ONS member Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about lung cancer treatment. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by May 16, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to lung cancer treatments. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episode: Episode 359: Lung Cancer Screening, Early Detection, and Disparities ONS Voice articles: Non-Small Cell Lung Cancer Prevention, Screening, Diagnosis, Treatment, Side Effects, and Survivorship Oncology Drug Reference Sheet: Amivantamab-Vmjw Oncology Drug Reference Sheet: Cisplatin Oncology Drug Reference Sheet: Lazertinib Oncology Drug Reference Sheet: Nivolumab and Hyaluronidase-Nvhy Oncology Drug Reference Sheet: Fam-Trastuzumab Deruxtecan-Nxki Optimize Your Testing Strategy and Improve Patient Outcomes With NeoGenomics' Neo Comprehensive™–Solid Tumor Assay Clinical Journal of Oncology Nursing article: Oncogenic-Directed Therapy for Advanced Non-Small Cell Lung Cancer: Implications for the Advanced Practice Nurse ONS Biomarker Database ONS video: What is the role of the KRAS biomarker in NSCLC? Biomarker Testing in Non-Small Cell Lung Cancer Discussion Tool ONS Huddle Cards: Checkpoint inhibitors External beam radiation Monoclonal antibodies Proton therapy To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “Unfortunately, because lung cancer is pretty aggressive, we'll see lung cancer mostly in stage IV. So about 50%–55% of all cases are not caught until they are already metastatic, or stage IV. And then about another 25%–30% of cases are caught in stage III, which means they're locally advanced and often not resectable, but we do still treat that with curative intent with concurrent chemoradiation. And then 10%–20% of cases are found in the early stage, and that's stage I and II, where we can do surgical approaches.” TS 2:53 “The majority of radiation that you're going to see is for patients with stage III disease that's inoperable. At my institution, a lot of stage III is inoperable. Now, neoadjuvant immunotherapy has changed that a little bit. But if you have several big, bulky, mediastinal lymph nodes that makes you stage III, surgery is probably not going to be a great option. So we give curative-intent chemoradiation to these patients.” TS 10:51 “Oligoprogression would mean they have metastases but only to one site. And sometimes we will be aggressive with that. Particularly, there's good data, if the only site of progression is in the brain, we can do stereotactic radiation to the brain and then treat the chest with concurrent chemoradiation as a more definitive approach. But outside of that, the majority of stage IV lung cancer is going to be treated with systemic therapy.” TS 15:00 “It's important for nurses to know that there's a lot of different options now for treatment. Probably one of the most important things is making sure patients are aware of what their biomarker status is, what their PD-L1 expression level is, and make sure those tests have been done. … It's good that the patients understand that there's a myriad of options. And a lot of that depends on what we know about their cancer, and then that guides our treatment.” TS 31:05

Episode 359: Lung Cancer Screening, Early Detection, and Disparities “I was actually speaking to a primary care audience back a few weeks ago, and we were talking about lung cancer screening. And they said, ‘Our patients, they don't want to do it.' And I said, ‘Do you remind them that lung cancer is curable?' Because everybody thinks it is a death sentence. But when you're talking about screening a patient, I think it's really important to say, ‘Listen, if we find this early, stage I or stage II, our chances of curing this and it never coming back again is upwards of 60% to 70%,'” ONS member Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about lung cancer screening. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at courses.ons.org by April 18, 2027. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to lung cancer screening. Episode Notes  Complete this evaluation for free NCPD.  ONS Podcast™ episodes: Episode 313: Cancer Symptom Management Basics: Other Pulmonary Complications Episode 295: Cancer Symptom Management Basics: Pulmonary Embolism, Pneumonitis, and Pleural Effusion Episode 247: Tobacco Treatment for Patients With Cancer ONS Voice articles: Lung Cancer Screening and Early Detection Drastically Improves Survival Rates Pack-Year History Is a Biased and Inadequate Criterion for Lung Cancer Screening Eligibility, Researchers Say CMS Expands Eligibility Criteria for Lung Cancer Screening With Low-Dose Computed Tomography Non-Small Cell Lung Cancer Prevention, Screening, Diagnosis, Treatment, Side Effects, and Survivorship Clinical Journal of Oncology Nursing articles: Nurse-Led Tobacco Cessation for Veterans Using Motivational Interviewing in a Lung Cancer Screening Program Identifying Primary Care Patients at High Risk for Lung Cancer: A Quality Improvement Study Oncology Nursing Forum article: Patient–Provider Discussion About Lung Cancer Screening Is Related to Smoking Quit Attempts in Smokers ONS Tobacco, E-Cigarettes, and Vaping Learning Library American Cancer Society Lung Cancer Screening Guidelines American Lung Association lung cancer resources To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “Unfortunately, the current state of lung cancer screening is pretty low. Our rate of uptake in eligible patients is somewhere between 6% and 20%. And that falls much further below what we see for screening, such as breast cancer screening, prostate cancer screening, and colorectal cancer screening. So certainly, we can do better.” TS 1:32 “If you quit more than 15 or 20 years, your risk of developing lung cancer at that point is significantly lower. And so that's why once patients have quit more than 15 years, they're actually not eligible for screening anymore—because their risk of developing lung cancer is dramatically reduced. And that takes into account when you are a primary care provider, pulmonary, whatever field you work in, and you are running a screening clinic each year that you screen the patient, you have to remind yourself when they quit smoking, because once they reach that 15 years, then they're no longer eligible for screening.” TS 5:17 “One of the strategies that they've used to get the word out is, I watch a lot of baseball. I love the Philadelphia Phillies, watch Phillies games. And so at least once a year, maybe even twice a year, they will take an inning of the baseball broadcast on TV and on the radio separately, and they will bring on either an oncologist or pulmonologist from one of the local cancer centers in our area, and the whole inning—between batters of course—they will talk about lung cancer screening and why it's beneficial.” TS 13:16 “Medicare always has its idiosyncrasies. So Medicare—I went over the rules with you, so the age, the smoking. They follow all of it, except they have a slight difference in age. They cover it for age 50 to 77, as opposed to 80.” TS 16:52 “I think just the other thing that people don't think about is that to go get a medical test done, no matter what test it is, typically people have to take time off of work. And it can be really hard to do that when you are relying on your job, maybe you don't have vacation time, maybe you have children at home that you need to get home to. When people are weighing the risk/benefit and thinking, ‘Well, I'd love to get screened for lung cancer, but I just can't find time to fit it into my schedule, and my job won't let me take off.' These are all things that we don't always think about if you have the luxury of just taking the day off.” TS 20:01

Dr Alexander Perl from Abramson Cancer Center in Philadelphia, Pennsylvania, Dr Richard M Stone from Dana-Farber Cancer Institute in Boston, Massachusetts, Dr Eunice S Wang from Roswell Park Comprehensive Cancer Center in Buffalo, New York, Prof Andrew H Wei from Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, and moderator Dr Eytan M Stein from Memorial Sloan Kettering Cancer Center in New York, New York, discuss updated data from ASH 2024 influencing the current and future treatment paradigm for treatment-naïve and relapsed/refractory acute myeloid leukemia.

Dr Alexander Perl from Abramson Cancer Center in Philadelphia, Pennsylvania, Dr Richard M Stone from Dana-Farber Cancer Institute in Boston, Massachusetts, Dr Eunice S Wang from Roswell Park Comprehensive Cancer Center in Buffalo, New York, Prof Andrew H Wei from Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, and moderator Dr Eytan M Stein from Memorial Sloan Kettering Cancer Center in New York, New York, discuss updated data from ASH 2024 influencing the current and future treatment paradigm for treatment-naïve and relapsed/refractory acute myeloid leukemia. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/ASHAML24).

Can we prevent breast cancer before it even starts? While treatments have made great strides in curing and slowing cancer, researchers are now focusing on strengthening the immune system to stop cancer in its tracks. In this episode, Dr. Robert Vonderheide, director of the Abramson Cancer Center at the University of Pennsylvania, shares his groundbreaking work on how the immune system interacts with cancer. As a leader in cancer immunology, Dr. Vonderheide explores how boosting our body's natural defenses could lead to new ways to prevent, treat, and even cure breast cancer.

Dr Ibiayi Dagogo-Jack from Massachusetts General Hospital in Boston and Dr Corey J Langer from the Abramson Cancer Center in Philadelphia, Pennsylvania, discuss the implications of recent datasets for the current and future management of non-small cell lung cancer with actionable targets beyond EGFR, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/WCLC2024/TargetedLung).

Dr Ibiayi Dagogo-Jack from Massachusetts General Hospital in Boston and Dr Corey J Langer from the Abramson Cancer Center in Philadelphia, Pennsylvania, discuss the implications of recent datasets for the current and future management of non-small cell lung cancer with actionable targets beyond EGFR.

ABOUT THIS EPISODEWhat is immunotherapy? How effective are they for neuroendocrine neoplasms (NENs)? Dr. Jennifer Eads from Penn Medicine answers common questions about immunotherapy. She discusses the latest in CAR T therapy, DLL3, and vaccine therapy for NENs. TOP TEN QUESTIONS ABOUT IMMUNOTHERAPY FOR NENS:What is immunotherapy? How does it work? How does immunotherapy differ from other treatments? When is immunotherapy used? Which neuroendocrine cancers are they used for? What are the various immunotherapy drugs used for neuroendocrine cancer and how do they work? What are immune checkpoint inhibitors?What is CAR-T therapy?What is DLL3?What is vaccine therapy?What side effects might someone have when taking immunotherapy? How does it make me look (will I lose my hair)? How will it make me feel (will I be able to work)? Does immunotherapy cause someone to be immunocompromised? What monitoring needs to be done while on immunotherapy?How do you decide when to use immunotherapy, which to use, and for what patient?What do you see as the future of immunotherapy in neuroendocrine cancer treatment? MEET DR. JENNIFER EADS, MDDr. Jennifer Eads is an associate professor of medicine at the University of Pennsylvania, Abramson Cancer Center where she is a gastrointestinal medical oncologist focusing on the treatment of and research in patients with neuroendocrine tumors and gastroesophageal cancers. She is the Physician Lead for GI Clinical Research, overseeing the Penn GI clinical research portfolio. She is the Penn institutional principal investigator for the Eastern Cooperative Oncology Group (ECOG-ACRIN) and serves as the Director of the National Clinical Trials Network (NCTN) for the Abramson Cancer Center. She has served as principal investigator for multiple phase I/II/III clinical trials, including as the national study chair for multiple cooperative group trials. She has served on the National Clinical Cancer Network (NCCN) neuroendocrine tumors guidelines committee, is a former member of the North American Neuroendocrine Tumor Society (NANETS) Board of Directors and is currently on the Board of Scientific Advisors for the Neuroendocrine Tumor Research Foundation (NETRF). In 2022, she was named as the ECOG-ACRIN Young Investigator of the Year.For more information, visit lacnets.org/lacnets-podcast/36For more information, visit LACNETS.org.

Drs. John Sweetenham and Angela DeMichele discuss potentially ground-breaking abstracts in breast and lung cancer as well as notable research on artificial intelligence and its impact on cancer care, all of which were featured at the 2024 ASCO Annual Meeting.  TRANSCRIPT Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham from UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News Podcast. My guest today is Dr. Angela DeMichele, the Marianne and Robert McDonald Professor in Breast Cancer Research and co-leader of the Breast Cancer Program at the University of Pennsylvania's Abramson Cancer Center. Dr. DeMichele also served as the chair of the 2024 ASCO Annual Meeting Scientific Program. Today, she'll be sharing her reflections on the Annual Meeting and we'll be highlighting some advances and innovations that are addressing unmet needs and accelerating progress in oncology.  Our full disclosures are available in the transcript of this episode.  Dr. DeMichele, congratulations on a very robust and highly successful program at ASCO24, and thanks for joining us on the podcast today. Dr. Angela DeMichele: Well, thanks so much for having me, Dr. Sweetenham. It's a pleasure to be here.  Dr. John Sweetenham: The presidential theme of the Annual Meeting this year was the "The Art and Science of Cancer Care: From Comfort to Cure." And this was certainly reflected throughout the meeting in Chicago that welcomed more than 40,000 attendees from across the globe. I know our listeners will be interested to hear some of your own reflections from the meeting now that we're on the other side of it, so to spea  Dr. Angela DeMichele: Yes. Well, I will say that playing this role in the annual meeting really was a highlight of my career, and I feel so fortunate to have had the opportunity to do it. We had over 200 sessions, and in many, if not all of these sessions, we really tried to make sure that there was a case that really sort of grounded the session to really help people understand: you're going to hear about science, but how are you going to apply that? Who is the patient for whom this science really is important?  We had over 7,000 abstracts submitted, and our 25 tracks and their chairs really pulled through to find really the best science that we could present this year. I think what you saw really was a representation of that across the board: incredible advances in lung cancer, breast cancer, melanoma, GI cancers; also really cutting-edge technologies: AI, as we'll talk about in a little while circulating markers like ctDNA, new drug development, new classes of drugs. So it was really an exciting meeting. I mean, some highlights for me, I would say, were certainly the Plenary, and we can talk a little bit about that. Also, we had a fantastic ASCO/AACR Joint Session on “Drugging the “Undruggable Target: Successes, Challenges, and the Road Ahead.” And, if any of the listeners have not had a chance to hear this, it's really worth going in and watching this because it really brought together three amazing speakers who talked about the successes in KRAS, and then really, how are we using that success in learning how to target KRAS to now targeting a variety of other previously thought to be undruggable targets. I learned so much. And there's really both the academic and the pharma perspective there. So I'd really encourage watching this session. The other session that I really thought was terrific was one that I was honored to chair, which was a fireside chat (“How and Where Will Public Investment Accelerate Progress in Oncology? A Discussion with the NIH and NCI Directors”) with both Dr. Monica Bertagnolli, who is the director of the NIH, and Dr. Kim Rathmell, who's now the director of the NCI. And boy, I'll tell you, these two incredibly smart, thoughtful, insightful women; it was a great conversation. They were really understanding of the challenges we face conducting research, practicing medicine. And maybe different from leadership at the NIH in the past, they've really taken the approach to say that everything they do is focused on the patient, and they don't limit themselves to just research or just science, that everything that the NIH does, and particularly the NCI does, really has to be focused on making sure we can give patients the best possible care. And I think they're being very thoughtful about building important infrastructure that's going to take us into the future, incorporating AI, incorporating new clinical trial approaches that are going to make it faster and easier to conduct clinical trials and to get the results that we need sooner. So just a few of the highlights, I think, from some really interesting sessions. Dr. John Sweetenham: It certainly was an extremely enriching and impactful ASCO24. And I think that the overall theme of the meeting was extremely well reflected in the content with this amazing mix of really, truly impactful science, along with a great deal of patient-centered healthcare delivery science to accompany it. So, I completely agree with you about that. There was a lot, of course, to take in over the five days of the meeting, but I'm sure that our listeners would be very interested to hear about one or two abstracts that really stood out for you this year.  Dr. Angela DeMichele: Sure. I'm a breast cancer specialist, so I can't help but feel that the late breaking abstract, the DESTINY-Breast06 trial, was really important for the field of breast cancer. So just briefly, this is a study of the antibody drug conjugate T-DxD, trastuzumab deruxtecan. This is a drug that is actually now approved in metastatic breast cancer, really effective in HER2-positive disease. But the question that this trial was trying to answer is, can this drug, which is built with the herceptin antibody against HER2, then linked to a chemotherapeutic molecule, can this work even in the setting of very, very low HER2 expression on a tumor? I think this is an incredibly important question in the field of antibody drug conjugates, of which there are now many across diseases, is how much of the target do you really need to have on the surface of the tumor?  We had seen previously HER2 overexpressing tumors respond really well to this drug. HER2 tumors that have an intermediate level of expression were tested in the DP04 trial, and we saw that even those 2+ intermediate tumors responded well to this drug. The DP06 trial that was presented at ASCO was looking at this group of patients that have even less HER2 on the surface. So we typically measure HER2 by immunohistochemistry as 0, 1+, 2+, or 3+. And this was looking at patients whose tumors were over 0, but were at 1+ or below, so low and ultra-low. And it turned out that compared to treatment of physician's choice, the drug really had quite a lot of activity, even in these patients who have very little HER2 on their tumors, really showing progression-free survival benefits in the HER2-low and HER2-ultra-low groups that were appreciable on the order of about 5 months, additional progression free survival hazard ratios around 0.6, so really demonstrating that utilizing an antibody drug conjugate, where you've got very little target, can still be a way to get that drug to a tumor.   And I think it'll remain to be seen whether other ADCs can have activity at very low levels of IHC expression of whatever target they're designed against. I think one of the tricky things here for implementing this in breast cancer will be how do pathologists actually identify the tumors that are ultra-low because it's not something that we typically do. And so we'll go through a period, I think, of adjustment here of really trying to understand how to measure this. And there are a bunch of new technologies that I think will do a better job of detecting low levels of the protein on the surface of the tumor because the current IHC test really isn't designed to do that. It was only designed to be focused on finding the tumors that had high levels. So we have some newer technologies with immunofluorescence, for example, that can really get down to very low levels. And I think this is going to be a whole new area of ADCs, target detection – how low can you go to still see activity? So I thought that this was an important abstract for many reasons.  I will just say the second area that I was really particularly impressed with and had a big impact on me were the two lung cancer abstracts that were presented in the Plenary, the LAURA trial (LBA4) and the ADRIATIC trial (LBA5). And I think, I've been in the field of oncology for 30 years now, and when I started in the late ‘90s, lung cancer was a disease for which we had very few treatments. If we didn't catch it early and surgery wasn't possible for non-small cell lung cancer, really, it was a horrible prognosis. So we knew this year was the 20th anniversary of the discovery of EGFR as a subtype of lung cancer. That was really, I think, a turning point in the field of non-small cell lung cancer – finding a target. And now seeing the LAURA trial show that osimertinib really had such an enormous impact on progression-free survival amongst these patients who had EGFR-positive non-small cell lung cancer, progression-free survival hazard ratio of 0.16; there was a standing ovation.  And one of the really big privileges of being the Scientific Program Chair is getting to moderate the Plenary Session, and it's a really amazing experience to be standing up there or sitting there while the presenter is getting a standing ovation. But this was well deserved because of the impact this is having on patients with EGFR positive lung cancer. And it was similar with the ADRIATIC trial, which looked at the benefits of adding immunotherapy in limited-stage small-cell lung cancer. Again, a disease that treatment has not changed in 30 years, and so the addition of durvalumab to the standard backbone of chemotherapy for small cell lung cancer had its survival advantage. These patients are living longer and it was really an impressive improvement. And I think it really underscores just the revolution that has happened in lung cancer between targeted therapy and immunotherapy has completely changed the prognosis for patients with this disease. So to me, these were really landmark reports that came out at ASCO that really showed us how far we've come in oncology. Dr. John Sweetenham: Yeah, absolutely. I think that, as you mentioned, those results are truly remarkable, and they reflect extraordinary advances in science. I think we see that both in terms of the therapeutic arena, but also, I think we've started to see it in other areas as well, like symptom control, remote patient monitoring, and so on and so forth, where some of the newer virtual technologies are really having major impacts as well. Dr. Angela DeMichele: Yes, we really wanted to have a focus on artificial intelligence in this meeting, because it's having such an enormous impact on our field in everything from care delivery to diagnostics. I'd love to hear what you thought was the most interesting, because there really was just new data across the board presented. Dr. John Sweetenham: I've actually chosen 3 abstracts which I thought were particularly interesting for a couple of reasons, really. They're all based on virtual health interventions, and I think they're interesting in really reflecting the theme of the meeting, in that they are extremely advanced technology involved in the virtual platforms, a couple of which are artificial intelligence, but very impactful to patients at the same time in terms of remote symptom control, in terms of addressing disparities, and in one case, even influencing survival. So I thought these were three really interesting abstracts that I'll walk the listeners through very quickly.  The first of these was a study, Abstract 1500 (“National implementation of an AI-based virtual dietician for patients with cancer”) which looked at an artificial intelligence-based virtual dietitian for patients with cancer. This is based on the fact that we know nutritional status to be a key driver of patient experience and of cancer outcomes. And as the authors of the presentation noted, 80% of patients look for nutritional support, but many of them don't get it. And that's primarily a workforce issue. And I think that's an important thematic point as well, that these new technologies can help us to address some of the workforce issues we have in oncology. So this was an AI-based platform developed by experts in nutrition and cancer patients, based on peer reviewed literature, and a major effort in terms of getting all of these data up together. And they developed an artificial intelligence platform, which was predominantly text message based. And this platform was called INA. And as this is developing as a platform, there's a machine learning component to it as well. So in theory, it's going to get better and better and better over time.  And what they did in their study was they looked at little over 3,000 patients across the entire country who were suffering from various types of cancer, GU, breast, gynecological malignancy, GI and lung. And most of them had advanced-stage disease, and many of them had nutritional challenges. For example, almost 60% of them were either overweight or obese by BMI. And the patients were entered into a text exchange with the AI platform, which would give them advice on what they should eat, what they shouldn't eat. It would push various guidance and tips to them, it would develop personalized recipes for them, and it would even develop menu plans for the patients. And what's really interesting about this is that the level of engagement from the patients was very high, with almost 70% of patients actually texting questions to this platform. About 80% of the patients completed all of the surveys, and the average time that patients interacted with the platform was almost nine months, so this was remarkable levels of engagement, high levels of patient satisfaction. And although at this point, I think it's very early and somewhat subjective, there was certainly a very positive kind of vibe from patients. Nearly 50% have used the recommended recipes. More than 80% of them thought that their symptoms improved while they were using this platform. So I think as a kind of an assistant for remote management of patients, it's really remarkable. And the fact that the level of engagement was so high also means that for those patients, it's been very impactful.   The second one, this was Abstract 100 (“AI virtual patient navigation to promote re-engagement of U.S. inner city patients nonadherent with colonoscopy appointments: A quality improvement initiative”) looked again at an AI-based platform, which in this case was used in an underserved population to address healthcare disparities. This is a study from New York which was looking at colorectal cancer screening disparities amongst an underserved population, where historically they've used skilled patient navigators to address compliance with screening programs, in this case specifically for colorectal cancer. And they noticed in the background to this study that in their previous experience in 2022, almost 60% of patients either canceled or no-showed for colonoscopy appointments. And because of this and because of the high burden of patients that this group has, they decided to take an AI-based virtual patient navigator called MyEleanor and introduce this into their colorectal cancer screening quality improvement.  And so they introduced this platform in April of 2023 through to the end of the year, and their plan was to target reengagements of around 2,500 patients who had been non adherent with colonoscopy appointments in a previous year. And so the platform MyEleanor would call the patients to discuss rescheduling, it would assess their barriers to uptake, it would offer live transfer to somebody to schedule for them, and then it would go on closer to the point of the colonoscopy to call the patients and give them advice about their prep. And it was very nuanced. The platform would speak in both English and Spanish versions. It could detect nuances in the patient's voice, which might then trigger it to refer the patient to a live agent rather than the AI platform. So, very sophisticated technology. And what was most interesting about this, I think, was that over the eight months of the study, around 60% of patients actually engaged with this platform, with almost 60% of that group, or 33% overall, accepting a live transfer and then going on to scheduling, so that the completion rate for the no show patients went from 10% prior to the introduction of this platform to 19% after it was introduced. So [this is] another example, I think, of something which addresses a workforce problem and also addresses a major disparity within cancer care at the moment by harnessing these new technologies. And I think, again, a great interaction of very, very high-level science with things that make a real difference to our patients.  So, Dr. DeMichele, those are a couple of examples, I think, of early data which really are beginning to show us the potential and signal the impact that artificial intelligence is going to have for our patients in oncology. I wonder, do you have any thoughts right now of where you see the biggest impact of artificial intelligence; let's say not in 20 years from now, but maybe in the next year or two?  Dr. Angela DeMichele: Well, I think that those were two excellent examples. A really important feature of AI is really easing the workload on physicians. And what I hope will happen is that we'll be able to use AI in the very near future as a partner to really offload some of the quite time-consuming tasks, like charting, documentation, that really take us away from face-to-face interaction with patients. I think this has been a very difficult period where we move to electronic medical records, which are great for many reasons, but have really added to the burden to physicians in all of the extra documentation. So that's one way, I think, that we will hope to really be able to harness this. I think the other thing these abstracts indicate is that patients are very willing to interact with these AI chatbots in a way that I think, as you pointed out, the engagement was so high. I think that's because they trust us to make sure that what we're doing is still going to be overseen by physicians, that the information is going to get to us, and that they're going to be guided. And so I think that in areas where we can do outreach to patients, reminders, this is already happening with mammograms and other sorts of screening, where it's automated to make sure you're giving reminders to patients about things that they need to do for some of their basic health maintenance. But here, really providing important information – counseling that can be done by one of these chatbots in a way that is compassionate, informative and does not feel robotic to patients.   And then I was really impressed with, in the abstract on the screening colonoscopy, the ability of the AI instrument to really hear nuances in the patient's responses that could direct them directly to a care provider, to a clinician, if they thought that there might be some problem the patient was experiencing. So again, this could be something that could be useful in triaging phone calls that are coming in from patients or our portals that just feel like they are full of messages, no matter how hard you try to clear them all out, to get to them all. Could we begin to use AI to triage some of the more mundane questions that don't require a clinician to answer so that we can really focus on the things that are important, the things that are life threatening or severe, and make sure that we're getting to patients sooner? So there's just a few ways I really hope it'll help us. Dr. John Sweetenham: Yeah, absolutely. I think we're just scratching the surface. And interestingly enough, in my newsfeed this morning through email, I have an email that reads, “Should AI pick immunotherapy combinations?” So we'll see where that goes, and maybe one day it will. Who knows? Dr. Angela DeMichele There was a great study presented at ASCO about that very thing, and I think that is still early, but I could envision a situation where I could ask an AI instrument to tell me all of the data around something that I want to know about for a patient that could deliver all of the data to me in real time in the clinic to be able to help me make decisions, help me quote data to patients. I think in that way it could be very, very helpful. But it'll still need the physicians to be putting the data into context and thinking about how to apply it to the individual person. Dr. John Sweetenham: Absolutely, yes. And so just to round off, the final abstract that caught my eye, which I think kind of expands on a theme that we saw at an ASCO meeting two or three years ago around the impact of [oncology] care at home, and this was Abstract 1503 (“Acute care and overall survival results of a randomized trial of a virtual health intervention during routine cancer treatment”). So, a virtual platform but not AI in this case. And this was a study that looked at the use of an Integrative Medicine at Home virtual mind-body fitness program. And this was a platform that was used to look at hospital admission and acute care of patients who used it, and also looked at survival, interestingly enough. So what was done in this study was a small, randomized study which looked at the use of virtual live mind, body and fitness classes, and compared this in a randomized fashion to what they called enhanced usual care, which essentially consisted of giving the patients, making available to the patients, some pre-recorded online meditation resources that they could use. And this was applied to a number of patients with various malignancies, including melanoma, lung, gynecologic, head and neck cancers, all of whom were on systemic therapy and all of whom were reporting significant fatigue.  This was a small study; 128 patients were randomized in this study. And what was very interesting, to cut to the chase here, is that the patients who had the virtual mind-body program, compared with the control group, actually were less likely to be hospitalized, the difference there being 6.3% versus 19.1%, respectively. They spent fewer days in the hospital. And remarkably, the overall survival was 24.3 months median for patients in the usual care arm and wasn't reached in those patients who were on the virtual mind-body fitness class platform. So very preliminary data, certainly are going to need more confirmation, but another example of how it appears that many of these non-pharmacological interventions have the potential to improve meaningful endpoints, including hospital stays and, remarkably, even survival. So again, I think that that is very consistent with the theme of this year's meeting, and I found that particularly interesting, too.  I think our time is up, so I want to thank you, Dr. DeMichele, for sharing your insights with us today on the ASCO Daily News Podcast. We really appreciate it. And once again, I want to congratulate you on what was really a truly remarkable ASCO this year.  Dr. Angela DeMichele: Well, thanks so much for having me. It's been a tremendous pleasure to be with you today. Dr. John Sweetenham: And thank you to our listeners for joining us today. You'll find links to the abstracts discussed today in a transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow ASCO on social media:    @ASCO on Twitter    ASCO on Facebook    ASCO on LinkedIn      Disclosures:   Dr. John Sweetenham:   Consulting or Advisory Role: EMA Wellness  Dr. Angela DeMichele: Consulting or Advisory Role (an immediate family member): Pfizer Research Funding (Inst.): Pfizer, Genentech, Novartis, Inviata/NeoGenomics  

Molecular imaging tests can offer comprehensive views of breast cancers, especially for locally advanced or metastatic breast cancer, and can help paint a clearer picture of the extent and characteristics of the cancer. This can then give doctors the ability to help guide treatment and evaluate response to treatment. Joining us on today's show is Dr. David Mankoff, Vice Chair of Research, Radiology and the Matthew J. Wilson Professor of Radiology at the University of Pennsylvania and Associate Director of Education and Training at Penn's Abramson Cancer Center. Dr. Mankoff is going to help us understand the complexities of breast cancer tumors, what these molecular imaging tests are looking for and who should be getting them.

“What is it like to be a clinician with a patient who either comes because they're going to be dying or it happens in the treatment -  what is it like for the clinician? It's lonely in a way because there is a lot of parallel with what the patient is going through. To me, and as a field, I would like to think we could talk about this and write about it. My peer group at the time was terribly important to me - colleagues, people that basically would be with me in this. But in the end I was the one that went alone to the service at the funeral home and I went to my patient's luncheon, not to have the lunch but to talk to the family, and then I left - I didn't stay for the lunch, I thought that might be a little intrusive. There's nothing really to read about, talk about, pick somebody's brain about how do they experience this in their work or I don't really understand why we've been so quiet about this in our work.” PW   “You mentioned about being alone in it, and there is a way in which it's very true. I think a large part is that not many of our colleagues have had this experience. But on the flip side, maybe because I've worked with so many patients and I'm beginning to notice a certain consistency, but I've also had such an experience of close intimacy with these patients. There's a closeness that is to be had particularly in analytic work and work over time - but it happens quite quickly in the work with dying patients, and in that regard, I felt less alone in my work. In some ways in the rest of our work, because we maintain a careful distance in a way, a boundary with the patient, a frame - I feel with the dying patients, I feel like both of us are more in the room together.” MM     Episode Description: We begin with acknowledging the tension that exists between the literal and metaphoric aspects of the analytic relationship and how that is highlighted in the face of physical illness in either party. We focus on patients' illnesses both as they present upon initial consultation and when they develop in the course of treatment. Mark describes his years of work with cancer patients, and Peggy shares her experience with an analysand who, in the 6th year of her treatment, developed a terminal illness. We consider the emotional challenges associated with making home visits, the meaning of 'boundaries', feelings associated with fees, and the shared experience of love between patient and analyst. We consider the ways that the analyst's affective intensity may also be associated with earlier and feared illnesses in their own life. We close with considering the difficulties that our field has in honestly communicating this aspect of the heart and soul of psychoanalysis.   Linked Episodes: Episode 23: A Psychoanalyst Encounters the Dying – Discovering ‘Existential Maturity'   Episode 40: How Psycho-Oncology Informs an Approach to the Covid-19 Crises with Norman Straker, MD   Our Guests: Mark Moore, PhD, is a clinical psychologist and psychoanalyst who works in private practice in Philadelphia. He was the Director of Psychological Services at the Abramson Cancer Center at Pennsylvania Hospital from 2004-2014 where he supervised psychology interns and post-doctoral fellows during their psycho-oncology rotation and provided psychological services to cancer patients and their families. He is also currently a co-leader for a weekly doctoring group for neurology residents at Penn Medicine. He was the Director of the Psychotherapy Training Program from 2014-2020 at the Psychoanalytic Center of Philadelphia, where he currently teaches courses on Writing, Assessment, Core Concepts, and a comparative course on Psychotherapy and Psychoanalysis. He was a recipient of the 2020 Edith Sabshin Teaching Award from the American Psychoanalytic Association, and he runs a monthly teaching forum for faculty at his institute. Dr. Moore's clinical work focuses on health issues, notably chronic illness, losses, and life transitions associated with cancer, and the fear of dying. He has written several book chapters on topics including the concept of harmony in Japan, cultural perspectives on lying, conducting therapy outside the office, the experience of bodily betrayal in illness and aging, the experience of shame across the adult lifespan, and more recently about friendship.    Peggy Warren, MD, is a psychiatrist and psychoanalyst in Boston. Originally from Chicago, she danced professionally with Giordano Dance Chicago from ages 15 to 21, which created a lifelong interest in the effects of creativity and mentoring on human development. Fascinated by cell biology, she received a master's degree in microbiology from Chicago Medical School and then an MD from Rush University. In medical school, she was chosen to be an Osler Honor Fellow in Pathology/Oncology, where she was first exposed to dying patients. Awarded the Nathan Freer prize for excellence in a medical student at graduation, she used the prize money to buy the Complete Works of Freud and began to learn about the power of the unconscious. After completing residency training in psychiatry at Massachusetts General Hospital, she pursued analytic training and graduated from the Boston Psychoanalytic Society and Institute. She was on the teaching and supervising faculty of the MGH/McLean psychiatry residency program for 30 years, the Boston Psychoanalytic faculty for 20 years, and won the teaching award from the Harvard Medical School MGH/McLean residency program in 2010. She has given talks on “Vaslav Nijinski: Creativity and Madness,” was a discussant with Doris Kearns Goodwin on Abraham Lincoln and depression, lectured on the effect of twinships on siblings, was a discussant in the “Off the Couch Film Series,” (Boston Coolidge Corner theater), a case presenter “On the Dying Patient” at the 2017 American Psychoanalytic meetings, and is a faculty member of the American Psychoanalytic Association's annual Workshop on Psychoanalytic Writing. She has been in private practice in Boston as a psychoanalyst for 38 years.   Recommended Readings: Bergner, S. (2011). Seductive Symbolism: Psychoanalysis in the Context of Oncology. Psychoanalytic Psychology, 28,267-292.   Emanuel, L. (2021). Psychodynamic contributions to palliative care patients and their family members. In H. Schwartz (Ed.), Applying Psychoanalysis to Medical Care. New York: Routledge.    Hitchen, C. (2012). Mortality. New York: Hatchette Book Group.   Minerbo, V. (1998). The patient without a couch: An analysis of a patient with terminal cancer. Int. J. Psych-Anal., 79,83-93.   Norton, J. (1963). Treatment of a Dying Patient. Psychoanalytic Study of the Child, 18, 541-560   Didion, Joan: The Year of Magical Thinking. Vintage/Random House, 2007   Jaouad, Suleika: Between Two Kingdoms: A Memoir of a Life Interrupted; Random House, 2022.   Bloom, Amy: In Love: A Memoir of Love and Loss;Random House, 2023.  

“Of all the eight different pulmonary toxicities you and I have talked about over these two different podcasts, they're all very different etiologies and treatments. So, we went everywhere from infection and good stewardship with antibiotics to pulmonary GVHD to diffuse alveolar hemorrhage. And I think that's what's the hardest part for us as nurses. It's not just one thing that's causing it, and there's multiple different ways to treat these things,” Beth Sandy, MSN, CRNP, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a conversation about pulmonary toxicities in cancer treatment. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by May 24, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: Learners will report an increase in knowledge related to pulmonary complications in people with cancer. Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast episodes: Episode 295: Cancer Symptom Management Basics: Pulmonary Embolism, Pneumonitis, and Pleural Effusion Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies Episode 206: Graft-Versus-Host Disease: Biomarkers and Beyond Oncologic Emergencies 101 series ONS Voice articles: Pneumonitis With Immunotherapy Treatment The Case of the Post-Transplant Pulmonary Problem How Inhaled Cannabis May Contribute to Pulmonary Toxicity in Patients With Cancer ONS courses: Essentials in Oncologic Emergencies for the Advanced Practice Provider Oncologic Emergencies Treatment and Symptom Management—Oncology RN ONS books: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition) Clinical Manual for the Oncology Advanced Practice Nurse (fourth edition) Clinical Journal of Oncology Nursing article: Influenza Adherence Tool Kit: Implementation and Evaluation Among Allogeneic Hematopoietic Transplantation Recipients Oncology Nursing Forum articles: Community Respiratory Virus Infection in Hematopoietic Stem Cell Transplantation Recipients and Household Member Characteristics Emergence of Stereotactic Body Radiation Therapy Multifactorial Model of Dyspnea in Patients With Cancer ONS Huddle Cards: Hematopoietic Stem Cell Transplantation Proton therapy Radiation Sepsis ONS Guidelines™ and Symptom Interventions: Dyspnea American Cancer Society patient resources: Shortness of Breath Infections in People With Cancer American Lung Association To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From This Episode “[Intensity-modulated radiation therapy] is a type of radiation that can really take into account certain movements. And this is particularly important with the lungs, because we can't necessarily have patients hold their breath for a long period of time, so the chest rises and falls and the heart beats while you're trying to do radiation to the lungs. So with IMRT, they can simulate that, so that the beam is going to follow that specific movement in that patient. That's really helpful because then, hopefully, we're going to keep that radiation dose mostly on cancer tissue and not on healthy tissue. And thus, that should reduce the amount of radiation that's to the healthy tissue and hopefully reduce pneumonitis.” TS 3:44 “Proton beam radiation is something that we've described in the past as radiation that will typically have an entrance dose but not an exit dose, so minimizing toxicity by hopefully around 50%. … If you're doing proton beam therapy, that radiation is designed to only have an entrance dose from either the back or the front or the side, whichever way they're going, but then hopefully stop on a dime at that tumor so that they're only really getting the entrance dose of that radiation. … So in turn, especially if you're doing that to the lungs, that should minimize dose of radiation to healthy lung tissue.” TS 5:03 “If they're having a fever, low blood count, thick ugly mucus, this often, typically can be infection as well. And then get a chest x-ray because, a lot of times I've been saying for a lot of these things, we need a CT scan to see this. Actually, infection is probably best noted on a chest x-ray because this is something that will consolidate.” TS 18:58 “[Tumors] may be directly invading a vessel. They may directly be invading the bronchus where there's a lot of capillaries or there's a lot of blood vessels that can break and then cause them to cough up blood. You can have tumors or prior treatment that then cause a bronchial fistula that then can cause bleeding. Patients with squamous cell carcinoma of the lung are much more likely to have hemoptysis and pulmonary hemorrhage than patients with adenocarcinoma, though it definitely can happen with adenocarcinoma as well.” TS 22:00 “One of the best treatments for tumor-direct hemorrhage is radiation. This is where radiation can be very helpful for these patients. It's one of the first things that we do. We're going to go in with radiation, shrink that tumor really fast to get it away from those vessels, so patients stop bleeding.” TS 27:17

Phil Gee was first diagnosed with Parkinson's Disease (PD) in 2015, one year after retiring from a very successful thirty-three-year career holding a number of engineering, manufacturing and supply chain senior level positions. Since his PD diagnosis, Phil and his wife, Julia (who first met in the 1st grade & have been married for 36 years), have become active advocates for others living with PD and their care partners. In 2017, they moved from metro Atlanta to Hilton Head, and immediately joined the local Rock Steady Boxing program, an intensive boxing/exercise program that has proven to slow the progression of  Parkinson's Disease, which is  incurable.They began to look throughout the South Carolina Lowcountry and didn't really see other Black people who said that they had PD. That started their journey to become PD advocates, helping others with PD and their care partners to learn more about PD and how to live a better life with the disease. Phil has served four years on the Parkinson's Foundation People with Parkinson's Advisory Council. Julia is currently on the Advisory Board for the Foundation's Carolina Chapter, and chairs their local PD Support & PD Care Partner Support groups. Together they have participated as panelists and speakers in a number of PD symposiums, co-chaired multiple Parkinson's Foundation Moving Day Fundraisers, and participated in several pharmaceutical focus groups/patient panels. Today, they are active with the Special Interest Group – Black Diaspora steering committee working to drive development of solutions to mitigate health disparities in the Black Community with a focus on issues of the Black PD Community.Evelyn Stevens, MPH, is the Senior Director of Community Engagement at the Parkinson's Foundation since September 2022. Prior to this role, Evelyn held positions as Clinical Research Project Manager, Clinical Research Coordinator III, and Clinical Research Coordinator II at the Children's Hospital of Philadelphia in the Division of Hematology and Comprehensive Sickle Cell Center. Before that, Evelyn worked as a Health Educator and Clinical Research Coordinator at Penn Medicine's Raymond and Ruth Perelman Center for Advanced Medicine in the Abramson Cancer Center. Evelyn holds a Master of Public Health (M.P.H.) in Epidemiology and Biostatistics from Temple University and a Bachelor of Arts in Psychology: Bio-Psychosocial Health from Lincoln University.   

In this episode of the IJGC podcast, Editor-in-Chief Dr. Pedro Ramirez is joined by Dr. Dimitrios Nasioudis to discuss immunotherapy in vulvar melanoma. Dr. Nasioudis is from the Division of Gynecologic Oncology at the Abramson Cancer Center of the University of Pennsylvania. His current research focuses on translational therapeutics and population-based research with an emphasis on rare gynecologic tumors.   Highlights: • Prognosis of patients with vulvar melanoma and inguinal lymph node metastasis is poor. • In our study using real-world data approximately 1 in 4 patients received adjuvant immunotherapy with no clear overall survival benefit.            • Further research to identify biomarkers to select patients who may benefit from immunotherapy is needed. 

  “So much of this is just knowing what is their diagnosis, what medications are they on, what could be the root cause of this—where is their disease to begin with? There's really a lot of differential diagnosis and workup that has to be thought about, you know, when you're dealing with shortness of breath and pulmonary toxicities,” Beth Sandy, MSN, CRNP, OCN®, thoracic medical oncology nurse practitioner at the Abramson Cancer Center at the University of Pennsylvania in Philadelphia, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about just a few of the pulmonary toxicities oncology nurses may encounter in patients receiving pharmaceutical cancer treatments. This episode is part of a series on cancer symptom management basics; the rest are linked below.  You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.75 contact hours of nursing continuing professional development (NCPD), which may be applied to the nursing practice, oncology nursing practice, symptom management, palliative care, supportive care, or treatment.ILNA categories, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by January 19, 2026. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge of pulmonary complications from cancer treatment.   Episode Notes  Complete this evaluation for free NCPD.   Oncology Nursing Podcast Cancer Symptom Management Basics series  ONS Voice articles: Pneumonitis With Immunotherapy Treatment Hematologic Cancers Have Higher Long-Term Risk of Clots and Bleeding  Clinical Journal of Oncology Nursing articles: Durvalumab Immunotherapy: Nursing Management of Immune-Related Adverse Events During the Journey of Patients With Stage III Non-Small Cell Lung Cancer Heart and Lung Complications: Assessment and Prevention of Venous Thromboembolism and Cardiovascular Disease in Patients With Multiple Myeloma Chronic Obstructive Pulmonary Disease: Clinical Implications for Patients With Lung Cancer  Oncology Nursing Forum article: Multifactorial Model of Dyspnea in Patients With Cancer  ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)  ONS Symptom Interventions and Guidelines™: Dyspnea  To discuss the information in this episode with other oncology nurses, visit the ONS Communities.    To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode  “Your lungs are what is needed to have the gas exchange within your bloodstream. So, when we inhale, we're inhaling oxygen, and we need that gas exchange to occur in the alveoli, which are the tiny, little bubble-like structures within the periphery of the lungs. And they're communicating with tiny, itty-bitty little blood vessels. And that's where the gas exchange occurs, where you get rid of the carbon dioxide from the blood and you get oxygen to the blood. And what ends up happening is there is, for whatever reason it may be, that gas exchange can't occur, and that can result in so many different forms from different toxicities, whether there's an inflammation causing the alveoli not to work correctly, whether there's an obstruction where there's literally something obstructing the air getting into the lungs, or whether there's compression from an external source like a fusion or something like that that is pressing against the lungs where that gas exchange cannot occur.” TS 2:36  “Pulmonary embolism, I'll tell you, is one of the most common things that we see in cancer. As a matter of fact, often patients are diagnosed with cancer because they present with a pulmonary embolism into the E.R. (emergency room) and there's really not a lot of reasons why healthy-otherwise patients develop a PE [pulmonary embolism]. So, we start looking for cancer. So, just having cancer in general puts you in that hypercoagulable state. . . . And then, being on chemotherapy increases that risk.” TS 6:38  “I think we need to really make sure that they're compliant. We need to make sure they're not having bleeding. Are you having significant bruising anywhere? Are you having unprovoked nosebleeds? And by that, I mean, I always tell people, ‘Were you just sitting watching TV and it started dripping?' versus, ‘Oh, I blew my nose and some blood came out.' Okay, well, that is probably pretty common side effect of this and should stop quickly.” TS 12:06  “The problem is the majority of these patients have metastatic disease or an incurable cancer. So, we prefer not to stop it [PE medication] in those patients because if you think about it, their risk comes from the cancer. And we're not getting rid of that if they have metastatic disease. I think for those patients with metastatic disease, as long as they're tolerating it, they're not having bleeding events, we will typically tend to just keep them on it.” TS 13:09  “The main difference with the targeted therapies is it tends to be worse, and it's not something that you can rechallenge. And I think that's kind of one of the most important things to think about here. In immunotherapy, it's like, okay, it's T-cell mediated; we gave you corticosteroids; it calmed itself down. And a lot of times we can rechallenge, and we don't necessarily see it again. Whereas with targeted therapies, you have to be much more cautious. If you look at the package inserts for the EGFR and ALK inhibitors, most of them are going to tell you this is not something you ever rechallenge. Any kind of symptomatic pneumonitis, you're going to permanently discontinue the drug. Because if you give it again, it's going to recur in a pretty bad way, where corticosteroids may not even be helpful again even if you rechallenge them.” TS 17:52  “What can happen in cancer, typically, thoracic cancers—so lung cancer, mesothelioma for sure, thymic cancers like thymomas and thymic carcinomas—often will have pleural effusion or pleural disease as well. But when cancer cells get into that fluid, there's irritation which causes an increase in the amount of fluid there. And then what happens is when that space, that pleural space, is now enlarged with fluid or engorged with fluid, a few things occur here. Patients are short of breath because it's a pressure gradient there. So, you're trying to inhale against this fluid-filled cavity that's making it hard. So, often patients will describe it as it feels like someone's giving you a really tight hug and they won't stop.” TS 21:59  “There is another procedure called a talc pleurodesis, where you can have a procedure where you inject some powder in there that will kind of dry it up. The downside of that is that it kind of fuses the pleura to the lung, so there can be some complications there, some pain, and decreased lung function just from doing that, but it can be an easy fix that you certainly don't want to have an indwelling catheter there.” TS 25:11  “So, patients need to know, if they are short of breath at all, call us; let us know. The other thing that's important is know with their baseline vital signs are, especially their pulse ox. You know, some people, their pulse oximetry may be in the low 90s or upper 80s at baseline. We need to know that because there's a big difference if a patient has, you know, they're living at 99% versus 91% normally. Because if they come in and they live at 99 and they're 91, that's a huge drop. But if they come in and they were 91 to begin with and they're 90, that's not a big difference. So, we really do need to make sure we know what their baseline is before they're starting any treatments.” TS 29:18  “This is not something that you want to downplay. You can't sit there and say, you know, ‘Oh, they smoke a lot, so it's probably that.' Or, ‘They have this type of cancer, so it's probably that.' I think this is something that you have to take shortness of breath seriously, and you have to work up and understand and know your patient. But for the most part, this is not something you're going to just triage to the next day or to a few days later. You're going to need some kind of urgent intervention or workup to be done pretty quickly.” TS 32:54  “I think the biggest misconception is that they can't be treated even if they're severe. Most of these things can be reversed. Part of it is just diagnosing it at first and then going from there and starting the appropriate treatment strategy.” TS 33:29 

You might be familiar with economics or the study of monetary scarcity, but have you heard of healthcare economics? In this episode, we explore the daily trade-offs inherent in healthcare with Dr. Jayadevappa, whose dedicated focus revolves around healthcare economics and racial disparities between African American and white Prostate Cancer patients. Dr. Jayadevappa offers a glimpse behind the scenes of healthcare decision-making and initiates a discussion on how to address the racial disparities prevalent among patients. This episode was supported by the Patient-Centered Outcomes Research Institute (PCORI) and features this study by Dr. Jayadevappa. Key Highlights: The three trade-offs in healthcare economics are: equity, efficiency, and quality of care. What are examples of overuse of low-value care? What are examples of underuse of high-value care? Racial disparities in healthcare, specifically in Prostate Cancer, between African American and white patients A current solution to disparities that healthcare researchers like Dr. Jayadevappa are looking into is shared decision-making through a preference assessment. About our guest: Dr. Ravishankar Jayadevappa, Ph.D., is an Associate Professor at the Perelman School of Medicine, University of Pennsylvania. He is also affiliated with the Abramson Cancer Center, the Leonard Davis Institute of Health Economics, and the Institute of Aging. Additionally, he holds a position as a Core Investigator at the Center for Health Equity Research and Policy at the Philadelphia VA Medical Center.  Dr. Jayadevappa's research aims to analyze the tradeoff between economic efficiency, equity, and quality, particularly in addressing health disparities based on race, ethnicity, income, and age. He has secured over $20 million in federal, non-federal, and industry-sponsored grants, leading numerous projects related to chronic diseases such as prostate cancer, bladder cancer, obesity, breast cancer, and Alzheimer's. With over 150 peer-reviewed papers and abstracts, Dr. Jayadevappa has made significant contributions to the oncology field and serves as an editor for several medical journals.  Key Moments: At 3:18 “... healthcare is kind of complex and our resources are limited. So it's always like when you try to achieve one thing, excess more of equity, then you are trading off with efficiency. Or if you are looking at only quality of care, you are trading off with equity or efficiency.” At 20:29 “...our hypothesis asked: is it true for African American patients, if they go to high volume physicians, is their quality of care naturally improved? But we found out that's not true… Then our next series of studies looked at the continuity of care. For instance, fragmented care, when they are in and out of the insurance plans or the healthcare providers. So that may be the reason…. And both recent papers concluded that lack of continuity of care was one of the driving forces of disparity in observed outcomes for African American patients." Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their healthcare professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

Dr. Joseph Carver is the Bernard Fishman Clinical Professor of Medicine at the Abramson Cancer Center of the University of Pennsylvania, the Chief Operating Officer of the Abramson Family Cancer Research Institute of the Abramson Cancer Center of the University of Pennsylvania and the Chief of Staff of the Abramson Cancer Center. He is also an editor of the Cardio-Oncology Journal. For submission information and to read the latest science go to: https://cardiooncologyjournal.biomedcentral.com/

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, Cancer.Net Associate Editor for Lung Cancer, Dr. Charu Aggarwal, and Cancer.Net Specialty Editor for Thymoma, Dr. Ryan Gentzler, discuss what people with early-stage non-small cell lung cancer should know about their treatment options before and after surgery, called neoadjuvant therapy and adjuvant therapy, respectively. Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine. Dr. Gentzler is a thoracic medical oncologist and Associate Professor of Medicine in the Division of Hematology/Oncology at the University of Virginia (UVA) Comprehensive Cancer Center. View disclosures for Dr. Aggarwal and Dr. Gentzler at Cancer.Net.  To begin, Dr. Gentzler will discuss what people with early-stage non-small cell lung cancer should know about neoadjuvant treatment options before lung surgery. Welcome, Dr. Gentzler. Dr. Gentzler: Hi, this is Ryan Gentzler from the University of Virginia. We're here to discuss the role of neoadjuvant chemotherapy and immunotherapy for the treatment of locally advanced non-small cell lung cancer. So first, I thought I'd address some of the data and definition of what is neoadjuvant treatment. So when we think about treating lung cancer that is not metastatic, that is earlier stage disease, there typically involves multimodality treatment. Sometimes these lesions or tumors can be very small and can be stage I and treated with surgery alone or perhaps radiation alone and no further treatment is needed. But the vast majority of lung cancers that are considered early stage are in fact either larger tumors, involve lymph nodes, and typically fall into the category of stage II or III lung cancers. And these are cancers that often require multiple treatments beyond the local surgery approach alone. When we think about how we deliver that treatment, it can either be given before surgery or after a surgery. If we give treatment before a surgery, we call that neoadjuvant. If it is given after the surgery, we call that adjuvant. And most of the data that we have today in lung cancer uses one or the other of these approaches, and we don't typically give treatments both before and after, at least in terms of the chemotherapy part of that treatment. Historically, most of the data exists in the adjuvant treatment of lung cancer going back several decades that showed that the benefit of chemotherapy after a surgery, particularly for those with stage II and stage III lung cancer, derived a clear benefit of survival by giving chemotherapy after surgery. More recently, with the advent of immune therapy, which we have used in patients with stage IV lung cancer as well as those with stage III lung cancer who cannot undergo surgery, those immunotherapy drugs have been shown to improve overall survival and improve clinical outcomes for a wide range of patients with more advanced disease. And so in the last 4 or 5 years, we have really looked at new trials that have added immunotherapy in what we call perioperative space, either before surgery or after surgery for those that have surgically resectable disease. I'm going to focus on the neoadjuvant approaches that we have seen today, and this largely all started with data from Patrick Forde out of Johns Hopkins and Jamie Chaft from Memorial Sloan Kettering looking at single agent treatment with nivolumab immunotherapy. This was no chemotherapy given for 3 treatments prior to or three cycles prior to surgery. And that trial demonstrated a high degree of patients with tumor reduction and more importantly, we saw that the pathologic response, meaning how much tumor was left under the microscope at the time of surgery, was higher than what anyone anticipated with just immunotherapy alone. That launched a whole series of larger randomized prospective trials evaluating largely the combination of chemotherapy and immune therapy prior to surgery. Now, before we get into some of the results of these trials, I really wanted to emphasize some of the theoretical advantages to neoadjuvant approach. Now, the first potential advantage of giving neoadjuvant treatment is that we know when you start with immunotherapy and chemotherapy regimens and that's the first type of treatment, everyone is guaranteed to get that treatment. And we know that the completion rate prior to surgery is higher than it is after surgery. These patients can get all of the prescribed treatment and will be more likely to get it than if they get it after surgery. So this is one advantage. The other is potentially starting these medications which go throughout the body and treat the cancer, wherever it may be, earlier. We know that one of the risks of all cancers, but lung cancer in particular, is that even with good surgery and removing all of that cancer, there is a chance that there are cancer cells left behind, which leads to risk of recurrence in the years to come after surgery. Naturally, if we start the treatment that can eliminate those cancer cells, wherever they may be, and do that first, perhaps we catch this earlier with fewer cells that have escaped and have a more likely chance of success of eliminating the cancer and resulting in a cure. The third, I think, is one that we still have yet to learn more about, but if we give immunotherapy in particular, these are medications that activate the immune system, particularly the type of immune system cell called a T cell. If that T cell is able to recognize tumor cells, it is more likely to be able to continue to attack those tumor cells. And if we give that treatment prior to removal of the tumor, perhaps that activates the immune system in a more robust way that it can go after these cancer cells and eliminate those that are left behind after the surgery. If you give the immunotherapy after a surgery and the bulk of the tumor, most of the cancer cells have been removed, it may be harder to find those antigens or foreign proteins that are expressed in cancer cells. So the immune system may not be as robustly able to go after cancer if you give it solely after a surgery. Another potential advantage of neoadjuvant approaches is that it really helps us learn as oncologists how well a cancer is responding to a treatment. If we give these treatments for 4 cycles after a surgery, we don't know whether it's eliminating those residual cancer cells or whether it is totally ineffective. If we give it before a surgery and we see that there is tumor reduction or that there is a complete elimination of the cancer, we know that that treatment was an effective treatment at attacking the cancer cells and eliminating them. We know that the cancer was sensitive to that treatment. We can then better prognosticate how well the patients are going to do after surgery. We know based on the latest data that if you achieve what we call a pathologic complete response with chemotherapy and immunotherapy prior to surgery, meaning there are no cancer cells left when we look at that surgical specimen under the microscope, we know that those patients have a much better likelihood of surviving for longer periods of time than those who have active cancer at the time of surgery after prior treatment. And so neoadjuvant approaches allow us in a 2-month time frame to get a great sense of how well our treatments are working and able to prognosticate outcomes based on how well those cancer cells have been eliminated at the time of surgery. One large phase 3 trial called the CheckMate 816 trial was a randomized phase 3 trial and that enrolled patients with stage IB through IIIA non-small cell lung cancer using the old staging system of the 7th edition. These would all now be categorized as stage II and stage III non-small cell lung cancer patients. And it randomized these patients to 3 cycles of chemotherapy plus nivolumab, which is an immunotherapy drug, and compared that to patients treated with chemotherapy alone for 3 cycles. After these 3 cycles of chemotherapy, which is about a 9-week time frame, patients had surgical resection of their tumors. And then after surgery, patients received no further treatment, although treating physicians were allowed to give additional treatments like chemotherapy or radiation if they thought it would be beneficial for these patients, although it was not mandated by the study. One of the first results we saw from this study was that there was a much higher rate of pathologic complete response of 24% of patients achieving a path CR [pathologic complete response] with the nivolumab plus chemotherapy combination compared to only 2.2% with chemotherapy alone. This was highly statistically significant and demonstrated a clear benefit for those receiving the immunotherapy. The other main endpoint of this study was event-free survival, meaning that the time that the patients were alive and without any significant event like cancer progression or death after the enrollment of the trial. And in this analysis, the median event-free survival was significantly longer in those who have received the immunotherapy plus chemotherapy combination prior to surgery. One of the potential concerns about neoadjuvant treatment is that it may render patients unfit for surgery who otherwise could have had their cancer removed. When we look at the outcomes from this CheckMate 816 trial, it actually did not appear to be the case to a large degree. In fact, those that got the nivolumab plus chemotherapy combination were more likely to proceed on with surgery, and the majority did; 83% received the planned surgery. There were patients who were unable to receive surgery due to adverse events of their treatment, but that was only 1% of patients enrolled in the trial. Other reasons for canceling the surgery included disease progression, meaning the cancer got worse to the point where they could not undergo surgery, or other reasons, such as the patient declined surgery, or it was found to be unresectable at the time the surgeon wanted to remove the cancer, or poor lung function.   One of the insights we got from the surgical data from this trial were that those who received the combination of chemotherapy and immunotherapy had slightly higher rates of smaller surgeries like a lobectomy compared to a pneumonectomy for those who had received [chemotherapy alone.] There were also fewer numbers of patients who required a conversion from a minimally invasive surgical procedure to an open surgical procedure if they were getting the immunotherapy combination. A higher number of patients also were able to have complete resection of their tumor if they received the immunotherapy/chemotherapy combination. The length of hospitalization was slightly lower, and the rates of pain were slightly lower in those who received the combination as well. These comparisons were not statistically significantly different, but numerically, there seems to be at least a trend toward benefit in surgical outcomes in this neoadjuvant chemotherapy/immunotherapy approach. And I think this makes sense. We know that this combination is more able to eliminate a cancer and make it a pathologic complete response when we look at it under the microscope, and therefore, if there is shrinking the tumor to a higher degree, naturally, it seems there would be more likely of completely removing the tumor, using a smaller incision to remove that tumor, shortening the length of stay in the hospital and recovery time and pain control. All makes sense if we know that the treatment itself is able to reduce that size of the tumor. There are many other phase 3 trials ongoing studying the impact of immunotherapy plus chemotherapy in the neoadjuvant setting. The AEGEAN trial has recently reported data at the AACR meeting this year in 2023 with similar results that we saw with the CheckMate 816 trial. There are 3 other phase 3 trials that are ongoing, one of which we will see later this summer called the KEYNOTE-671 trial evaluating pembrolizumab plus chemotherapy in the neoadjuvant setting and then 2 other trials evaluating nivolumab, the CheckMate 77T trial, or atezolizumab in the IMpower030 trial. Each of these more recent trials typically have used 4 cycles of chemotherapy plus immunotherapy prior to surgery and also continued the immunotherapy after surgery for a period of time, most commonly approximately 1 year. From the data we have seen so far, it remains uncertain whether additional immunotherapy beyond the 3 or 4 cycles given in the neoadjuvant setting provides any additional benefit. We still do not understand what to do with patients who did not achieve a pathologic response whether further treatment would be of any additional benefit. We do not know if there will be further benefit even in those that achieved a pathologic complete response whether a slightly longer duration of immunotherapy would further improve outcomes in that group. We suspect with longer-term follow-up over the years of all of these phase 3 trials that some of these questions will be answered. So what are some key questions that patients should ask when considering a neoadjuvant chemotherapy/immunotherapy approach? I think the first question that's key is what is my tumor stage? We know that the trials that enrolled patients with a neoadjuvant approach enrolled patients using our current staging system would be a stage II or stage III lung cancer. And this is where it gets really tricky is, what subdivision of stage III is it? We tend to think of stage IIIA's as being one that it would be surgically resectable, with a smaller number of stage IIIBs, and then stage IIIC, one that we would not typically recommend surgery for. I think the next question within the tumor stage is, is this based on imaging or based on the biopsies? And we know that biopsies are really the best way to stage locally advanced cancers, particularly getting samples of lymph nodes in the mediastinum. Sometimes what looks like a stage I or stage II on imaging is, in fact, a stage III based on biopsies that are done at the time of surgery. It's ideal to know that information prior to making the decision about surgery so that that surgery is not futile.   On the opposite side, sometimes there is imaging suggestive of lymph nodes that are enlarged in the mediastinum, and it's presumed that this is a more advanced stage III and is not surgically resectable. However, if you go and biopsy those lymph nodes, sometimes they are benign. Sometimes they are inflammation related to infection or cancer but do not actually contain cancer cells. And so we typically advise that getting biopsies of lymph nodes in the mediastinum, at least any that are particularly suspicious, is highly recommended for these locally advanced cancers. I think the next question that's key to ask is, what are my tumor biomarkers? And there are multiple biomarkers that we look at in non-small cell lung cancer that help us decide what is the best treatment. What is the best approach? What is the best medicine to treat the cancer? We know that one of these biomarkers that is a key is a mutation. So multiple different mutations can occur in lung cancers, particularly those that are adenocarcinoma subtypes. And these mutations may be less likely to benefit from immunotherapy and we may want to take a different approach with surgery, chemotherapy, and potentially targeted therapies that specifically target that mutation that exists in the tumor. The other key biomarker here is PD-L1. We know that tumors with a higher level of PD-L1 are more likely to respond and benefit from immunotherapy. As of right now, that PD-L1 status plays a more important role in the adjuvant setting. All of the chemotherapy plus immunotherapy combinations in the neoadjuvant setting seem to benefit the group as a whole regardless of that PD-L1 status. But still, an important biomarker that we should have prior to making all final decisions on treatment. I think another question that should be asked any time you have an earlier stage cancer is, is my tumor surgically resectable? And there can be many reasons why cancers are not resectable, perhaps due to the anatomy of where the tumor is located, if it invades into the mediastinum, for example, or is near large blood vessels, or perhaps because there are too many lymph nodes and this is a more advanced stage. And so I think the main reasons for not being surgically resectable would be the tumor is too large, if the stage is too high, or is it more of a function of fitness for surgery and that can be because of other underlying lung disease. Perhaps removing part or all of a lung would not be safe due to impaired lung function to begin with. And I think it's important to understand that sometimes stage III lung cancers are resectable and sometimes they are not, and understanding the reason why they are not, I think, is important. And then I think lastly and ultimately when we're talking about a neoadjuvant approach, you want to ask your treating oncologist, "Would it be better to give my treatment before surgery or after surgery?" And really discuss the pros and cons with the physician and have them incorporate all of the factors that go into these treatment decisions. How well you'll tolerate chemotherapy, other medical conditions that may play a role in the likeliness of getting through those treatments safely, perhaps underlying diseases that may increase the risk of immune-related side effects with immunotherapy. You really want to factor in all of these things and discuss the pros and cons of a systemic treatment first versus surgery first before making final decisions on how to treat locally advanced lung cancer. All right. Thank you. ASCO: Thank you, Dr. Gentzler. Next, Dr. Aggarwal will discuss what people with early-stage non-small cell lung cancer should know about their adjuvant treatment options for after lung surgery.   Dr. Aggarwal: This is Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at University of Pennsylvania's Abramson Cancer Center. And today I will talk to you about the use of adjuvant immunotherapy in the setting of early-stage non-small cell lung cancer. We'll start by discussing what adjuvant therapy is, what types of options we have for adjuvant therapy, what kind of testing is important, and what options there may be in terms of adjuvant immunotherapy. So let's get started. Early-stage lung cancer comprises of stages between stage I to stage III. These stages vary by the size of the tumor as well as the level of lymph node involvement. In the setting of very early-stage lung cancer, such as stage I and stage II, as well as some select stage III lung cancers, we recommend surgical resection. And in these patients, the use of additional treatment is recommended based upon the pathological determination of the tumor size as well as the lymph node status. If usually lymph nodes are involved, we recommend adjuvant chemotherapy, and also, many experts will deliver adjuvant chemotherapy for tumors that may be larger than 4 centimeters even in the absence of lymph node involvement. The data for adjuvant chemotherapy comes from several large clinical trials that were conducted about a couple of decades ago now that demonstrated not only an improvement in preventing recurrence of the cancer but also a modest improvement in overall survival, really laying the ground for improvement and therefore becoming the gold standard. Four cycles of chemotherapy are usually administered about 6 to 12 weeks following surgical resection, and this is really the basis of our treatment in the early-stage setting. In today's time and age, we now have several other options. We have treatment options that include molecular therapy, which is biomarker driven, as well as the use of immunotherapy. So it's actually very important for us in the adjuvant setting--or in the post-surgical setting--to test for mutations such as EGFR. It's also important for us to test PD-L1 status. So let's dive into why each of these may be important. Patients with EGFR mutations, especially those with sensitizing mutations in EGFR exon 19 or 21, now have the opportunity to receive a targeted therapy in the form of osimertinib, which is an oral drug, very targeted and specific for the EGFR mutation that has been studied in a clinical trial setting in patients with early-stage non-small cell lung cancer. In patients with stage IB to IIIA non-small cell lung cancer with EGFR mutation, use of osimertinib was associated with a significant improvement in our ability to delay the recurrence of cancer. Based on this significant improvement, FDA approved therapy with osimertinib, and it is currently available and ready to use. We usually recommend it for 3 years, so daily therapy for 3 years, and patients are monitored with routine CAT scans and lab work. For patients who don't have an EGFR mutation, we do recommend broad panel testing. Of course, this is not the standard, but I think it's important for us to identify patients who may not benefit from immunotherapy. Patients that have an ALK mutation, for example, or ROS1 translocation, may not have the best chances of responding to adjuvant immunotherapy, and therefore, I think testing should be performed to make sure that we are having a shared decision-making conversation with our patients about the use of the correct adjuvant options. In terms of adjuvant immunotherapy, we now have 2 approved agents. One of them is atezolizumab, and the other one that was just recently approved is pembrolizumab. Atezolizumab was approved on the basis of a large clinical trial called the IMpower010 study, which randomized 1,280 patients with stage IB to IIIA non-small cell lung cancer to either 1 year of atezolizumab or best supportive care. Of note, all of these patients had to have had adjuvant chemotherapy that included a cisplatin platinum chemotherapy. In the first analysis, we found that the disease-free survival or the probability of the patients remaining cancer-free was significantly improved in those patients that had a tumor expression of PD-L1 greater than or equal to 1% and received atezolizumab compared to patients who did not receive atezolizumab. On the basis of this positive primary endpoint, the U.S. FDA approved the use of adjuvant atezolizumab for patients with stage II to IIIA resected non-small cell lung cancer after surgical resection and adjuvant chemotherapy. Recently, we heard that this does lead to small but significant improvement in overall survival. There is a trend towards improvement in overall survival. However, the data are quite immature at this point, and we do need longer follow-up to be able to follow this trend. The greatest magnitude of overall survival benefit was found in patients who had the PD-L1 greater than or equal to 50%. So it's important to know what the PD-L1 level of a patient may be when I'm thinking about adjuvant immunotherapy because adjuvant immunotherapy is most likely to benefit those that don't have an actionable mutation, such as EGFR, and those that have the highest PD-L1 staining, at least in the IMpower trial. Secondly, the PEARLS clinical trial is a clinical trial that evaluated the use of pembrolizumab, which is another immunotherapy agent, again, in the adjuvant setting. For this clinical trial as well, there was a small but significant improvement in disease-free survival, again preventing the probability of recurrence in all patients that received pembrolizumab compared to the best supportive care. And basically, this led to also an approval by the FDA for the use of pembrolizumab. Again, now we have 2 options. Both of these are administered for 1 year. What should patients know about therapy? These drugs are usually administered once every 3 weeks. They are given intravenously. Sometimes, we can change the treatment schedule to be either once every 4 weeks in the case of atezolizumab or every 6 weeks in the case of pembrolizumab. These may be associated with some side effects. Immunotherapy side effects that are most common are fatigue, chills, myalgias, or basically a feeling of pains in the body or joints. But also, some serious life-threatening reactions can occur such as activation of the immune system to such an extent that the immune system may start to attack the body's organs. So this may lead to swelling or inflammation in the organs that may manifest itself as colitis if the gut gets inflamed, or pneumonitis if the lungs were to get inflamed, or pancreatitis if the pancreas were to get inflamed. Any organ in the body can really get inflamed. We've certainly seen cases of thyroiditis. We've seen cases of polyarthritis. We've seen cases where the brain may also get inflamed or the pituitary may get inflamed. So there are definitely some life-threatening reactions or side effects that can occur with the use of immunotherapy that should be closely monitored. The benefit of having used immunotherapy in the metastatic setting is that now we have a lot of experience managing these side effects. And if recognized early, these side effects can be managed appropriately with the use of steroids as well as holding therapy. Many of the times, we can even reinstitute immunotherapy without significant harm to the patients. However, I think immunotherapy benefits as well as side effects should be discussed in detail with the provider, especially in the adjuvant setting. Patients may ask if neoadjuvant immunotherapy along with chemotherapy is a better approach compared to adjuvant immunotherapy. At this time, we don't have a clinical trial that is comparing neoadjuvant chemoimmunotherapy followed by surgery to an approach that is surgery followed by adjuvant immunotherapy. In general, I would say that if the decision by a multidisciplinary team has been made to proceed with surgery, careful discussion should be had about adjuvant chemotherapy as well as the use of adjuvant immunotherapy, and molecular testing should be performed. All patients with early-stage disease should have a multidisciplinary tumor board discussion, which includes engagement with surgeons, radiation oncologists, pulmonologists, pathologists, and medical oncologists so that they can ensure that many experts have had the chance to weigh into their case as well as come to the right conclusion on whether or not to use new adjuvant chemoimmunotherapy or just to proceed with surgical resection. ASCO: Thank you, Dr. Aggarwal. You can learn more about neoadjuvant and adjuvant treatment options for early-stage non-small cell lung cancer at www.cancer.net/lung. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.   And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.  Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate. 

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research advances in treating non-small cell lung cancer, small cell lung cancer, and mesothelioma.  Dr. Charu Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the 2023 Cancer.Net Associate Editor for Lung Cancer. Dr. Melina Marmarelis is an assistant professor at the University of Pennsylvania, the Medical Director of the Penn Medicine Mesothelioma Program, and the co-director of the Molecular Tumor Board at the University of Pennsylvania. She is also the 2023 Cancer.Net Specialty Editor for Mesothelioma. Dr. Kristin Higgins is a radiation oncologist, Professor and Vice Chair in Clinical Research in the Department of Radiation Oncology at Emory University School of Medicine and medical director of radiation oncology of The Emory Clinic at Winship Cancer Institute's Clifton campus location. She is also a 2023 Cancer.Net Advisory Panelist for Lung Cancer. You can view disclosures for Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net Research Round Up podcast. Today, we will be talking about the latest research from the Annual Meeting of the American Society of Clinical Oncology from June 2023, and I'm joined today by 2 experts in the field of lung cancer. Before I introduce them, I'd like to introduce myself. I'm Dr. Charu Aggarwal. I'm an associate professor for lung cancer excellence at the University of Pennsylvania's Abramson Cancer Center. I'd now like to introduce Dr. Melina Marmarelis. Dr. Marmarelis: Hi, so happy to be here. I'm Melina Marmarelis. I'm an assistant professor at the University of Pennsylvania and the medical director of the Penn mesothelioma program. Dr. Aggarwal: And Dr. Kristin Higgins. Dr. Higgins: Hi, everyone. I'm Kristin Higgins. I am a thoracic radiation oncologist at Winship Cancer Institute of Emory University. I'm a professor and vice chair for clinical research for radiation oncology. Dr. Aggarwal: Fantastic. So today, we'll talk about relevant research as it applies to practical implications in the clinic for practitioners, but most importantly, patients with lung cancer. I'd like to start off by discussing 2 key studies, and I would love for perspectives from our faculty here. The first study I want to highlight is the ADAURA trial. This is a trial that has already sort of changed practice in most recent years when the study was presented at the Annual Meeting of the American Society of Clinical Oncology in 2020, but we have new updates on this study as of 2023. So, in brief, this was a study that looked at the value of administering an oral pill called osimertinib that is a tyrosine kinase inhibitor against the EGFR, or the epidermal growth factor receptor, in patients with non-small cell lung cancer. We know that non-small cell lung cancer is quite a heterogeneous disease with some subsets of patients having mutations that may render them increasingly sensitive to the effects of these tyrosine kinase inhibitors. In fact, these pills have been used in the metastatic setting for several years based on an improvement in overall survival. What the ADAURA study tried to do was ask the question if this pill would add an incremental advantage after receiving curative-intent surgical resection in those with early-stage lung cancer. So this study enrolled patients with stage IB to IIIA non-small cell lung cancer after surgical resection and focused only on those patients that had sensitizing EGFR mutations with EGFR exon 19 deletion or L858R mutations. Patients could receive chemotherapy after having the surgery and then were basically randomized into 2 groups, one of whom received osimertinib at a dose of 80 milligrams once daily for a total of 3 years. Patients were followed up for recurrence. We already know from the earlier results that patients who received osimertinib had a better chance of delaying the recurrence of disease. However, what we found at the Annual Meeting this year is that the administration of this osimertinib also improved overall survival, which is really what we all look for in the oncology world. If you're administering a therapy, especially for a long duration, we want to be able to see a survival benefit, and that's what we saw. In fact, in patients who received osimertinib, there was a 49% less likelihood of dying from lung cancer compared to those who did not receive osimertinib. This, I think, is practice-affirming. It may not be practice-changing because some of the practitioners started using osimertinib after its FDA approval in December of 2020, but I think it just confirms our practice as it delivers an overall survival advantage in these patients. One thing that's increasingly important is to identify patients who have this mutation, so now we have efforts underway locally as well as nationally to perform molecular genotyping on all patients with lung cancer so that we can adequately and appropriately treat those with early-stage lung cancer following curative resection or following surgery. Melina and Kristin, what are your thoughts? Dr. Marmarelis: Well, I think these results are really important because it did, as you say, affirm kind of what we're already doing, but I think the most convincing part of this for me is the prevention of spread of disease to the brain. This is not comparing osimertinib after surgery versus osimertinib ever, which I think is a difficult part about interpreting this trial. But I think the fact that it prevented disease from going to the brain is really meaningful to everyone, to patients, to the physicians that are caring for them, so I think that's a really important endpoint. Dr. Higgins: I agree with Melina. I think this is really exciting for our patients. It's exciting to have more treatment options for early-stage lung cancer. I think patients that are diagnosed with early-stage lung cancer are highly motivated to do everything they can to improve their likelihood of being cured. So I tend to have a lot of conversations about side effects and toxicities with patients that have questions and are sort of wondering how it will affect their quality of life, and of course, that is an important piece of it because patients that do have curable lung cancer are probably starting off with a better overall quality of life, but I think generally speaking, our patients have tolerated it well. I'm also kind of excited from a radiation oncology point of view. We treat patients with stereotactic body radiation therapy [SBRT] that are medically inoperable. And we have another trial with a cohort looking at osimertinib for those patients that have EGFR mutations, too, and that's ongoing, again, applying the same concept of trying to really use these SBRTs that work really well in the advanced setting, moving them into earlier stages of disease to help us care for more patients. So overall, I think it's really exciting, and I think it's a huge win for the clinical research community. Dr. Aggarwal: Well, that's wonderful. And I think this certainly advances the field as this is the first targeted therapy approved for patients with early-stage non-small cell lung cancer. I should add that AstraZeneca, the company that makes this drug, has provided institutional research funding to my institution, and I also serve as an advisor to them, but I was not involved personally in the research of this clinical trial. I'd like to move on but stay within the field of early-stage lung cancer and talk about another study called the KEYNOTE-671 study, and this is important because it really applies the idea of using immunotherapy before and after surgical resection in patients with early-stage lung cancer. Just to give a little bit of background to our listeners, we now have 3 approvals for the use of immunotherapy in patients with early-stage lung cancer. Two of those are in the adjuvant setting, meaning that if a patient undergoes surgical resection or surgery for early-stage lung cancer, they can receive either atezolizumab or pembrolizumab following that surgery, and that has been shown to improve outcomes in terms of reducing the chances of recurrence. We also have another approval, which is the third approval in early-stage lung cancer, where 3 cycles of chemotherapy and immunotherapy are administered prior to surgery, also called as the neoadjuvant chemo-immunotherapy approach. This drug that has been approved in combination with chemotherapy is nivolumab, and this approval came from a clinical trial called CheckMate 816 that showed both that patients who received this neoadjuvant chemo-immunotherapy approach had a higher proportion of patients who had complete response or pathologic complete response in their tumors at the time of surgery and also showed that the chances of the disease coming back after surgical resection was much lower amongst those that had received this intervention. The current study, the KEYNOTE-671 study, builds upon this concept and adds both a before-surgery intervention as well as an after-surgery intervention. So what this study did was it enrolled patients with early-stage, stage II to IIIB non-small cell lung cancer, and patients in the intervention arm received 4 cycles of chemotherapy in combination with pembrolizumab, underwent surgery, and then received immunotherapy with pembrolizumab for up to 13 cycles. Patients in the control arm received only chemotherapy prior to surgery and then placebo for up to 13 cycles after. This was a large study with about 786 patients randomized, and what we found was that those patients that received the intervention had a much higher likelihood of remaining disease-free or event-free following surgical resection as well as in the early analysis, an improvement in overall survival with about a 27% reduction in the risk of death. So I do think that this is the first study that shows us that use of both neoadjuvant as well as adjuvant. So sort of this perioperative approach of using immunotherapy before and after surgical resection can actually lead to improved outcomes. This is ultimately what we want for our patients, improvement in overall survival, improvement in cure rates, etc. The study has been silent on the use of radiation therapy, although it has gone into details in terms of the kinds of surgery that was done. Kristin, what are your views about this? Dr. Higgins: I think postoperative radiation after resection for non-small cell lung cancer has sort of started to fall out of favor because of the Lung ART trial that was published in Europe, a randomized phase III trial that showed no differences in disease-free survival or overall survival. And that's not to say that there aren't more study questions on ways to give it safer and ways to incorporate radiation in with the chemo-IO approach, and there are some novel ways to do that, and we're going to see some data presented at the World Lung Cancer Conference looking at some of those novel approaches. But standardly, when patients receive neoadjuvant chemo-immunotherapy followed by surgery, we typically would not offer radiation. There are instances, though, when patients have positive margins, for example, and in that situation, it's sort of a discussion on a case-by-case basis. But ideally, we're hoping that most of these patients that go to surgery are able to get a complete resection, and that's really the key component of the decision-making for deciding if patients are eligible for this approach. Dr. Aggarwal: I agree. Melina, any additional thoughts on this trial? Dr. Marmarelis: I think it's an exciting trial for the reasons that you mentioned. I think it does bring up a number of questions about whether both neoadjuvant and adjuvant immunotherapy are needed. I tend to like the idea of having immunotherapy present when the tumor is present before surgery, so I like kind of having that on board, but I think we still don't know which is more important. Dr. Aggarwal: So it certainly raises many more questions, which hopefully will be answered in the future. KEYNOTE-671 trial was conducted by Merck that produces the drug Keytruda, or pembrolizumab. We have received institutional research funding for other trials. I was not personally involved in this clinical trial. I do serve as an advisor for Merck. I think we'll bring you more research from the ASCO Annual Meeting. And I'll turn it over to Dr. Marmarelis to discuss some more exciting research. Dr. Marmarelis: Thanks, Charu. So perhaps it's not surprising that one of the exciting things I picked from ASCO has to do with mesothelioma. And I just want to put into context a little bit about why this trial was important. This is IND227. It was a cooperative group trial done across Canada, France, and Italy, and this was chemotherapy plus or minus pembrolizumab in patients with pleural mesothelioma that did not undergo surgery. So this was their first treatment, and they were not undergoing surgery. And the reason this trial was important is that in the last few years, we had results from CheckMate 743, which was looking at IPI/NIVO, so a combination of immunotherapies versus chemotherapy. And there was an improvement in survival for those that received double immunotherapy, and that improvement was most pronounced in the non-epithelioid population, which is actually a smaller subset of pleural mesotheliomas. And so as we've seen in the lung when we look at immunotherapy versus chemo, it raises the question of whether combination immunotherapy plus chemotherapy would actually be better for all and, in particular, for all histologies in pleural mesothelioma. So this was looking at that concept. It took the standard chemotherapy, carboplatin-pemetrexed or cisplatin-pemetrexed, and then combined it with one immunotherapy, so slightly less than the combo immunotherapy seen in CheckMate 743, and that was pembrolizumab. And what they saw was that there was a small overall survival improvement in the group that got pembrolizumab. Again, that was most pronounced in patients in the non-epithelioid group, so those with sarcomatoid or biphasic histology. And this is really a prelude to several other trials that are coming out in mesothelioma, namely the DREAM3R trial, which is looking at chemotherapy plus or minus durvalumab. That control arm also includes IPI/NIVO, so that will be really important to be able to compare those, and then also the BEAT-meso trial, which is looking at chemotherapy-immunotherapy but also with an anti-VEGF agent, bevacizumab. So I think this was an important trial. It's a little bit of proof of concept, but there's still a lot that we're looking forward to. It's not quite practice-changing in the clinic, although I think it's certainly an option that people are using, but I'm looking for more data going forward. Dr. Aggarwal: It's incredible to see how far we've come in mesothelioma within the last decade. We are introducing immunotherapy. We're introducing novel agents in the first-line setting. Dr. Marmarelis: The other trial that I was interested in was KEYNOTE-789, which is looking also at patients with EGFR mutations and those that had the original osimertinib as their first-line treatment or another tyrosine kinase inhibitor and then had disease progression on that TKI. And this is an area of huge need. We have patients that do really well on targeted therapies, and then they have disease progression, and we're looking for additional targeted options, but we're also looking for effective chemotherapy options. And one of the questions that has risen from this is whether there's a role for immunotherapy. We know that immunotherapy alone in patients with EGFR mutations is not very effective when you look at a broad population, but in combination with chemotherapy, it's possible that it can add some benefit. So this trial looked at those that had EGFR mutations, had disease progression after a targeted therapy, and then it randomized them to chemotherapy plus or minus pembrolizumab, so chemotherapy plus or minus immunotherapy, and interestingly, it had no difference in the progression-free survival or the overall survival. So the 2 arms were really similar in terms of outcomes. There was also no difference in the overall response rates of the amount that the drug actually shrinks the tumor. So it really doesn't look like immunotherapy is adding much to chemotherapy for these patients. I think we still need to look a little bit closer because there are probably some patients with EGFR mutations that could benefit from immunotherapy, but we're really not very good at identifying those. One of the questions that comes up in this space is whether to add anti-VEGF treatment in addition to chemotherapy and immunotherapy. So there are some upcoming trials looking at that. Dr. Aggarwal: I think this was a trial that was actually very important and again, practice-affirming that this idea of continuing chemotherapy without adding immunotherapy, patients are not losing much. In fact, they're not gaining anything by adding immunotherapy as shown in this clinical trial. I think continuing immunotherapy, so continuing osimertinib, may be important in this setting also because we know that osimertinib can cross the blood-brain barrier. It can provide that CNS [central nervous system] protection. Dr. Marmarelis: Yeah, I think that's a great point that the comparison here is not chemotherapy plus osimertinib. It's chemotherapy alone. So I agree that the control arm is not quite what some of us do. I agree. I do the same as you do. I also just want to mention that the KEYNOTE trial and the previous trial about mesothelioma used pembrolizumab, which is made by Merck. We have received institutional funding, and I've served as an advisor as well as received honorarium from Merck.   Dr. Aggarwal: Melina, those were 2 very important studies and certainly, I think, answer some very relevant questions in clinic in the management of patients with EGFR-mutant lung cancer, for example. And then I think we look forward to more practice-changing data in mesothelioma. Kristin, I would love to hear research from ASCO from you. What caught your interest? Dr. Higgins: So I have a special interest in small cell lung cancer. And I think there was one important small cell lung cancer trial that I wanted to review with everyone. It was SWOG S1929. And SWOG is the Southwest Oncology Group, and it's a cooperative group that conducts clinical trials in cancer funded by the National Cancer Institute. And this is a randomized phase II trial of atezolizumab and chemotherapy followed by randomization to continuing the maintenance of atezolizumab with a PARP inhibitor. Now, we know from prior data that PARP inhibition is attractive for small cell lung cancer because PARP is expressed frequently in small cell lung cancer, and there is a biomarker called Schlafen-11 that preclinical data and prior data has shown can predict response to PARP inhibition. And this trial was sort of a proof-of-concept trial, a small, randomized phase II trial testing whether or not that Schlafen-11 biomarker could be used to direct therapy. Now, in this trial, there were 309 patients that were registered. They then had to have their tumor samples sent for central testing for the Schlafen-11 expression. One thing that I think is important to bring up is that in small cell lung cancer, there's this belief that it's really hard to get tissue samples from small cell lung cancer and it's a difficult thing logistically because it's just a lot harder to access these tumors. But interestingly, in this trial, 80% of patients had tumors that were evaluable for the biomarker, and the median time to the test result was only 7 days. So patients were able to get their tumor tested, get it sent out, get results in a rapid manner, and then be randomized based on these results. The primary endpoint for this trial was progression-free survival, and the primary endpoint was met. Progression-free survival was 4.2 months versus 2.8 months. Now, I think many people will say the magnitude of benefit here is not very much, but it's small cell lung cancer, and we don't have a lot of positive trials in this space, and we also don't have many trials that have used a biomarker to direct therapy. So I think for those reasons, it's really exciting to see these results. It was also conducted within a cooperative group with multiple different sites across the United States, and the fact of the matter is that we can do trials like this in small cell lung cancer patients, and I think it will sort of serve as a precedent for future trial design. Now, the overall survival for the trial is still premature. It didn't look that much different with the PARP inhibitor, but that doesn't mean that, again, things could change with more follow-up. And I really like the approach of this trial design, and I'm excited to see biomarker-driven trials in small cell lung cancer. Charu and Melina, what do you guys think about this study? And what do you think about our small cell lung cancer patients and our ability to conduct future trials like this? Dr. Aggarwal: I think this is certainly an advance. As you pointed out, Kristin, it shows us that we can conduct trials in the space. I think it offers a lens into the potential of personalized therapy in small cell lung cancer, which has eluded us for a very long time. The standard of small cell lung cancer has not changed significantly for a very long time, so I think this is very exciting and can't wait to see more things come in the future. Dr. Marmarelis: Yeah, I agree. I think we've always been asking for additional biomarkers, especially in such a difficult disease like small cell. And so this is really exciting to see potential biomarkers and that it was feasible to actually pose that question and study it. So that part's really exciting. Dr. Higgins: Great. And I should also say I was not involved in the study, and I'm not associated with any of the pharmaceutical companies that were involved in the study for S1929. And the final study that we wanted to talk about was the phase III LUNAR study, and this is sort of a different type of trial in the setting of advanced non-small cell lung cancer. It was studying tumor treatment fields with standard of care in metastatic non-small cell lung cancer after progression with platinum-based therapies. And first, I just want to step back and explain what tumor treating fields are. Tumor treating fields are applied to a patient with a transducer that's placed on the skin, and what it does is it applies an electrical field, and that disrupts mitosis when the cancer cells are trying to divide. And the mechanism of cell death is a little bit unclear. There are sort of many mechanisms that are postulated, one of which is immunogenic cell death, but we don't really know, I think, what's happening. But there have been studies that show improved results with tumor treating fields and other diseases. For example, particularly in glioblastoma multiforme, tumor treating fields are used in combination with surgery, radiation, and temozolomide (Temodar). So it's something that's being used in other disease sites, and this is some of the early data that we've seen in metastatic non-small cell lung cancer. And so in this trial, 276 patients were randomized to tumor treating fields plus standard of care or standard of care alone. Now, I should mention that this trial began enrolling patients in 2016, and so the standard of care was very different. After platinum-based therapies, the standard was considered docetaxel. Of course, platinum-based therapy alone for frontline treatment of advanced non-small cell lung cancer is also not the standard of care anymore. And so I think with that in the background, it does make interpretation of these results somewhat difficult, and that's probably the major caveat to this study. But nonetheless, patients were randomized, 276 patients. The primary endpoint of the study was overall survival. They were looking at progression-free survival and overall response rates as secondary endpoints as well as overall survival in patients that received immunotherapy versus just chemotherapy alone. And the trial was positive. Overall survival was improved. The median overall survival was 13.2 months for patients that received tumor treating fields with standard of care versus 9.9 months for standard of care alone. If you look at 3-year survival, it was 18% versus 7%. I think this is a new type of therapy for our patients with non-small cell lung cancer. It is somewhat of a difficult thing to wear the transducer, and you have to wear it for many, many hours. So that is one thing that I think can be difficult for patients that are using this treatment, but nonetheless, it is something new for advanced non-small cell lung cancer. I do know that the technology of tumor treating fields is being studied in other settings for non-small cell lung cancer, for stage III non-small cell lung cancer, for example, and also in the frontline setting. I think this trial kind of speaks to the fact that the landscape of advanced non-small cell lung cancer is changing so rapidly, and when we're studying something novel, we have to make sure that we make these trials feasible for enrollment so that we can get them completed rapidly, and we can get a readout and it doesn't become obsolete based on this shift in the standard of care. So I think it just really kind of drives home that we need to make sure that we're taking that into account with trial design. It's not standard of care changing right now, but it'll be interesting to see how the data evolves over time. Melina, I'm interested to hear your point of view because I know that these can be used in mesothelioma, maybe not that frequently. What is your experience with tumor treating fields, if any? Dr. Marmarelis: Tumor treating fields are approved as a device in pleural mesothelioma in the first-line setting in combination with chemotherapy. They have been used off-label in other settings, but that's the device approval. The trial that looked at tumor treating fields in mesothelioma was a single-arm trial, so there was no control arm, and it was really actually just looking at the safety of the device. So I have not used it personally in mesothelioma, although I know of patients and I know of real-world studies looking at its use, and I think it's potentially an interesting modality of treatment, especially in combination with immunotherapy, given that it really doesn't have a lot of additive toxicity. But I think the question is really, which patients are benefiting from it, and which patients are able to actually wear the vest in the case of mesothelioma? Dr. Higgins: Yeah. Any thoughts, Charu? Dr. Aggarwal: I agree, and I think this is going to be largely driven by patient experience. I think this is going to be quite onerous to wear this, carry the suitcase, so I would be very interested in patient reported outcomes as well as patient experiences and stories, which will really drive our use here. Dr. Higgins: Yeah, that's a great point. I should say that this trial was sponsored by Novocure. My institution does have other Novocure studies underway, and we receive research funding, but I was not involved in the study, and I did not personally receive any research funding. Dr. Aggarwal: Thank you, Kristin. This has been a wonderful review of practice-changing and some promising research that came out of the ASCO Annual Meeting. I hope our listeners enjoyed it, and we'll be sure to update you with the next annual research conference. Thank you, everyone. ASCO: Thank you, Dr. Aggarwal, Dr. Marmarelis, and Dr. Higgins. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

“It's really an exciting time to be in the field of oncology because we can have these specific drugs that target these specific variants rather than, back in the day, when we had to use kind of generic cancer therapies that weren't specific for an individual's cancer,” ONS member Suzanne Walker, PhD, CRNP, AOCN®, senior advanced practice provider and coordinator for thoracic malignancies at the Abramson Cancer Center at Penn Presbyterian Medical Center in Philadelphia, PA, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the latest updates in chemotherapy and immunotherapy treatments. Walker is one of the editors of ONS's second edition of the Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice book. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD), which may be applied to the treatment ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by August 18, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to updates in chemotherapy and immunotherapy. Episode Notes Complete this evaluation for free NCPD.  Oncology Nursing Podcast: Episode 242: Oncology Pharmacology 2023: Today's Treatments and Tomorrow's Breakthroughs Episode 139: How CAR and Other T Cells Are Revolutionizing Cancer Treatment ONS books: Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice (second edition) Clinical Guide to Antineoplastic Therapy: A Chemotherapy Handbook (fourth edition) Guide to Cancer Immunotherapy ONS Biomarker Database ONS courses: ONS/ONCC Chemotherapy Immunotherapy Certificate Course ONS/ONCC Chemotherapy Immunotherapy Certificate Renewal Course Fundamentals of Chemotherapy Immunotherapy Administration Fundamentals of Chemotherapy Immunotherapy Administration Renewal ONS Huddle Cards™️: Antineoplastic Administration Chemotherapy Immunotherapy Targeted Therapy ONS Immuno-Oncology Learning Library ONS Congress® American Cancer Society U.S. Food and Drug Administration (FDA) Oncology Drug Approvals National Cancer Institute National Comprehensive Cancer Network Nature Reviews Drug Discovery article: Trends in the Approval of Cancer Therapies by FDA In the Twenty-First Century OncoLink To discuss the information in this episode with other oncology nurses, visit the ONS Communities.  To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.  Highlights From Today's Episode “We've seen significant improvement in cancer survival over the past one to two decades. And primarily we've seen this not only from reductions in smoking and earlier cancer detection, but advancements in some of our treatments, most notably in the realm of immunotherapy and targeted therapy.” Timestamp (TS) 02:07 “With the discovery of the biomarkers, it has brought around the discovery of genomic-driven therapies that are specific to these biomarkers. That's really changed the landscape of oncology for people that have one of these driver variants.” TS 07:55 “I've definitely seen in my practice where therapy has been completed and, especially for some of these immunotherapy drugs, a couple of months later the patient develops a toxicity that is from the prior immunotherapy. Even chemotherapy can have some long-term toxicities, but we do have to even keep it in mind for immunotherapy that once these drugs are finished, there still could be some long-term side effects. Since they are newer drugs, we still are learning about what some of these long-term toxicities look like.” TS 26:56 “There haven't been a ton of new FDA approvals specific for chemotherapy; however, we have seen chemotherapy still used in practice, particularly in combination with some of these novel therapies. Particularly, we see a lot of chemotherapy and immunotherapy combinations.” TS 27:47

Drs. Pedro Barata and Naomi Haas discuss the emergence of clinical trials investigating triplet combinations in advanced renal cell carcinoma, factors that influence treatment decisions, strategies to personalize therapies in the frontline setting, including response-adaptive treatment strategies, and the use of biomarkers such as gene expression analysis to guide initial therapy. TRANSCRIPT Dr. Pedro Barata: Hello, I'm Dr. Pedro Barata. I'm your guest host of the ASCO Daily News Podcast today. I'm an associate professor of medicine and also a GU medical oncologist at University Hospital Seidman Cancer Center, Case Western University in Cleveland, Ohio. I'm also an associate editor for the ASCO Educational Book. Today I'm really delighted to welcome Dr. Naomi Haas, the director of the Prostate and Kidney Cancer Program at the Abramson Cancer Center and professor of medicine at the University of Pennsylvania.  Welcome, Dr. Haas. Dr. Naomi Haas: Thank you, Dr. Barata. It's a pleasure to be interviewed. Dr. Pedro Barata: Thank you. As you know, we've seen significant strides in the frontline treatment for patients with advanced clear cell renal cell carcinoma (RCC), and there are multiple doublet regimens that are now the standard of care for those patients. The goal for us to chat today is to discuss the emergence of clinical trials that are really investigating triple combinations and the factors that influence treatment decisions around triplet combinations for patients with advanced renal cell carcinoma. I want to congratulate you for the great work that you did in a recently published article in the 2023 ASCO Educational Book. So thank you for your contributions. And just before we get started, I just want to highlight that our full disclosures are available in the transcript of this episode. So, Dr. Haas, again, it's great to have you. Thank you for taking the time. Let me get started. So, we know that there are multiple standard of care doublet regimens, all of them immunotherapy-based combos, and they usually include 1 checkpoint inhibitor or 2, such as ipilimumab plus nivolumab or a combination of an immune checkpoint inhibitor with a VEGF TKI. And we have a number of examples like that. Can you tell us about the trials that have emerged exploring triplet therapies in the first-line setting for patients with advanced RCC? Dr. Naomi Haas: Sure, and I'm going to focus just on triplet therapies that are just about ready to go. But as you know, Pedro, there are probably many different combinations that we'll see in the future. Some of the combinations that have already been conducted as clinical trials include combinations of VEGF receptor tyrosine kinase inhibitors along with immune checkpoint inhibitors. I'll highlight one which was batiraxcept plus cabozantinib and nivolumab, and it's a combination of VEGF inhibitor, immune checkpoint inhibitor, and also an AXL inhibitor. So, most of these capitalize on other vulnerabilities with renal cell carcinoma.  So, as you said, they build on the tyrosine kinase inhibitor pathway or on the immune checkpoint inhibitor pathway. Some of them are combining drugs such as CDK inhibitors. There was axitinib plus nivolumab plus palbociclib trial that is getting ready to launch. Others are combining the use of belzutifan, which is a HIF inhibitor in combination with VEGF inhibitor and immune checkpoint inhibitor. There are a couple of those that are ongoing, one of them looking at combinations with lenvatinib. And I think there are also trials getting ready to launch that are using it in combination with cabozantinib and nivolumab.  Additionally, another very interesting direction is trying to affect the gut microbiome. And there was a clinical trial presented by Dr. Monty Pal at the gut microbiome session at ASCO, which combined CBM-588, which is a probiotic, in combination with cabozantinib and nivolumab. And that showed an improvement in progression-free survival compared to the combination of cabozantinib and nivolumab alone. And previously there was work published using CBM-588 in combination with ipilimumab and nivolumab. So that's an area of high interest to patients. But most of these combinations capitalize on either vulnerabilities, signs of resistance in pathways or in adding other pathways that have previously been unaddressed in renal cell carcinoma, and are combined with pathways that we know are effective. Dr. Pedro Barata: Wow, that's a fantastic overview of some of the approaches being considered in the frontline, so thank you for that. And actually to your point, some of them we've seen some data, others more later stages of development. So with that in mind, we also know that we have on one side of the story we have how much of these combos of triplets can actually be effective and help patients. From the other perspective is about tolerability, treatment options, and patient health. They're both very important considerations.  Can you tell us a little bit about the safety profile of these triplet combos? I know we're talking about many different things. The microbiome triplet has a different safety profile than perhaps a combination with a TKI and different checkpoints, for instance. Can you tell us a little bit about what we expect from the safety profile when we start to combine these therapies in the upfront setting?  Dr. Naomi Haas: Sure. I think 2 of the very tolerable triplet regimens have been the combination of the CBM-588 in combination with ipilimumab and nivolumab. Really in those combinations, the authors at least have demonstrated that there has not been a great difference between the two study arms of either the doublet or the doublet in combination with the CBM-588 trial. And that's based on basically changing the bacterial flora of the gut. The Avera trial, which was using the AXL inhibitor in combination with cabozantinib and nivolumab, also seems to have a very tolerable safety profile. Now, this trial was not compared to sort of a standard of care arm, so it's a little bit difficult. A standard of care arm that I would have considered for this clinical trial would have been to use either cabozantinib alone or cabozantinib with nivolumab. Instead, this was more of a dose-finding protocol. So, more work needs to be done with that, but the side effects of that combination additive to what we already know seem to be just infusion reactions from the AXL inhibitor.  The trial that got the most attention so far has been COSMIC-313, which was combining cabozantinib with ipilimumab and nivolumab upfront. And of course, the concern with this triplet combination was that there was more hepatotoxicity seen and it was difficult to know whether the hepatotoxicity was from the combinations of the immune checkpoint inhibitors or the use of the cabozantinib. And although the trial showed an improvement in progression-free survival, it did not show as many complete responses as the comparator arm. And the other concern was that there was quite a bit of dropout due to toxicity. And of course, we don't have the overall survival endpoint for that trial yet. Dr. Pedro Barata: Great, thank you for that. I agree completely. We've seen many different safety profiles with these different triplets.  Let me touch base on a slightly different topic, and that has to do with what kind of strategies can we think to personalize treatment for clear cell RCC in the frontline. And this is not necessarily applicable only to triplet therapy. There are also some efforts with doublets, but the goal is, I would argue, is response adaptive treatment strategies or even the use of upfront biomarkers such as gene expression analysis, for example, to help us guide initial therapy. Can you give us an idea what your thoughts are about what is coming? What do you think the future will look like in terms of developing this like a biomarker-based approach? What kind of factors or markers we can use to select who gets what in the frontline setting? Dr. Naomi Haas: Sure. So, I'll just highlight ahead of that that one important biomarker that we're already using is the IMDC criteria, which I think if that algorithm had not been developed, we would be struggling a lot in renal cancer and that's, of course, the algorithm that uses the thing such as performance status, hemoglobin, calcium, and time for the development of metastatic disease as well as the neutrophil count and the platelet count. And that has helped us divide categories of patients with clear cell renal cell carcinoma into poor risk, intermediate risk, or favorable risk categories. And that was recently validated in the immune therapy combinations that were previously been validated just in VEGF inhibitor therapies.  But the other useful, let's start with clinical tools that I think are going to be very important are the health-related quality of life tools which primarily measure things such as functional health, as well as toxicity. And one of these is the FKSI-19 score which captures most renal disease-related symptoms, treatments, side effects, and functional well-being. And this has been implemented in some trials and are looked at over time whether the patient's functional status improves. And patients who are responding to therapies generally will improve as far as their overall well-being. Although that can be difficult as a tool because if patients are experiencing toxicity, those signs might not be apparent. But that's one tool that's being used.  Now, people, both patient advocates and patients, have pointed out that it's very hard to use a tool like this in real life to implement in clinic, but there are efforts being carried out to make these tools a little bit easier so that people can use them day-to-day. So, I can see that being implemented more often.  The others have to do with response assessments, and I think it's very important to look at immune-related responses which kind of builds on the resist response, but it uses two dimensions of measurement as opposed to one dimension of measurement. And looking at those, we know now that patients who have what we call a deep response, so something better than a 75% shrinkage or even a 90% shrinkage in a very short period of time tend to be those patients who behave like patients who have complete responses. And both progression-free survival and overall survivals seem to be going in a very encouraging way looking at these tools so you could see that this tool could be implemented in real life with treating a patient and if they have a very deep response quickly, you can feel, the physician or the APP, could be very confident that the patient is going to do well for a long period of time. I think the tools that we're waiting for the most, however, are as you said, the biomarker tools. And this is where we still have a lot of work to do, but one example of this is the transcriptomics which has been conducted in both the atezolizumab-based trials such as the IMmotion trials, and also to some extent with the JAVELIN trials, the avelumab and axitinib trials. And this goes back to looking at the tissues sample and looking at transcriptomics which show mRNA expression as well as some alterations in some of the important genes such as BAP1 and PRBM1.  And those tools have been implemented, especially in the IMmotion trial, there were 7 clusters identified, and two of the clusters are groups of patients whose tumors have transcriptomics that indicate that they would respond well to a VEGF inhibitor. And a couple of them also showed very good responses to immune checkpoint pathways. There were additional pathways which suggested that patients wouldn't be responsive to either of these. And there is a trial called OPTIC that is funded by the Department of Defense (DOD) which is currently applying these transcriptomics, and then assigning patients to get either a VEGF IO therapy combination or a dual immune checkpoint inhibitor combination, based on their transcriptomics.  And I think what everybody would really like to see is, number 1, that these transcriptomics consistently bear out that there isn't irregularity in using these as predictors. So, they do need to be validated. But I think if there was a quick and easy way to do this, to assign patients to therapies based on these profiles, that would perhaps go a long way in predicting what therapy a patient should start with.  Another useful tool is the development of artificial intelligence. And there are a number of companies that are looking at these tools. We're implementing this retrospectively in the ASSURE trial, which was the adjuvant seraphinib synontib or placebo trial, for patients at high risk for RCC. And we're working with a company to identify, using AI, looking at the slides. And I think that if these kinds of techniques, which are already being used in prostate cancer, are something that can be developed, then what I could see in the future is that a patient's slide could be tested very quickly, and that that might also indicate things that perhaps we can't see under the microscope, as far as either a response to treatment or a risk. So, you could use that in the adjuvant setting to predict whether a patient might need adjuvant therapy or not. So I can see those being implemented.  And then the third is looking at cell-free DNA. And there are many different mechanisms that have been tested in other solid tumors, using either circulating tumor DNA or cell-free DNA. Now, the circulating tumor DNA seems to be a little bit more difficult to assess in metastatic kidney cancer because it doesn't have the mutational burden and doesn't seem to have as many mutations and things floating around that can be captured. However, cell-free DNA, which has the capability of measuring DNA methylation profiles, does seem to be showing some promise, and there have been some publications.  So this has also been tested in cancers of all stages and can be measured in both the plasma and in the urine. And that could be another helpful tool that needs to be validated, but that could be used to start a patient on treatment. And if the amounts of cell-free DNA went down with therapy, that could be a good indication, perhaps in advance of imaging, that a patient is doing well with therapy.  So those are some examples that I see potentially being used in the future to help direct therapy, provided that we can make these tools, that we can validate these tools, and secondly, that these tools are relatively inexpensive and that they're nimble, that they could be used right away, that it wouldn't take a long time to get the results back to help guide. Dr. Pedro Barata: For sure. I couldn't agree more. What a masterclass of all the emerging tools that are being investigated in RCC, this is fantastic.  So, I guess maybe one last question before I let you go. We have now a number of doublets, we have perhaps a triplet, if not more. If you were to guess, who do you think will be the ideal population for a triplet therapy? Some, in addition to all the tools you mentioned, maybe sarcomatoid features, etc. that might be part of the AI complement to what you mentioned earlier. But if you were to guess, do you think that 5 years from now, we're going to be offering a triplet therapy, whatever that triple therapy might be, to everybody, to certain populations? What can you tell us to help us predict what might happen in the near future to make us think about a thoughtful, shared decision-making process and try to predict who might be the ideal population for triplet therapy? Dr. Naomi Haas: So, I don't think we're going to use triplet therapy in everybody. And in fact, I hope we don't use triplet therapy in everybody because I have patients who have responded to single-agent nivolumab and remained in a continuous CR many years after they were treated that way. And I have other patients who really progressed very rapidly or relapsed very quickly after doublet therapy combinations. So, I think that what I would see in the future would be using the triplet therapy combinations in the challenging patients, the patients who we know we're not getting as far along with the doublet approach. And that's really our challenge. And I would see that perhaps some of this transcriptomics which indicates that there are subsets of renal cell carcinoma which are not going to respond well to a VEGF inhibitor or to an immune checkpoint inhibitor, that those are areas where there might be other relevant pathways where maybe the signal isn't quite as good with– maybe they have some response, but not an optimal response. And then combining another pathway into that would be a way forward to achieve a complete response in those populations.  I also want to emphasize that it may be that triplet therapy isn't the way to go, but that triplet therapy can be more of an adaptive design where a doublet therapy is started, and then the third drug, a triplet, is added at a later time. And an example of that is PDIGREE, which is the combination of ipilimumab and nivolumab. And then following imaging, patients are assigned, depending on the response, to get either cabozantinib alone, cabozantinib with nivolumab, or to continue on just nivolumab alone. And that might be a better way to address toxicity. But some of these other triplet combinations, one could also see- you could start, for example, with ipilimumab and nivolumab, and if they were having a response but you wanted to heighten the response, maybe adding the CBM-588 as an adaptive response or adding a CDK inhibitor, but sort of staggering the combination so that you spare patients some of the toxicity. So, I think all of those approaches need to be tested. Dr. Pedro Barata: That is fantastic. Dr. Haas, this is an incredible podcast. You did highlight several triplet combinations that are currently under investigation. You highlighted very, very important ongoing clinical trials. You touched base on what the future might bring as far as tools that might help us decide or optimize patient selection. We talked about adaptive designs. So really outstanding work. And also, I think this reflects the fantastic work in the manuscript that you wrote in the 2023 ASCO Educational Book.  So, thank you so much, Dr. Haas, for the incredible work that you have done and you continue to do in the GU field, and for taking the time to share your insights with us today on the ASCO Daily News Podcast. It's truly been a pleasure to chat with you today. Dr. Naomi Haas: Thank you.  Dr. Pedro Barata: Thank you again. And thank you also to our listeners for joining us today. Really happy with talking about this topic with Dr. Haas. You can also find links to the studies that we discussed today in the transcript of this episode. And finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review and subscribe wherever you get your podcast.  So again, it has been a privilege to be here today with Dr. Haas. Thank you for joining us and have a good day.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow today's speakers:  Dr. Pedro Barata @PBarataMD Dr. Naomi Haas   Follow ASCO on social media:  @ASCO on Twitter  ASCO on Facebook  ASCO on LinkedIn    Disclosures:  Dr. Pedro Barata: Honoraria: UroToday Consulting or Advisory Role: Bayer, BMS, Pfizer, EMD Serono, Eisai, Caris Life Sciences, AstraZeneca, Exelixis, AVEO, Dendreon Speakers' Bureau (Inst): Caris Life Sciences, Bayer, Pfizer/Astellas Research Funding (Inst.):  Blueearth, AVEO, Pfizer, Merck   Dr. Naomi Haas: Consulting or Advisory Role: Pfizer, Merck Sharp & Dohme, Calithera, Eisai, Exelisis, AVEO, Roche/Genentech Expert Testimony: Lilly

Listen to ASCO's Journal of Clinical Oncology essay, “But Where is My Doctor? The Increasing and Relentless Fragmentation of Oncology Care,” by David Mintzer, Chief of Hematology and Medical Oncology at the Abramson Cancer Center of Pennsylvania Hospital. The essay is followed by an interview with Mintzer and host Dr. Lidia Schapira. Mintzer stresses the need for oncologists to make an effort to maintain relationships with patients as cancer care becomes more fragmented. TRANSCRIPT  Narrator: But Where is My Doctor? The Increasing and Relentless Fragmentation of Oncology Care, by David M. Mintzer, MD (10.1200/JCO.23.00805) For the past 7 years, I have cared for Michael, a man with pseudomyxoma peritonei. He has undergone two aggressive surgical resections with hyperthermic intraperitoneal chemotherapy and endured multiple chemotherapy regimens, all of which resulted in questionable benefit. Recently, his health has declined due to progression of his cancer, and he has had frequent admissions for infectious complications, obstructive symptoms, and several fistulae. I had always been his attending on previous admissions unless I was away, but when I last saw him, he asked me why I had not been his doctor this time. Even before he asked, I felt guilty for not being there for him.  For most of my career, I would see my own inpatients on a daily basis, rounding before, and sometimes after office hours. Currently, owing to system changes that likely have evolved with most practices and hospitals, only one of us sees inpatients on the teaching service, with the rest being off service. This happened long ago for our obstetrical, primary care, and other subspecialty colleagues, but for as long as possible, I held onto the belief that in oncology, we and our patient relationships were different. While most of the kerfuffle over the past few years in medicine relates to the electronic medical record and its effect on our lives and on physician-patient interactions, I think the fragmentation of care—while less frequently acknowledged—has been as relentless and impactful though more insidious. While most published articles on fragmentation define it as patients receiving care at more than one hospital, my focus is on the fragmentation of care within our own practices and institutions. Our patients are at their sickest and most frightened, thus most in need of us, when they are hospitalized. But now, instead of providing care with a consistent presence, patients are regularly passed back and forth from the outpatient to inpatient teams, then sometimes to the palliative care team, and then perhaps to a hospice team or, for those with the best outcome, transitioned to a survivorship team. While all these practitioners are kind and competent, they are not a constant.  When I am covering our inpatient service, I do not know the detailed medical history of the majority of patients who have been cared for by my colleagues. Can I seriously be expected to know their complex oncologic and other medical issues, let alone their psychosocial needs, in any appropriate depth when I walk in on a Monday to start the week covering 16 new patients?  I can be empathetic and do my best to communicate with their outpatient physician, but both emotionally and medically, it is never the same as being cared for by someone one has known and trusted throughout one's disease trajectory. Our relationship with the house staff is also fragmenting. We used to spend a month at a time as teaching attending, giving us a chance to get to know our students, interns, and residents. This has now been reduced to a week, and with our house staff rotating on an every 2 week schedule, we may work with a resident or intern for just a couple of days before one of us rotates off service. Furthermore, they spend much of teaching rounds staring into their smart phones and computer screens feverishly trying to complete their electronic workload.  As practices have become larger and medical teams more complex, care has become less personal and often less efficient. If the patient calls with an issue or sends a message, it is notclear to them, and often to us, who will be assuming responsibility for their concern. Should it be directed to my administrative assistant, our triage nurse, the nurse navigator, the palliative care nurse, my nurse practitioner, an off-site call center nurse, or myself? The inbox proliferates; the toss-up for ownership of the message begins; six people now read what used to be handled by one or two.  While I was an initial enthusiast for the early integration of palliative care alongside primary cancer care, I now also fear that it has further removed us from some of our most important interactions and deepest responsibilities. The inpatient oncologist used to be the one to provide symptomatic and supportive care and run the family meetings. Our house staff now routinely consults palliative care for even the simplest pain management issues, and we increasingly outsource goals of care and other serious discussions to our palliative care teams, who do not have a longstanding relationship with the patient or their family nor a complete understanding of their disease trajectory and past and future treatment options. Nor do I if it is not my patient and I am just the covering attending of the week. Too often it seems that palliative care has replaced us in some of the roles that used to be integral to our practice as oncologists, and we seem to have eagerly stepped back from some of these responsibilities. Our interactions with our colleagues have also fragmented. Mostly gone are the days when we would sit down in the hospital cafeteria with other physicians from other specialties for coffee or for lunch after grand rounds. And the days when we would review films with our radiologists or slides with our pathologists are mostly long gone. Our tumor boards provide some interaction, but since the pandemic, these tend to be virtual and less intimate. I mourn the loss of our sense of a hospital community. There have been some definite benefits to the fragmentation of care, which is why it has evolved and why we have accepted the bargain. As we increasingly subspecialize, we can get better and more focused on what we do which helps us cope with the explosion of data and new information across every area in our discipline. Some of us can devote more quality time to research, and it has also made our professional lives easier in some ways. How nice not to have to trek to the hospital to see very sick inpatients every day, but rather just a few weeks a year. How much easier to have someone else take charge of difficult end-of-life discussions. There is no point in bemoaning the loss of the old ways of more personalized care, as there is no going back. The current generations of physicians will not feel this loss of inpatient/outpatient continuity having grown up in an already changed environment, just as they will never have known a world before the electronic medical record. Patients have also accepted our absence from their bedside with less resistance than I would have expected, perhaps knowing from the rest of their care experience how depersonalized it has become—not that they have had much say in the matter. The changes in the delivery of health care will likely accelerate as we enter the medical metaverse and how we will navigate artificial intelligence while maintaining our emotional intelligence remains to be seen. The continued emphasis on increased efficiency and throughput of physician efforts—structuring medicine as a fragmented assembly line—runs counter to what is so meaningful to the physician-patient relationship—a function of time spent developing personal connections. As we continue our efforts to keep up to date with the rapid expansion of medical knowledge in our field, we also need to make equivalent efforts to maintain our personal and emotional connections with patients. As we have less frequent direct contact due to so much fragmentation of care, we need to make the time we do have with them more impactful. And sometimes that means going over to the hospital to see Michael after a long office day, although you are not on service. It is the right, human thing to do, and still gratifying—for all of us. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lydia Schapira, Associate Editor for Art of Oncology and a Professor of Medicine at Stanford University. Today we are joined by Dr. David Mintzer, Chief of Hematology and Medical Oncology at the Abramson Cancer Center of Pennsylvania Hospital. In this episode, we will be discussing his Art of Oncology article, “‘But Where's My Doctor?': The Increasing and Relentless Fragmentation of Oncology Care.”  At the time of this recording, our guest has no disclosures.   David, welcome to our podcast, and thank you for joining us. Dr. David Mintzer: Thank you for the invitation, Lidia. Dr. Lidia Schapira: It's a pleasure to have you. I'd like to start these conversations by asking our authors if they have any books they want to recommend to listeners or if they're currently enjoying anything we should all know about.  Dr. David Mintzer: Well, I just finished David Sedaris's most recent book, which is a series of essays. I get a big kick out of him. I think I often mesh with his sense of humor and a little bit of cynicism, a lot of truth, but heartfelt and always amusing. Dr. Lidia Schapira: I love his work. Thank you. That's a great recommendation, especially for the summer.  So let's dive into your essay and your perspective, which is really such an important topic for us. You talk about the fragmentation of care and how it's impacted our practice, our relationships, and even our joy in the work that we do. Can you talk a little bit about your feelings about this? Dr. David Mintzer: Certainly. So I've been practicing medical oncology for a long time, about 40 years, so I've seen a lot of change. Favorably, most of that change is certainly in the good sense. We have so much more to offer our patients in terms of therapies that are more numerous, more effective, and less toxic. But there's been a price, I guess, to pay with those changes. We've all become more subspecialized, and the care has increasingly fragmented. And I was stimulated to write this essay because I've been disturbed to some degree by some of the changes. I think they are inevitable. I didn't want to write a piece just about how far I had to walk to school every day, uphill both ways, and complain. But I got a sense that others might have shared these observations and feelings, and I just kind of wanted to get them down.  Dr. Lidia Schapira: One of the things that you said that really resonated with me is when you talk about patients being at their most vulnerable and at their sickest and most frightened when they're hospitalized, and that's when they need us. And what you say here, what I'm interpreting that you're saying, is that by not showing up at bedside, in a way, we're abandoning them. And that is something that feels terrible to us as well, those of us who really value that presence and that relationship. Can you talk a little bit about how you're dealing with that and how you see your colleagues dealing with that? Dr. David Mintzer: Well, it's a bit of a Catch-22. Yes. I think a lot of this is driven by guilt, by not being there for patients that we cared for sometimes for many years and know well. And although this happened in university hospitals a long time ago, in our hospital it was relatively recent, that it was recommended in part for house staff accreditation regulations to have only one attending on service at a time, which is understandable so as not to confuse the house staff.  But in doing so, we're not there for our patients every day. And so you're kind of torn between running over to the hospital after a long day when you're exhausted and seeing your patients and fulfilling what feels like some responsibility, and also feeling that this is no longer my role, this is no longer the way medicine is practiced. It's not efficient. I don't get paid if I go over, someone else is collecting the RVUs. And in addition to that, the concern that the patients may not be getting not just the optimal emotional care, but even the medical issues. Certainly, the doctors covering are good and do their best, but they don't know these patients. They don't know their whole history, they don't know their complications in the past. That's the trade-off we make.  Dr. Lidia Schapira: Let's talk a little bit about those relationships that we invest in so heavily in oncology. Oncology is different than many other fields and we've always valued the time we spend with patients and forming those relationships. Can you talk a little bit about how you see those relationships threatened when you as the oncologist and the person who's given them guidance for the entire trajectory of their illness can't be present just when they're at their sickest and most vulnerable?  Dr. David Mintzer: So care of cancer patients certainly takes a village and we have tremendous support with so many different practitioners, including our nurse practitioners, our palliative care nurse practitioners, palliative care attendings, nurse navigators. But as we introduce all of these people, we actually have less direct contact time with patients. We're less likely to be the ones to call them on the phone or even answer their email. And one of the great things about practicing oncology is not just the science and what we can do for patients medically, but these bonds and relationships we form. It's been chipped away at rather insidiously, but I think rather steadily over 20 years.   Medicine thinks it's so scientific and advanced and technological. But I always kind of reflect that we're probably 20 years behind every other industry, whether it's banking or going to the supermarket or the clothing store or the hardware store. You used to go to your neighborhood pharmacist and you knew him and he would give you advice or your hardware store guy would give you some advice about how to fix something. So those industries lost their personal relationships a long time ago. We're really far behind them, but we're catching up. So now everything is done more remotely, more on the phone, and as I said, there's less direct contact time, which I think we all miss. But we're different. We're different from going to your local banker or grocer or bookstore dealer.   This is medicine. These are important medical events for patients. They're very emotionally fraught, they're complicated. And so what may be adaptable to other industries, even though it seems to be being forced upon us, is not as adaptable in medicine. Now, maybe there is some respite for this. I saw recent data that telehealth is going down. We thought telehealth was going to be here to stay with COVID and everyone was going to love it. And yet it's interesting, although it may be partly regulatory and partly because of the end of the epidemic, but I get a sense that both physicians and patients are a little bit less interested in it. I think that shows that we might be a little bit different from other industries, but we'll see how that plays out. Dr. Lidia Schapira: Absolutely. I couldn't agree with you more, but you talk about relationships also with trainees, for instance, that part of this fragmentation and these new schedules that we have also limit the contact you have with the house staff when you are assigned to be the doc on service. Perhaps you don't know all these patients very well, but you also bring up the fact that you don't get to know your trainees very well either because they're coming and going with different schedules. So what I took away was sort of a sense of loss, a bit of a lament that a lot of things are being lost in this super fragmentation. Can you address that a little bit, perhaps for our listeners?   Dr. David Mintzer: Yes, I think that's exactly right. So the fragmentation that I describe is not just in patient care, although that's probably the most important to all of us, but the fragmentation with kind of the extended family that was our hospital community. We've gone now to a nuclear family. So if we're a specialist in one particular area, we still have kind of a nuclear family. But my sense is we've lost that extended family, meeting people in the cafeteria after ground rounds, dealing with other subspecialists. And if you're only in the hospital a few weeks a year, you just have less contact, passing people in the hallway, meeting them at conferences, reviewing films, as I said, with radiologists, reviewing slides with pathologists. We're all too busy, we're all sitting in front of our computers at lunch, we're all doing conferences on the phone, driving home from work, but we have less time with each other. And that holds also true for students and residents who now rotate very quickly. Dr. Lidia Schapira: Let's talk a little bit about one of the other points that you make in this very thoughtful essay, and that is that you say that you were an early enthusiast of the integration of PalCare, but now you find that certainly, the younger generation seems to be outsourcing symptom management and communication very early to PalCare. And as a result, perhaps from the patient's perspective, care becomes even more fragmented. And that's sort of a bit of a loss all around. We're not able to do some of the things that we enjoy too, in terms of family meetings and communication, but also everybody's becoming more deskilled. Talk a little bit about that. Dr. David Mintzer: Yes, I was an early enthusiast for palliative care, and I still am an enthusiast, don't get me wrong. You can't criticize palliative care. It's like criticizing mom and apple pie. But the idea was, and still is, of course, that you would work in conjunction with a palliative care specialist, that they would be called in, say, on the very difficult cases, cases that needed particular expertise, or to spend more time. And certainly, that happens, and I have tremendous respect for my palliative care colleagues. But what's happened, as you note, is that we've kind of outsourced it. It's much easier to have someone else have that difficult conversation, particularly if you're just covering a patient that belongs to someone else, you're just seeing them for a few days during the week, you don't feel comfortable in doing so. And so I'm concerned that we've abdicated our responsibility in many of these important discussions and left it to the palliative care team who, by the way, are overwhelmed because there aren't enough of them now that they are getting all these consults for almost everything.   We should, as oncologists, still be able to run the meetings, to refer patients to hospice, to discuss goals of care. But as we all become more specialized, as we become busier, we have less time and we've built this metaphorical moat between our offices and the hospital, I find that we're just doing it less and less, and I feel some guilt about that and also some loss. Dr. Lidia Schapira: David, you say in your essay, we have accepted the bargain. What I hear from you today and what I read and inferred in reading the essay when it came to us, is that there are feelings of guilt, there's less joy, there's feelings that somehow this bargain isn't so good for us after all, even though at some level it makes our work a little bit more simple and our hours perhaps a little bit more predictable. So can we think together a little bit about what lies ahead and how we get over this deep ditch that we seem to be in?  Dr. David Mintzer: Well, as you say, there's both benefit and loss involved with this and it does make our lives easier. If you're seeing relatively healthy outpatients month after month in the office, you get to feel oncology is not so bad and you can kind of put that two-week hospital rotation when everybody's in the ICU and having multiple unfixable problems and poor palliation behind you. So you can almost kind of go into denial. And it does make your quality of life easier to be able to just go to the office and go home most weeks of the year.  How are we going to deal with this going forward? I mean, we do have to make the effort. I don't think it's going to go back. I don't think writing this article is going to change the way medicine is structured. This is a more efficient way and in some ways, it may be safer and more high reliability, which are kind of the watchwords. So I'm worried. I don't know where it's going. I think it is going to be a little less personal. But my point is we have to be aware of it and in doing so make the time we have with patients more impactful, be a little bit more aware of our need to support them. Maybe if you're not at the hospital every day, go over once or twice a week, or certainly when there's a big change in event.  Dr. Lidia Schapira: Do you think we could use technology to sort of stay in touch and pay a social visit via FaceTime? Or remain connected to our patients, even if it is in a social function, but somehow, for their sake and for ours, remain connected when they're in hospice when they're hospitalized. But we're not the attending of the month.  Dr. David Mintzer: Certainly, the way we communicate has changed. I remember being a young attending and I was working at a small community hospital, and one of the surgical attendings would just call their patient on the weekend on the phone, but wouldn't bother to come in. And I thought, my gosh, that's terrible. What kind of impersonal, awful medical care is that? But indeed, now, calling or more likely, texting, communicating, emailing with patients may work.  What's coming with virtual or augmented reality or whether EPIC can eventually just plant a chip in our brain and we can all be online all the time, I don't know. But yes, any type of communication helps. I've often said that there's nothing like an unsolicited phone call to a patient to encourage them. Just, “Hey, you didn't call me, but I'm calling you. I was thinking about you. How are you doing?” So, yes, staying in touch by whatever means, I think can be greatly beneficial and mean a lot to the patient, even if it's a brief text or phone call. Dr. Lidia Schapira: Yeah, even encouraging your trainees if you have residents or fellows working with you to go with you to that unsolicited visit or participate in that, I think that sort of would model the kind of behavior that we would want if our loved one is the patient, right?  Dr. David Mintzer: For sure.  Dr. Lidia Schapira: And that's always a good question because what we hear from patients is how much they value and love their oncologists when there is a strong connection. So let's perhaps finish the conversation by going back to Michael, your patient. How did you and Michael resolve this? Dr. David Mintzer: Honestly, we haven't resolved it. So when he's in the hospital, he's now cared for by whoever's on service at the time. Fortunately, he hasn't been in the hospital lately, but I will make an effort to go over and stay in touch with him. Dr. Lidia Schapira: I'm sure Michael would appreciate your presence.   Are there any other thoughts that you would like to convey to our listeners or readers? We have dealt with some of these futuristic issues in Art of Oncology before, including one essay I remember was published years ago where there was sort of this very impersonal imagining of what it would be like for an oncology patient to basically be seen by a series of robots along the chain without this human connection. And it was really terrifying to read. So thank you for reminding us about what is lost for us as well as what is lost for patients, something that we all need to go back and revisit, I think, as we think about the future. Any final thoughts, David, for listeners? Dr. David Mintzer: So as a physician who's getting close to the end of their career, I don't want to come off as just protesting against change. We need change. You know, change is crucial, but I think it's not really been clear to a lot of people how much this has been eroded over time -  that our direct contact and the fragmentation has impacted us and our patients and other caregivers. And this separation between inpatient and outpatient, I think, is becoming steeper. Our palliative care nurses used to go over to the hospital and see the inpatients as well as the outpatients, or our physical therapists, or our nutritionists. Now everyone is divided. I still think it's a great job. I love caring for patients. I love the teams that I work with. And as medicine gets better, though, we just have to be on guard to stay in touch with our patients and our feelings.  Dr. Lidia Schapira: I really appreciate your perspective. Thank you so much for sharing it with us.   And until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO Shows at asco.org/podcasts.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Show Notes:  Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio:  Dr. David Mintzer is a Chief of Hematology and Medical Oncology at the Abramson Cancer Center of Pennsylvania Hospital.  Additional Reading:  Ars Brevis, by Dr. George Sotos

In this episode of the Heidrick & Struggles Leadership Podcast, Heidrick & Struggles' Jeff Boyd sits down with Dr. Bruce Levine, the Barbara and Edward Netter Professor in Cancer Gene Therapy and the founding director of the Clinical Cell in Vaccine Production Facility in the Department of Pathology and Laboratory Medicine and the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania. Levine discusses the partnership between academia and industry and offers his perspective on what is important to attract the best technical, scientific, commercial, and leadership talent to the space of selling gene therapy. As an advisory board member for many companies, he also shares how he is advising these organizations, specifically with regard to their talent agenda and building out technical and CMC expertise. Finally, he discusses automation in medical manufacturing and advocates for the importance of leaders taking on mentorships and actively engaging in the development of their teams. Hosted on Acast. See acast.com/privacy for more information.

Within the last few years, an “explosion of data” regarding adjuvant and neoadjuvant treatment for resectable lung cancer has contained “major wins” for patient care. Although exciting, the rapid advancement has led to questions about when chemotherapy and chemoimmunotherapy should be adopted or avoided. Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars Sinai Cancer in Los Angeles, and Charu Aggarwal, MD, MPH, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania's Abramson Cancer Center in Philadelphia, discuss how to apply key recent findings. They also share “the special sauce” that allows Dr. Aggarwal's team to make the best determination for surgical timing.  

The early 1970's saw the start of the medical specialty we now know as oncology. How does one create standards and practices for patient care during that time? Dr. John Glick is a pioneer during the dawn of oncology. He says that early work involved humanity, optimism, and compassion, all of which were the foundation of his career. Dr Glick describes the clinical experiences that drove him to oncology (4:28), his rapport with patients, which was portrayed in Stewart Alsop's book Stay of Execution (9:21), and his groundbreaking work developing the medical oncology program at the University of Pennsylvania (12:22). Speaker Disclosures Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical Dr. John Glick: None More Podcasts with Oncology Leaders    Oncology, Etc. – In Conversation with Dr. Richard Pazdur (Part 1) Oncology, Etc. – HPV Vaccine Pioneer Dr. Douglas Lowy (Part 1) Oncology, Etc. – Rediscovering the Joy in Medicine with Dr. Deborah Schrag (Part 1)  If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org.   TRANSCRIPT Disclosures for this podcast are listed in the podcast page. Pat Loehrer: Welcome to Oncology, Etc. This is an ASCO education podcast. I'm Pat Loehrer, Director of Global Oncology and Health Equity at Indiana University. Dave Johnson: And I'm Dave Johnson, a medical oncologist at the University of Texas Southwestern in Dallas, Texas. If you're a regular listener to our podcast, welcome back. If you're new to Oncology, Etc., the purpose of our podcast is to introduce listeners to interesting people and topics in and outside the world of oncology. Today's guest is someone well-known to the oncology community. Dr. John Glick is undoubtedly one of oncology's most highly respected clinicians, researchers, and mentors. I've always viewed John as the quintessential role model. I will add that for me, he proved to be a role model even before I met him, which hopefully we'll talk about a little bit later.   To attempt to summarize John's career in a paragraph or two is really impossible. Suffice it to say, he is to the University of Pennsylvania Cancer Center what water is to Niagara Falls. You can't have one without the other. After completing his fellowship at NCI in Stanford, John joined the Penn faculty in 1974 as the Ann B. Young Assistant Professor. Some five decades later, he retired as the director of one of the most highly respected comprehensive cancer centers in the nation. Among his many notable accomplishments, I will comment on just a few. He established the Medical Oncology program at Penn and subsequently directed the Abramson Cancer Center from 1985 to 2006. Interestingly, he established the Penn Medicine Academy of Master Clinicians to promote clinical excellence in all subspecialties across the health system. He's been a driving force in philanthropy at Penn Medicine, culminating in his role as Vice President Associate Dean for Resource Development.  Over the past several decades, he has helped raise over half a billion dollars for Penn Med. We need you on our team, John. As a clinician scholar, John's research has helped shape standards of care for both breast cancer and lymphomas. For example, he pioneered the integration of adjuvant chemotherapy and definitive breast irradiation for early-stage breast cancer. In 1985, he chaired the pivotal NCI Consensus Conference on adjuvant chemotherapy for breast cancer. He also was a driving force in a clinical landmark study published in The New England Journal some 20 or so years ago about the role of bone marrow transplant for advanced breast cancer. Most impressive of all, in my opinion, is John's legacy as a mentor to multiple generations of medical students, residents, and fellows.   So, John, we want to thank you for joining us and welcome. Thought we might start by having you tell us a little about your early life, your family, your parents, where you grew up, and how you got into medicine. Dr. John Glick: Well, thank you for having me on the podcast, Pat and David, it's always a pleasure to be with you and with ASCO. I grew up in New York City in Manhattan. My father was a well-known dermatologist. He was my role model. And from the age of eight, I knew I wanted to be a doctor. Nothing else ever crossed my mind. But having seen my father's many interests outside of medicine, I realized from very early that there was much more to medicine than just science. And that really induced me, when I went to college, to major in the humanities, in history, art history, and I actually took the minimum number of science courses to get into medical school. That probably wouldn't work today, but it was the start of my interest in humanism, humanities, and dealing with people outside of the quantitative sciences.  Dave Johnson: So that's reflected in how we all view you, John. You're one of the most humanistic physicians that I know personally. I wonder if you could tell us about your interest in medical oncology, and in particular, as one of the pioneers in the field. I mean, there wasn't really even a specialty of medical oncology until the early 1970s. So, how in the world did you get interested in oncology and what drew you to that specialty? Dr. John Glick: Well, I had two clinical experiences that drove me into oncology. The first, when I was a third year medical student at Columbia PNS, my first clinical rotation in internal medicine, I was assigned a 20-year-old who had acute leukemia, except he was not told his diagnosis. He was told he had aplastic anemia, receiving blood and platelets, and some form of chemotherapy. And I spent a lot of time just talking to him as an individual, not just taking care of him. And we became friends. And he was then discharged, only to be readmitted about two weeks later. And in the elevator, the medical assistant had his admission sheet, and unfortunately, it was facing the patient, and it had his diagnosis, acute leukemia. So he came into the ward and he confronted me. "Why didn't you tell me I had acute leukemia?" Well, I couldn't say the attendees forbade me to do that. So I took what today we would call ‘the hit', and apologized. But it stimulated me to reflect that honesty with patients was extremely important, and that oncology was just in its infancy. We knew nothing about it. It was not considered even a specialty. I don't think we used the word "oncology."  But that inspired me to take an elective in my fourth year at PNS, at an indigent cancer hospital called the Francis Delafield Hospital. It only took care of indigent cancer patients, and there were wards, twelve patients in a ward, six on each side, and nobody would go see the patients. It was almost as if they were afraid that if they were to touch the patient, they would get cancer. And I started talking to the patients, and they were human beings, but nobody had told them their diagnosis. Nobody had told them if they were terminal. And there were a few patients who were getting a new drug at that time for multiple myeloma called melphalan, and they actually had relief of some of the symptoms, of their bone pain. But I realized that there was a huge void in medicine that I could possibly help to fill.  And that was the era of Vietnam, and so I applied to the National Cancer Institute to become a commissioned officer in the Public Health Service to avoid the draft, to be on a service with, at that time, some very notable oncologists Vince DeVita, Ed Henderson, Paul Carbone. I had read some of their papers, and I was lucky to be accepted. And I was a clinical associate at the National Cancer Institute. And that was life-changing because there every patient was considered to be potentially curable. The advances at that time using MOPP for Hodgkin's disease, C-MOPP for lymphoma, some treatments for leukemia. George Canellos pioneered the use of CMF for metastatic breast cancer. It was an amazing, amazing experience. That was in 1971 to ‘73. Oncology did not become a true specialty till ‘73, but my two years at NCI were formative.  However, I realized that there was something missing in my training. Everybody was considered curable, but I had never seen a patient with metastatic colon cancer, metastatic lung cancer. The radiotherapists there did not like to teach clinical associates, and I knew that there was a place called Stanford. And Stanford had Saul Rosenberg in medical oncology for lymphomas and Henry Kaplan in radiotherapy. So, everybody was going to California, and my wife and I packed up and went to California and spent a year at Stanford, which, combined with my training at the NCI, led me to the principles that guided my career in oncology; humanity, optimism, reality, compassion, and a love for clinical trials.  I was very, very fortunate to be there at the dawn of medical oncology shortly after I decided to go to Penn, which at that time did not have a medical oncologist. In fact, I was the only medical oncologist at Penn for four years and did every consult in the hospital for four years, much to the chagrin of my wife. But I was fortunate to have great mentors in my career: Paul Carbone, Vince DeVita, Saul Rosenberg, Henry Kaplan, among many, many others. And that impressed me about the importance of mentorship because my career would never have been where it was or is without these mentors. Pat Loehrer: John, just to echo what Dave said, you've been such a tremendous mentor for us. Dave and I particularly, you took us under your wings when you didn't know who we were. We were people in the Midwest. We weren't from any place shiny, but we really appreciate that. Dave Johnson: So, John, I mentioned at the very beginning that I met you before I met you, and the way I met you was through Stewart Alsop's book, Stay of Execution. He portrayed you as an extraordinarily caring individual, and it tremendously impacted me. It was one of the reasons why I chose oncology as a specialty. I realize it's been 50 or more years ago and most of our listeners will have no idea who Stewart Alsop was. And I wonder if you might share with us a little bit of that experience interacting with someone who was particularly well-known in that time as a columnist for The New York Times.  Dr. John Glick: His brother Joe Alsop and Stu Alsop were two of the most famous columnists at that time. Joe Alsop was a hawk right-winger who lived in the Vietnam War. Stewart was charming, was a centrist Democrat, wrote the back page for Newsweek for years. He and I had very similar educational backgrounds and interests. And we functioned on two different levels—one as a physician-patient, and then we became friends. And he and his wife adopted us into the Georgetown set.  And I received a lot of criticism for socializing with a patient. But over the years, I've been able to become friends with many of my patients, and I've been able to compartmentalize their medical care from our friendship. And I use the analogy if I was a doctor in a small town and I was the only doctor,  I'd be friends with people in town, with the pastor and likely the mayor. But I have always believed that patients can become your friends if they want it and if they initiated it.   Taking care of Stewart Alsop was an amazing, amazing experience. We didn't know what he had. People initially thought he had acute leukemia. In reality, he had myelodysplastic syndrome, but that hadn't been described yet. He had a spontaneous remission, which I rarely see, probably due to interferon released from a febrile episode, all his blasts went away in his marrow. One of my children's middle name is Stewart. But professionally and personally, it was an incredible experience. It taught me the importance of being available to patients. They had my home phone number. We didn't have cell phone numbers in those days. We had beepers, but they didn't work. And from that point on, I gave my home phone number to patients, and I actually trained my children how to answer the phone. “This is Katie Glick. How can I help you? My father's not home. You need my father? Can I have your phone number? I'll find him and he'll call you back.” Patients still remember my children and their way of answering the phone. Pat Loehrer: One of the things you did do is create this medical oncology program at Penn, which has graduated some incredible fellows that have become outstanding leaders in our field. But can you reflect a little bit about the process of creating something that was never created before, like a medical oncology program? Dr. John Glick: Well, I came to Penn, my first day. Person who recruited me was on sabbatical. I asked where my office was and there was no office. There was an exam room. There was a clinic for indigent patients which we scrubbed by hand. There was another office for patients who paid. Within two months, I had abolished that. We had one– I hate to use the word clinic, people still use the word clinic today, but one office that took care of all patients, irregardless of means.   I saw every oncology consult in the hospital for four years. But I had a mentor, not only Buz Cooper, but fortunately, Jonathan Rhoads was Chairman of Surgery, and he was also Chairman of the President's Cancer panel. And what he said at Penn in surgery became the law. And then when we introduced lumpectomy for breast cancer and radiotherapy, he endorsed it immediately. All the other surgeons followed suit. I don't think there's any hospital in the country that adopted lumpectomy and radiotherapy for breast cancer as quickly. And the surgeons were instrumental in my career.  Now, I was taking care of gliomas, head and neck cancers, and it was difficult. If I had a colorectal patient, I'd call Charles Moertel at Mayo Clinic and say, “What do I do?” I was there when Larry Einhorn in 1975 presented his data on testicular cancer with the platinum. Unbelievably inspiring, transformational. It also showed the importance of single-arm studies. You didn't have to do randomized studies because the results were so outstanding. And so in my career, I did both single-arm studies, proof of principle studies, and then many randomized trials through the cooperative groups.  But the first four years were very difficult. I didn't know what the word ‘work-life balance' meant in those days. If somebody was sick, I stayed and saw them. It was difficult introducing new principles. When I first mentioned platinum after Larry's presentation, I was laughed out of the room because this was a heavy metal. When patients were dying, they died in the hospital, and I wanted to hang up morphine to assist them. The nurses reported me to the administration. I had to fight to get the vending machines for cigarettes out of the hospital. So there were a lot of victories along the way and a lot of setbacks.  It took me several years to have an oncology unit of six beds, and now I think we have 150 or 160 beds and need more. So it was an interesting and, in retrospective, a wonderful experience, but I didn't know any better. Fortunately, I had a great wife who was working at Penn and then at Medical College of Pennsylvania, and she was incredibly understanding, never complained. And I think my kids knew that on Tuesdays and Thursdays, don't bring up anything difficult with dad because he's had a really tough day in clinic. Dave Johnson: We were not in that era, but we were very close. And many of the struggles that you had were beginning to dissipate by the time we were completing our training. But it was still a challenge. I mean, all those things. I gave my own chemotherapy for the first few years I was in practice. I don't know that our colleagues today who have trained in the last, say, 10 or 15 years, actually realize that that was what we did. Most of the chemo was given in the hospital. It was not uncommon in the early days to have 20, 30, 40 inpatients that you would round on because there just wasn't an outpatient facility. But the corporate mind made a big difference, allowing us to give drugs like platinum in the outpatient arena. You span all of that era, and so you've seen the whole panoply of change that has taken place.  John, the other thing you did that has impressed me, in part because of my time as a Chair of Medicine, is you created this Academy of Master Clinicians. Can you tell us a bit about that and what was the motivation behind that?  Dr. John Glick: Ben had a strategic plan, and one of the pillars was talking about valuing clinical medicine and clinical excellence. But there was no implementation plan. It was sort of just words and left in the air. And I was no longer director of the cancer center, and I realized we had a lot of awards for research, awards for education, and no awards for clinical excellence. So I created the idea of having an academy and master clinician spend six months talking to all constituencies, chairs of various departments, directors of centers to get a buy-in. Wrote a three-page white paper for the dean, who approved it immediately. And then, as typical at Penn, I raised all the money for it. I went to one of my patients who was an executive at Blue Cross. I said I need $500,000 to start this program. And then subsequently, I raised $4 million to endow it. Today, it is the highest honor that a Penn clinician can receive.  You could be on any one of our multiple tracks. You have to see patients at least 60% of the time. You not only have to be a great doctor, you have to be a humanist. So the world's best thoracic surgeon who has a demeanor in the operating room that is not conducive to working with a nurse as a team doesn't get in. We emphasize professionalism, mentorship, citizenship, teaching, national reputation, local reputation, and clinical excellence. And so we've elected over 100 people, maybe 3% of the Penn faculty. We give an honorarium. We have monthly meetings now by Zoom. We have monthly meetings on various topics. We never have a problem getting any dean or CEO to come talk to us.  We were the first to do Penn's professionalism statement. The school subsequently adopted, and it's become the highest honor for a Penn clinician. It's very competitive. It's peer-reviewed. The dean has no influence. And we're very proud that 40% of the members of the academy are women. We have a high percentage of diversity compared to the numbers on our faculty, but you really have to be elected on merit, and some people that you might expected to be members of the academy aren't. It's one of the things I'm proudest of. It will go on in perpetuity because of the money we've raised. I think many of my accomplishments as a researcher will fade, as they typically do, but I'm very proud of the Academy, and I'm very proud of the people that I've mentored. Dave Johnson: It speaks to your values, John, and I think it's one of the reasons why you're so widely admired. Thank you for creating that. It proved to be a model for other institutions. I know that for a fact. One would think that valuing clinical care would be preeminent in medical schools, but in fact, it's often ignored. So again, I know that your colleagues at Penn appreciate your efforts in that regard.  Tell us a little about your term as ASCO president. What are you most proud about and what were your most difficult challenges? Dr. John Glick: Well, the most difficult challenge was that ASCO was in transition. I had to fire the company that ran the meeting. We had to decide that ASCO was going to hire a CEO. We hired John Durant, made a small headquarters, tiny staff, and did a lot of the work as being chief operating officer myself. It was the year that email was just getting started, and ASCO wasn't using it. So every Saturday from 8:00 to 6:00, I came into the office and my secretary wrote letters inviting people to be on the program committee or various committees. But it was a society in transition. The growth of membership was huge. The meeting sites had to be changed. We emphasized science. Some of the things that we did are still in existence today.  We formed the ASCO ACR Clinical Research Methods course. It's still given. That's one of our real highlights. We forged relationships with other societies, the National Coalition for Survivorship. We made the ASCO guidelines much more prominent. And I remember that we were going to publish the first guidelines on genetic testing for breast cancer, and the MCI went up in absolute arms, so I arranged a meeting. I was at the head of the table. On my right were Francis Collins, Richard Klausner, Bob Wittes, and a few other people. Then the ASCO people who wrote the guideline were on the left, and they didn't want us to publish it. They thought it was premature to have a guideline about genetic testing. And what I learned from that meeting is that you can agree to disagree with even the most prominent people in oncology and still maintain those relationships. But we did what's right, and we published a guideline on the JCO. There were so many wonderful things that happened at ASCO that I can hardly restate all that happened I guess 27 years later. It was exciting. ASCO was still young. There was a lot we had to do, and we could do it. You could just go ahead and do it. It was exciting. It was gratifying. It was one of the most fun years of my life. Dave Johnson: I mean, that transition from an outside company in many respects, controlling the premier activity of ASCO, its annual meeting to ASCO, taking that on, that defined ASCO, and that's what I remember most about your time as president. It was a bold move, and the hiring of John Durant was brilliant. I mean, he was such an incredible individual, and it was great that you guys were able to pull that off. Pat Loehrer: Thank you for what you've done.  You've had a number of your mentees if you will, and colleagues that have gone on to prominent positions, including, I think, at least three directors of NCI Cancer Centers. Can you just talk briefly how you would describe your mentoring style because you've been so successful? Dr. John Glick: First, there are two aspects. One is when people come to you, and then when you go to people, you sense they're in need. The key aspect of mentoring is listening. Not talking, listening. Looking for the hidden meanings behind what they're saying, not telling them what to do, presenting options, perhaps giving them clues on how to weigh those options in pros and cons, being available for follow-up. Mentoring is never a one-time exercise. Not criticizing their decisions. You may disagree with their decision, but it's their decision, especially if they've considered it. Being proud of the mentee, being proud of their accomplishments, following them over the years. And when they've gotten in trouble or failed to get the job that they wanted, always be there for them, not just in the good times, but in the times that are difficult for them professionally. I think that's one of the most important things.  Even today, I mentor three or four clinical department chairmen, and people ranging from full professors to newly appointed assistant professors. Now that I'm retired, mentoring is the one activity that I've really retained. It's extraordinarily satisfying, and I'm proud of the people that I've mentored. But it's their accomplishments, and the key aspect of mentoring is never to take credit. Dave Johnson: I'll give you credit for mentoring me, and I appreciate it. You were very instrumental at a very decisive point in my career when the old Southeast Cancer Group disbanded, and we were looking for a new cooperative group home. And you were instrumental in helping my institution come into the ECOG fold, and not just as a very junior member, but really as a player. And I'll never forget that, and we'll always appreciate that very much. Pat Loehrer: Ditto on my side, too. Dave Johnson: John, you mentioned that you're retired. What do you like to do in your "free time” if you're not mentoring? Dr. John Glick: Life is good. My daughter says I have a disease, O-L-D. My grandson says, “He's not old; he's almost 80. Look how well he's done.” “Here's $20.” I'm having fun. We are fortunate to have homes in different places. We spend the summer up in the Thousand Islands on the St. Lawrence River, spring and fall down in Charleston, then lots of time in Philadelphia. We travel. I play golf poorly. I'm getting a chance to read history again, go back to one of my great loves. I'm with my children and grandchildren more. I lost my first wife. I've been remarried for about twelve years, and I'm enjoying every moment of that. I'm not bored, but I do wake up in the morning with no anxiety, no realization that I have to herd sheep or herd cats. I have no metrics, I have no RVUs,  not behind of the EMR.  Dave Johnson: You're making it sound too good, John.  Dr. John Glick: We're having fun. And I have not been bored. I've not been down in the dumps. Each day brings a different aspect. We see a lot more of our friends. I exercise. I deal with the health problems that people get when they get older, and I have plenty of those. Seeing doctors takes a lot of time, but I'm grateful that I'm having these few years of retirement. I'm one of the people who is most fortunate to have attained everything they wanted to do in their professional life, and now I'm trying to do some of the same in my personal life. Dave Johnson: John, Pat and I both love to read. We love history. You mentioned that you're reading some history. Is there a book that you've read recently that you might recommend to us? Dr. John Glick: “the Last of the Breed” {With the Old Breed} It's about a private in the Pacific campaign who was not a commissioned officer; it's just a grunt on the ground. It brings the horrors of the Pacific island campaigns to life. But there's a huge number of books, some historical fiction. I'm a great fan of Bernard Cornwell, who's written about the Medieval times, Azincourt, 1356. I'll read two or three books a week. I'm devoted to my Kindle. Dave Johnson: If you could go back in time and give your younger self a piece of advice, what would that advice be?   Dr. John Glick: Try and achieve more of a work-life balance. I didn't have any choice. If I didn't do the consult, it didn't get done. That's not the situation today. But I have a second piece of advice, don't treat medicine as a 9 to 5 job. If a patient is sick, stay with the patient. Give the patient your home or cell phone number. Remember, medicine is not just a profession, but it can be a calling. Too few of our physicians today regard medicine as a calling. And even if you're employed, as most of us are by an academic or other institution, do what's right for the patient, not just what's right for your timesheet or the EMR. Remember that the patient is at the center of all we do and that medicine is a calling for some people, as it was for me. Dave Johnson: Great advice, John. Great advice.  Well, I want to thank Dr. Glick for joining Pat and me. This has been a delight. You're one of our role models and heroes.  I want to thank all of our listeners of Oncology, Etc., which is an ASCO educational podcast where we will talk about oncology medicine and other topics. If you have an idea for a topic or a guest you'd like us to interview, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content of ASCO, please visit education.asco.org. Thanks again. Pat, before we go, I've got an important question for you. I've been trying to school you recently, and you've failed miserably. So I'm going to ask you, why is it that McDonald's doesn't serve escargot? Pat Loehrer: I can't do it. I don't know. I give up.  Dave Johnson: It's not fast food. Pat Loehrer: I like that. It's good.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experiences, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.    

When cancer advances to an incurable stage, some patients may prioritize treatment that will extend their life as long as possible, and others may prefer a care plan that's designed to minimize pain. Talking to patients about their prognosis and values can help clinicians develop care plans that are better aligned to each patient's goals. However, it's essential that the discussions happen before patients become too ill. The results of a long-term clinical trial showed electronic nudges delivered to health care clinicians based on a machine learning algorithm that predicts mortality risk quadrupled rates of conversations with patients about their end-of-life care preferences (JAMA Oncol 2023; doi:10.1001/jamaoncol.2022.6303). The study, published by Penn Medicine investigators, also found that the machine learning-triggered reminders significantly decreased use of aggressive chemotherapy and other systemic therapies at end of life. Oncology Times interviewed study author Ravi B. Parikh, MD, about the results. Parikh is an oncologist and Assistant Professor of Medical Ethics and Health Policy and Medicine in the Perelman School of Medicine at the University of Pennsylvania and Associate Director of the Penn Center for Cancer Care Innovation at Abramson Cancer Center.

Discover new developments in the management of metastatic squamous non–small cell lung cancer (NSCLC), including individualized care plans, efficacy and safety of novel therapies, and strategies to optimize survivorship for patients with NSCLC. This podcast is presented by expert faculty, Mark G. Kris, MD, Memorial Sloan Kettering Cancer Center, and Victoria Sherry, DNP, CRNP, AOCNP®, Nurse Practitioner, Abramson Cancer Center. Listen now to earn free CME/NCPD! To claim credit, click here: i3health.com/oda-squamous-nsclc

Dive Into Reiki Rounds Tables are conversations between Reiki masters from different backgrounds to talk about the challenges, experiences, and learnings that keep us growing as practitioners. It is also meant as a platform for new voices from our global community. There is only one rule: keeping it real. IMPORTANT NOTICE: Dive Into Reiki's mission is to bring information that allows Reiki practitioners from all over the world to deepen their practice. Although this information is shared freely on my platforms, all content is tied to copyrights. Please do not repurpose or translate these interviews without previous authorization. DIVE INTO REIKI ROUND TABLE—NOT SO DISTANT REIKI Today we have 3 amazing Reiki teachers: Ifetayo White, Helene Williams, and Danica Arizola. We discuss how their remote Reiki sessions have evolved over the years, the need for authorization, use of symbols and some of their remote session oops. Ifetayo White is a Reiki Master Teacher who is the founder and director of The Lowcountry School of Reiki on St. Helena Island, SC. Having practiced and taught Reiki for more than 25 years, Ifetayo was attuned in 2020 as a Usui Shinpiden Reiki Master by Frans Stiene of the International House of Reiki. For Ifetayo Reiki is the foundation of everything she does in her life and is devoted to the daily practices of living Reiki. Find more about Ifetayo at: ifetayowhite.comHelene Williams is a registered nurse and Reiki master/teacher based in Lancaster, Pennsylvania. She has over ten years of experience providing Reiki sessions in a hospital setting and has a well-established private practice. Helene has presented information on Reiki and holistic health care at national nursing conferences, participated in a hospital-based Reiki research study, implemented and facilitated a hospital Reiki Volunteer Program and in 2013 established the Lancaster Community Reiki Clinic. She also has experience providing Reiki for Caring Hospice Services and actively volunteers at the VA Medical Center in Lebanon, PA. Find out more about Helene at: helenewilliamsreiki.comDanica Arizola is a Reiki Master Teacher/Practitioner, Licensed Massage Therapist, End-of-LIfe Doula, Yoga instructor, and Certified Circle Caller living in Philadelphia. She came to learn Reiki 14 years ago at The Reiki School + Clinic, Philly's first Reiki school. After volunteering and then working at the school for several years, she eventually became a co-owner of the school. In 2016 she left the school to open her practice, A LoveThing Healing Arts. Currently, Danica splits her time between her practice and The Abramson Cancer Center at The University of Pennsylvania Hospital. Find more about Danica at: alovethinghealingarts.comNathalie Jaspar, founder of Dive Into Reiki,  is a Reiki master with over a decade of experience. She's a graduate teacher from the International House of Reiki. To gain an even deeper understanding of Reiki practice, Nathalie went to Japan to practice Zen Buddhism at the Chokai-san International Zendo. She is the author of Reiki as a Spiritual Practice: an Illustrated Guide, and the Reiki Healing Handbook (Rockridge Press). Support the show

This panel, first recorded at the 2022 IO360° Summit, reported on advances in achieving more diversity and inclusion in oncology clinical trials. Moderated by: Adrelia Allen, PharmD, Director, Clinical Trial Patient Diversity, Global Clinical Trial Operations, Merck Research Labs Panelists: Chétna Rao, PhD, Head of Site Strategy and Operations, BMSRobert Vonderheide, MD, DPhil, Director, Abramson Cancer Center, Perelman School of Medicine, University of PennsylvaniaKaren Peterson, Patient Advocate and Founder, Karen's ClubMichel Reid, Sr. Director and Head, Global Demographics & Diversity, Global Clinical, Delivery, Global Clinical Operations, R&D, GSK Learn more about the IO360° Summit at www.io360summit.com

Today's episode is nostalgic I sit down with an old friend and fellow fundraiser, Maddie Hansen. We share a few memories from our time singing together in our College a cappella group and analyze what skills we learned there that we can apply to fundraising. We then learn from Maddie about her grateful patient fundraising and how she has built an authentic voice and path finding meaning in her work. Madeleine Hansen is a Senior Associate Director of Development for Penn Medicine's Abramson Cancer Center. In this role, Maddie works closely with physicians, scientists, and grateful patients to support diverse research and patient care programs for women's cancers. This includes Penn's Breast Cancer Program, 2-PREVENT Translation Center of Excellence (TCE), Ovarian Cancer Research Center (OCRC), and Gynecologic Oncology Clinical Research Unit. Maddie also serves as a point person for fundraising for diversity, health equity, and inclusion (DEI) within the Division of Hematology Oncology. Maddie is a graduate of Trinity College in Hartford Connecticut where she received her BA in American Studies. --- Support this podcast: https://anchor.fm/devdebrief/support

From Cord Compression to Tumor Lysis Syndrome Do you freak out over oncologic emergencies like cord compression or tumor lysis syndrome? Join Dr. Aditi Singh (University of Pennsylvania, Abramson Cancer Center, @AditiSinghMD) for this comprehensive conversation on six commonly encountered oncologic emergencies we see in the hospital! Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | askcurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Cord Compression SVC Syndrome Malignant Obstruction Tumor Lysis Syndrome Blast Crisis Outro Credits Producer, Writer, Hosts: Meredith Trubitt, MD MPH; Monee Amin, MD Infographic and Cover Art: Caroline Coleman Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Associate Editor: Leah Witt, MD Showrunner: Matthew Watto MD, FACP Technical Production: PodPaste Guest: Aditi Singh, MD Sponsor: BetterHelp Visit BetterHelp.com/curb today to get 10% off your first month.   Sponsor: Indeed  Visit Indeed.com/internalmedicine to start hiring now.   Sponsor: Hello Fresh   Go to HelloFresh.com/curb65 and use code curb65 for 65% off plus free shipping.   

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, our guests will discuss new research in lung cancer, lymphoma, and childhood cancer that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois. First, Dr. Charu Aggarwal will discuss 3 studies looking at treatment options for people with non-small cell lung cancer. Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the Cancer.Net Associate Editor for Lung Cancer. You can view Dr. Aggarwal's disclosures at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net podcast. I'm bringing you updates from the Annual Meeting of the American Society of Clinical Oncology, held in Chicago in 2022. I'm Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania's Abramson Cancer Center. I will be discussing updates on 3 studies today that offer insights and new advances in the management of patients with non-small cell lung cancer. I don't have any direct relationship with any of these companies or studies, and you can view a list of my disclosures on the Cancer.Net website. First off, I would like to talk a little bit about advances in the management of patients with EGFR exon 20 mutations. We know that a lot of advances have been made in the management of patients with non-small cell lung cancer, and much of that has been attributed to the fact that we are now able to deliver targeted therapy for a subset of patients. EGFR mutations form one such subset where we have a lot of oral drugs that are available, and we can offer these that improve survival, and patients can avoid chemotherapy, immunotherapy, and other IV infusional therapies. Within the subset of EGFR mutations lies this unique subset of EGFR exon 20 insertion mutations, which have been historically harder to target with currently available EGFR inhibitors. And over the last 5 years, we have seen tremendous growth of opportunities, targets, and new drugs for this subset of patients. The mutations in this subset forms about 2% to 5% of all non-small cell lung cancers. But now we have 2 FDA-approved drugs in this space, one being intravenously administered, amivantamab, and another that is orally available, mobocertinib. We covered this in a podcast as well as a blog, so please check those out on our Cancer.Net website. But building upon that progress, there is now another drug that was reported at ASCO. This drug is called CLN-081. And we saw preliminary activity in a phase 1 and 2 study of this molecule or this drug in patients with EGFR exon 20 insertion mutations. It's an orally available drug. The top line data is that it is safe, it is effective, it was tested in different doses. It was tested at less than 65 milligrams, 100 milligrams, and 150 milligrams, again, as I mentioned, administered orally, and we saw responses and patients that had previously received other therapies and may have progressed on other therapies. And what we found was that this drug also tends to have activity against brain metastases, which I think is this huge unmet need in the management of such patients. So I think more to come, but again, I think offers us an insight into what may be in the future, an attractive drug for our patients with EGFR exon 20 insertion mutations. So stay tuned, more on that in the future. Shifting gears, I would like to now talk about one of the common mutations. So we talked about EGFR exon 20, which is about only 2% to 5%, but the largest subset of mutations in non-small cell lung cancer really revolves around KRAS mutations, and these form about 30% to 35% of all mutations in non-squamous, non-small cell lung cancer. And amongst this group there is another subset which is KRAS G12C non-small cell lung cancer, that forms about 13% of all lung cancers. We have 1 approved drug already in this space by the name of sotorasib that is FDA approved for the management of patients with this particular mutation after having received 1 prior therapy, be it chemo-immunotherapy or immunotherapy. At this year's ASCO meeting, we heard data from a study called KRYSTAL-1, which looked at the activity and safety of another molecule called adagrasib, which is an orally available drug targeting KRAS G12C, again, in a similar population of patients with advanced and metastatic non-small cell lung cancer harboring a mutation. We found that this drug is again effective, the overall response rate was about 43%, the majority of the patients had stabilization of disease, about 80%, and many patients were able to remain on treatment with stabilization of disease. We found that this drug does have side effects and adverse events and most commonly of this were diarrhea, nausea, vomiting, and fatigue. Many patients did require dose reductions, but the activity of the drug remained despite dose reductions. Now, what would be the advantage of this drug against the currently available sotorasib? In another smaller study reported at ASCO, there seemed to be activity in the brain, including intracranial penetration with the use of this molecule, adagrasib, which has not been demonstrated before with other KRAS G12C inhibitors, so I think that makes it a potentially attractive option. Again, I will say that the report of this intracranial activity was in a very small subgroup of patients, so I think needs to be further corroborated in a larger study. Shifting gears again and talking about our last study, so I would like to highlight what do we do if, in case, patients don't have a targetable mutation. I want to highlight that we do have a lot of available options, and we are continuing to improve upon available options. The way we treat such patients is by using immunotherapy, either alone or in combination with chemotherapy. But what do we do after this treatment stops working? Researchers from the Southwestern Oncology Group, or SWOG, launched a massive national effort called Lung-MAP, which is basically a clinical trial that evaluates several different strategies all at once, either for patients with targetable mutations or for patients without a targetable alteration. And they reported results from a study that evaluated the combination of pembrolizumab with ramucirumab in patients that may have progressed after frontline immunotherapy. Now, pembrolizumab is immunotherapy, so the concept was, can we continue immunotherapy beyond progression and perhaps get some synergistic activity by using ramucirumab, which is a drug that prevents blood vessels from forming in the tumor itself. It's an anti-angiogenic agent, meaning that it is a targeted molecule that prevents blood vessel formation and promotes tumor death. What they found was that patients that received pembrolizumab and ramucirumab were more likely to live longer, so overall survival was longer for patients with this combination compared to a physician investigator discretion choice, such as chemotherapy in combination with ramucirumab or other chemotherapies that are otherwise used in the second line setting. And interestingly, we did not find a significant improvement in shrinkage with this combination of pembrolizumab and ramucirumab or a significant reduction in the time of progression-- or, sorry, prolongation of the time of progression of disease. But the overall survival findings are interesting, and I think that's why we are including them in this podcast because that's one of the approaches that is leading to an improvement in survival and improvement in outcomes. I will point out that this is a phase 2 study. These results would need to be validated in a large prospective phase 3 trial so that we can account for certain confounding factors that may have led to these results. Having said that, I think there's a tremendous excitement, there's tremendous excitement in this field. I gave you examples of, or highlighted, 3 studies: one in patients with EGFR exon 20 insertion mutations, another in KRAS G12C mutations, and the third in patients who may have already received either immunotherapy or chemoimmunotherapy. We will continue to update our Cancer.Net website with updates as they come through, new advances, new studies, so thanks for following, thanks for listening, and more to come. Stay tuned. Thank you. ASCO: Thank you, Dr. Aggarwal. Next, Dr. Christopher Flowers will discuss new research in treating people with different subtypes of lymphoma, including mantle cell lymphoma and diffuse large B-cell lymphoma. Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interim of Cancer Medicine in August 2020. He is also the 2022 Cancer.Net Associate Editor for Lymphoma.   You can view Dr. Flowers' disclosures at Cancer.Net. Dr. Flowers: Hello and welcome to this podcast that is a review of late breaking abstracts from the ASCO Meeting and recent updates in lymphoma. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma and Interim Division Head for Cancer Medicine at The University of Texas MD Anderson. And it's my great pleasure to discuss with you some of these late breaking abstracts. I do have some disclosures that are related to the content that I will present from this year's ASCO Meeting and recent studies in lymphomas. Those are available at Cancer.Net. Those relate to my role as a consultant for the development of clinical trials in lymphomas and research funding that MD Anderson has received from companies related to my role in clinical trials in lymphoma and clinical trials across cancers. So, the ASCO Meeting had a host of new information that was presented. Some of that information centers around key clinical trials. One that was a pivotal clinical trial, the SHINE clinical trial, looked at patients with mantle cell lymphoma, a rarer lymphoma subtype, that looked at the combination of bendamustine and rituximab, a standard chemoimmunotherapy combination, compared to that same chemoimmunotherapy combination, bendamustine, rituximab, plus the Bruton's tyrosine kinase inhibitor ibrutinib. Ibrutinib, as some of you may know, is a kind of therapy that is typically used in the relapse setting for patients with mantle cell lymphoma when they have their disease come back. And the SHINE clinical trial was looking at adding it to frontline therapy. What this randomized, controlled trial in the phase 3 setting found was that patients who received the combination of bendamustine, rituximab, plus ibrutinib had improvement in their progression-free survival, meaning that the time that it took for their disease to come back or them to have deaths related to the lymphoma was longer for patients who received this combination. About 2.3 years longer than the group that received bendamustine, rituximab, plus placebo. And in total, that led to a median progression-free survival of 6.7 years. That study has now been published in the New England Journal of Medicine and was led by my colleague Dr. Michael Wong from MD Anderson. Dr. Wong also led another study that was presented at the ASCO Meeting looking at CAR T-cell therapy for patients with mantle cell lymphoma. That study has now been published in the Journal of Clinical Oncology, and it looks at brexucabtagene autoleucel, a kind of CAR T-cell therapy, where that-- the CAR T-cell therapy was successfully manufactured for 71 of the 74 patients in the trial. 68 of those patients received an infusion and the median progression-free survival, so the average amount of time that it took for patients to have progression of their disease, was about 25 months. And so a marked benefit for those patients who were receiving CAR T-cell therapy when their mantle cell lymphoma came back. There also were major breaking abstracts at the ASCO Meeting in the area of diffuse large B-cell lymphoma. As many of you may know, diffuse large B-cell lymphoma is the most common type of lymphoma that occurs in the United States. And there was a breaking trial that was presented in December at the American Society of Hematology Meeting describing polatuzumab, a CD79b antibody drug conjugate, as a new drug in the substitution of frontline therapy for patients with diffuse large B-cell lymphoma in combinations with rituximab, cyclophosphamide, adriamycin, and prednisone, or the pola-R-CHP arm, that compared favorably to rituximab and CHOP chemotherapy, which has been the standard of care for patients with diffuse large B-cell lymphoma. And that trial showed an improvement in progression-free survival. At this year's ASCO Meeting, Franck Morschhauser presented results from looking at subsets of that patient population. Those patients who had BCL2 by immunohistochemistry that was positive or MYC expression by immunohistochemistry that was positive, or both of those, what we call double-expressor lymphomas, those who have poorer risk than standard groups. And those double-expressor lymphomas, treated with pola-R-CHP, had improvement in progression-free survival compared to R-CHOP with a hazard ratio of 0.64 in that group. We also saw in a multitude of analysis that that supported the benefit of pola-R-CHP in patients with both BCL2-positive and MYC-positive diffuse large B-cell lymphoma. Another area that has been very hot in diffuse large B-cell lymphoma clinical trials is the role of bispecific antibodies. Bispecific antibodies are antibodies that bind both to CD20, a marker on the diffuse large B-cell or the lymphoma cells, and to the marker CD3, which is a marker on T-cells which brings the normal T-cells of the immune system in close proximity to the lymphoma cells and then leads to immune-directed killing of lymphoma cells. The agent glofitamab is an agent that was presented by Michael Dickinson at this year's ASCO Meeting in an abstract. And in this study, 107 patients who received more than 1 dose of steady treatment went on to have complete responses in about 35% of patients. And this showed that glofitamab induced durable complete responses and had a very favorable safety profile in patients with relapsed and refractory diffuse large B-cell lymphoma. And in this trial, they compared that also for patients who had prior exposure to CAR T-cells and showed that responses were also good in those patients. Another set of studies has also looked at bispecific antibodies and a whole host of other areas with multitude of other agents. Another study that was presented at this year's ASCO Meeting explored the use of bispecific antibodies in the frontline setting in combination with the R-CHOP regimen that I just discussed. In that study, Lorenzo Falchi presented results of the subcutaneous bispecific antibody epcoritamab in combination with R-CHOP. This was a relatively small study of 33 patients that showed that the combination of epcoritamab plus R-CHOP was something that was safe and tolerable. There were no new treatment emergent adverse events that led to discontinuation of epcoritamab in the study. And there are some adverse events that are of special interest that we see with the bispecific antibodies, and those include the kind of immune-mediated adverse events that we can also see with CAR T-cells, like cytokine release syndrome, or CRS, or neurologic toxicities that we can see there that are also called ICANS. What we've seen in this trial, that about 42% of patients had some form of cytokine release syndrome, but that most severe form of cytokine release syndrome, those that were greater than grade 3 in severity, was only in 3% of patients. And likewise, the neurologic toxicities, or ICANS, that were grade 2 was in only 3% of patients. Relatively few patients completed all therapy by the time that this was presented. Only 10 patients had completed 6 cycles of therapy, but that showed an overall response rate that was quite high in that patient population. There were a whole host of other trials that were presented at this year's ASCO Meeting, and those portend improved kinds of outcomes on the horizon for patients with lymphomas across the spectrum. And I think it's an exciting time moving forward for clinical trials in lymphoma and hopefully, to see new therapies that emerge for the management of this disease. One of those new therapies that happened outside of the ASCO Meeting was the recent FDA approval of CAR T-cell therapy in the relapse setting for follicular lymphoma. And this was based on the ELARA clinical trial. And I think the future is quite bright for therapies and for patients with lymphomas broadly. ASCO: Thank you, Dr. Flowers. Finally, Dr. Daniel Mulrooney will discuss new research in childhood cancers, including a study comparing treatment options for Ewing sarcoma, and several studies on neuroblastoma. Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children's Research Hospital. He is also the Cancer.Net Associate Editor for Pediatric Cancers. You can view Dr. Mulrooney's disclosures at Cancer.Net. Dr. Mulrooney: My name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I'm the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primary care for survivors of pediatric solid tumors. The annual ASCO Meeting is typically quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care. Today, I'd like to highlight some of the exciting presentations in pediatric cancer. Please note, I do not have any relationships to disclose related to any of these studies. At this year's meeting, one of the highlights was a European study in patients with relapsed or refractory Ewing sarcoma. Ewing sarcoma is a rare bone cancer that typically occurs in adolescents or young adults. While challenging to treat, it is difficult to cure in patients who have relapsed, and studies are needed to improve the care of these patients. Investigators from 13 European countries and Australia and New Zealand studied the most common relapsed therapies, which include irinotecan and temozolomide, gemcitabine and docetaxel, topotecan and cyclophosphamide, or high-dose ifosfamide. The study enrolled 451 patients between 2014 and 2021 and randomly assigned them to one of these four treatments. Based on response rates, the first 2 arms were dropped and the study was largely a comparison between topotecan cyclophosphamide and high-dose ifosfamide. The main outcome was event-free survival. Event-free survival is a common way in a clinical trial to see how well a treatment works. It measures the time from treatment that the patient remains free of complications, such as return or progression of the cancer. But investigators also looked at overall survival, toxicity, and quality of life. The 6-month event-free survival was better for high-dose ifosfamide at 47% compared to 37% for topotecan cyclophosphamide. The median overall survival was also better for high-dose ifosfamide compared to topotecan cyclophosphamide. The results were best for children younger than 14 years old versus those 14 or greater. Toxicities included fever and neutropenia, nausea, vomiting, and diarrhea. Patients receiving high-dose ifosfamide had more neurologic and kidney toxicities, which might be expected since ifosfamide is known to affect these organ systems, while only descriptive measurements of quality of life appeared higher for those children treated with high-dose ifosfamide compared to topotecan and cyclophosphamide. The strength of this trial is its large size, particularly for a rare cancer, and the fact that it randomized patients to the most commonly used treatment regimens for relapsed Ewing sarcoma. Importantly, data did not previously exist comparing these different treatments. While the results of this study are promising, clearly more needs to be done, and there was a lot of discussion at the ASCO Meeting about how to further improve survival in these patients. This study provides some information for doctors and patients, but importantly, provides data to advance future trials, which will concentrate on incorporating new targeted drugs with high-dose ifosfamide. This study is ongoing and is adding additional arms to continue to improve the outcomes for patients with relapsed or refractory Ewing sarcoma. In addition to this study in Ewing sarcoma, several studies investigating neuroblastoma were presented. Neuroblastoma is the most common extracranial solid tumor in children and for children with high-risk disease requires intensive and prolonged treatment, including chemotherapy, surgery, radiation therapy, and stem cell transplantation. Treatment for these patients has improved since the introduction of immunotherapy, particularly an antibody directed at a particular antigen named GD2 on the neuroblastoma cells. One study showed improvement in outcomes using this antibody for children with relapsed or refractory neuroblastoma, and another study demonstrated feasibility of using this antibody earlier in treatment, which was not previously known to be safe and tolerable. In what is called the BEACON study, investigators tested whether the antibody, called dinutuximab, would be effective when combined with chemotherapy for relapsed or refractory neuroblastoma. They enrolled 65 patients from 2019 to 2021 and randomized these patients to either chemotherapy alone or chemotherapy plus dinutuximab. The median age of these children was 4 years. The overall response rate, which means either a complete or partial response, was 18% for the chemotherapy-only arm but improved to nearly 35% for those treated with chemotherapy and dinutuximab. The progression-free survival was 27% for chemotherapy only and improved to 57% for those treated with chemotherapy and the antibody. There was no change in overall survival, though investigators think this may have been due to some patients who had progressive disease and crossed over to the antibody arm of the study. This presentation was followed by a study from the Children's Oncology Group, which investigated the feasibility of adding antibody treatment earlier in the treatment regimen for neuroblastoma. Prior studies had used antibody later in treatment when the tumor burden is thought to be lower. The endpoint of this study was tolerability measured by toxic deaths or unacceptable toxicities, such as adverse reactions to the medication. For example, sustained low blood pressure requiring a ventilator or breathing machine, or severe neuropathy. 42 high-risk neuroblastoma patients were enrolled from 8 different children's hospitals between 2019 and 2021. 41 of the 42 were able to complete the induction chemotherapy plus the antibody. There were no toxic deaths or unacceptable toxicities. Importantly, 85% were able to complete the next phase of treatment, called the consolidation phase, and 79% were able to complete the following phase after consolidation, called post-consolidation. One-year event-free survival was 83%, and 1-year overall survival was 95%. Now, it's important to know these are still early results, and the trial recently closed, and some of the patients have only completed therapy within the last year. Both of these studies add to the knowledge of chemoimmunotherapy for children with high-risk neuroblastoma. These studies provide a foundation for larger randomized trials that will further advance the care of these children. And finally, another study looked at race, ethnic, and socioeconomic disparities among children treated for high-risk neuroblastoma on Children's Oncology Group studies. There were no differences in event-free survival, but there were differences in overall survival based on ethnicity. The 5-year survival was lowest for Hispanic patients at 47%, 50% for non-Hispanic other ethnicities, which included Asian, Native American, Native Hawaiian, or Pacific Islanders, and 62% for non-Hispanic Black and non-Hispanic White children. Importantly, these investigators also studied household and neighborhood poverty. Overall, survival was lower for children living in poverty, though some of these differences went away when accounting for other factors, such as stage of disease or high-risk features. This study is important because it highlights the increasing need to collect data on clinical trials that may contribute to inequities in outcomes. While most studies collect data on the race and ethnicity of participants, other factors known as social determinants of health, such as income, neighborhood, education, access to health care, and insurance coverage, may also contribute to outcomes in pediatric cancer patients. Overall, the studies highlighted here and presented at this year's ASCO Annual Meeting focused on difficult-to-treat cancers, such as relapse or refractory disease, and they have laid the groundwork for future investigations to continue to improve survival rates for all children diagnosed with a malignancy through improved therapies and by addressing potential social barriers. Thank you for listening to this brief summary of the new research in pediatric oncology presented at the 2022 ASCO Annual Meeting. ASCO: Thank you, Dr. Mulrooney. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Dr. Bruce Levine, Ph.D. (https://www.med.upenn.edu/apps/faculty/index.php/g5455356/p3504) is the Barbara and Edward Netter Professor in Cancer Gene Therapy, and the Founding Director of the Clinical Cell and Vaccine Production Facility (CVPF) in the Department of Pathology and Laboratory Medicine and the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania. Dr. Levine received a B.A. (Biology) from University of Pennsylvania and a Ph.D. in Immunology and Infectious Diseases from Johns Hopkins, and is responsible for a range of important therapeutic “Firsts” including First-in-human adoptive immunotherapy trials that included the first use of a lentiviral vector, the first infusions of gene edited cells, and the first use of lentivirally-modified cells to treat cancer. Dr. Levine is co-inventor of the first FDA approved gene therapy (Kymriah), chimeric antigen receptor T cells (CAR-T cells) for leukemia and lymphoma, licensed to Novartis. Dr. Levine is co-inventor on 30 issued U.S. patents and co-author of over 200 manuscripts and book chapters with a Google Scholar citation h-index of 99. He is a Co-Founder of Tmunity Therapeutics (https://www.tmunity.com/), and of Capstan Therapeutics, both spin outs of the University of Pennsylvania. Dr. Levine is a recipient of the William Osler Patient Oriented Research Award, the Wallace H. Coulter Award for Healthcare Innovation, the National Marrow Donor Program/Be The Match ONE Forum 2020 Dennis Confer Innovate Award, serves as Immediate Past-President of the International Society for Cell and Gene Therapy, and serves on the Board of Directors of the Alliance for Regenerative Medicine. He has written for Scientific American and Wired and has been interviewed by the NY Times, Wall Street Journal, Washington Post, NPR, Time Magazine, National Geographic, Bloomberg, Forbes, BBC, and other international media outlets. The Tribeca Film Festival is currently debuting a documentary, Of Medicine And Miracles, tracing the transformative work in personalized cancer therapy, of Dr. Levine and his team - https://tribecafilm.com/films/of-medicine-and-miracles-2022

#veterinarian #bioethics #ONEHEALTH CONVERSATIONS WITH CALVIN WE THE SPECIES NEW: DAMIR HAMAMDZIC: DVM, PhD, (Veterinarian); ONE HEALTH NJ (Human, Animal, Plant) Steering Committee; Bio-Ethics; AND #Seinfeld “A diverse, fascinating, timely, introspective & much anticipated interview. Not to be missed…. you could listen to Damir all night….” 168 Interviews. GLOBAL Reach. Earth Life. Amazing People. PLEASE SUBSCRIBE (You can almost find any subject you want) https://www.youtube.com/c/ConversationswithCalvinWetheSpecIEs ** DAMIR HAMAMDZIC, DVM, PhD, (Veterinarian); ONE HEALTH NJ (Human, Animal, Plant) Steering Committee; Bio-Ethics; Animal Welfare and Regulatory Compliance (Janssen Pharmaceuticals) Animal-Human Transplantation?; Seinfeld.(TV) YouTube: CONTACT: LinkedIn: https://www.linkedin.com/in/damir-hamamd%C5%BEi%C4%87-dvm-phd-cpia-1437b015/ BIO: Dr. Damir Hamamdzic is a Scientist, veterinarian, & bioethicist. Currently he is Sr Scientist in charge of animal welfare & regulatory compliance at Johnson & Johnson. Previously, at Rutgers Office of Research Regulatory, also in charge of animal welfare, he established a post-approval monitoring program that encompasses all 4 Rutgers campuses, across 2 IACUCs, as well as oversight of NJIT's lab animal site. He utilized his scientific, scholarly, & quality assurance (QA) background to build lasting relationships with researchers & their staff. He also participated in teaching courses in Research Ethics for the grad students, as well as served as co-course director for “Animals and the Law” course for the Rutgers Undergrad program. As a GCLP QA Mgr and a GCP Auditor, Dr. Hamamdzic supported U of Pennsylvania's Abramson Cancer Center in its corporate alliance with Novartis to develop novel breakthrough therapies for cancer. GCLP bridges gap between GLP & GCP regulations, an institutional risk in cellular & biologics-based therapies. He established a GCLP QA program & served as an auditor for the clinical GCP studies. As a Sr Research Investigator & an Assnt Director, he managed preclinical (GLP and GLP-like) large animal cardiology research studies as a part of the academic-industry alliance. As an Assistant Prof at Dept of Microbiology & Immunology at Medical Univ of So Carolina, Dr. Hamamdzic was a Principal Investigator & managed an active research program. He managed & mentored grad students, post-doctoral fellows & laboratory technicians. Hamamdzic's teaching responsibilities included teaching grad level courses to Ph.D. students & medical students. Based on his interest in ethics in research, data integrity, and reproducibility & because he thinks that education is an ongoing and never-ending process, he is currently pursuing a Masters in Bioethics degree at the U of Pennsylvania. ** ALSO ON AUDIO: SPOTIFY http://spoti.fi/3bMYVYW GOOGLE PODCASTS http://bit.ly/38yH3yP edits by Claudine Smith- Email: casproductions01@gmail.com ** PLEASE SUBSCRIBE(You can almost find any subject you want) #animalwelfare #animalrescue #rutgers #climatechange #womenshealth #ONEHEALTH #water #USC #singersongwriter #branding #nayarit #Mexico ** ** ** ** ** CLIMATE UPDATE: IT'S N0W OR NEVER: Intergovernmental Panel on Climate Change (IPCC) released its second chapter on the impact of climate change. Many of the impacts of global warming are now simply "irreversible," the UN's latest assessment found. CLIMATE OPTIMISTS GROUP PANEL YOUTH and CLIMATE CHANGE and Beyond Sat June 4 2022 YouTube: https://lnkd.in/eWN6QzKT

Are you in perimenopause? Are you getting fine lines and wrinkles faster than you had imagined? Do you have acne breakouts more often than your teenager? If you answered "yes" to any of these questions then this is the episode for you! Please join Christen and Carla as they learn all about skin and how to take care of the skin they are in with expert Sarah Kagan. Sarah is the Lucy Walker Honorary Term Professor of Gerontological Nursing, School of Nursing; Gerontological Clinical Nurse Specialist, Abramson Cancer Center at Pennsylvania Hospital, Penn Medicine; University of Pennsylvania and her love and excitement for skincare is contagious! Interested in learning more? Here are some of Sarah's favorite websites for more information and some of her recommended products. www.paulaschoice.ingredient-dictionary.com www.carolinehirons.com www.cerave.com www.herbivorebotanicals.com www.janeirdale.com www.supergoop.com www.iliabeauty.com Remember, please follow our podcast by clicking the + sign on any platform you use to listen to your podcasts. If you follow the pod, you'll be automatically notified when new episodes are released. Thanks for your support! If you have any questions or episode suggestions please email us at www.perrymenopauseomg@gmail.com. Follow us on Facebook and Instagram @perrymenopauseomg! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/perrymenopause/support

This expert-led episode of Oncology Data Advisor™, presented by Ticiana Leal, MD, Director of the Thoracic Medical Oncology Program at Winship Cancer Institute of Emory University, and Beth Sandy, MSN, CRNP, Thoracic Oncology Nurse Practitioner at Abramson Cancer Center of University of Pennsylvania, will focus on emerging efficacy and safety data on immunotherapy-based strategies, supportive care plans for adverse events, and optimizing care plans for the survivorship of patients with non–small cell lung cancer. Listen now to earn free CME/NCPD!

Oncology nurses can dismantle ageism by providing person-centered care to all patients, no matter their age. ONS member Sarah H. Kagan PhD, RN, GCNS-BC, AOCN®, FGSA, FAAN, Lucy Walker Honorary Term Professor of Gerontological Nursing at the University of Pennsylvania and gerontology clinical nurse specialist in the Abramson Cancer Center at Pennsylvania Hospital, both in Philadelphia, and member of the Philadelphia ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss nursing considerations for older patients with cancer. Music Credit: "Fireflies and Stardust" by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by March 11, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Episode Notes Check out these resources from today's episode: Complete this evaluation for free NCPD. Oncology Nursing Podcast Episode 72: Caring for Older Adults With Cancer ONS Voice article: What You Need to Know About Caring for Geriatric Patients With Cancer ONS Voice article: Older Adults With Cancer ONS course: Advanced Practice Care Considerations for the Older Adult With Cancer ONS webinar: Geriatric Oncology Principles Helpful in Caring for Older Adults Age-Friendly Health Systems Alzheimers and Dementia Blog Alzheimer's Association Cancer and Aging Research Group Gerontological Advanced Practice Nurses Association Hartford Institute for Geriatric Nursing International Society for Geriatric Oncology To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.

Discover new developments in the management of metastatic squamous non–small cell lung cancer (NSCLC), including individualized care plans, efficacy and safety of novel therapies, and strategies to optimize survivorship for patients with NSCLC. This podcast is presented by expert faculty, Mark G. Kris, MD, Memorial Sloan Kettering Cancer Center, and Victoria Sherry, DNP, CRNP, AOCNP®, Nurse Practitioner, Abramson Cancer Center. Listen now to earn free CME/NCPD!

A cancer diagnosis sucks no matter what — but factors like income, education, racism, geography, housing, and access to health care, known as "social determinants of health," can worsen the burden. When researchers zoom out from individual experiences and survey cancer survivors, they see patterns called social determinants of health. Individual circumstances such as economic stability, physical environment, racial bias, proximity to a provider, or fluency in that provider's language can influence a survivor's health outcome before any cancer treatment begins. In this episode, we share stories of cancer mavericks who rebelled against the foreshadowing of health disparities. 23-year survivor Mary P. Lovato started a support group at her pueblo in New Mexico that expanded to reach American Indian and Alaska Native tribes across the United States. After learning she had breast cancer at 31, Maimah Karmo made it her mission to advocate for young women, Black women, and those with metastatic disease — and to end health disparities in our lifetime. Finally, health disparities researcher Dr. Carmen Guerra shares how the University of Pennsylvania's Abramson Cancer Center nearly doubled the number of Black patients in its clinical trials. For more information about this series, visit https://CancerMavericks.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

A cancer diagnosis sucks no matter what — but factors like income, education, racism, geography, housing, and access to health care, known as "social determinants of health," can worsen the burden. When researchers zoom out from individual experiences and survey cancer survivors, they see patterns called social determinants of health. Individual circumstances such as economic stability, physical environment, racial bias, proximity to a provider, or fluency in that provider's language can influence a survivor's health outcome before any cancer treatment begins. In this episode, we share stories of cancer mavericks who rebelled against the foreshadowing of health disparities. 23-year survivor Mary P. Lovato started a support group at her pueblo in New Mexico that expanded to reach American Indian and Alaska Native tribes across the United States. After learning she had breast cancer at 31, Maimah Karmo made it her mission to advocate for young women, Black women, and those with metastatic disease — and to end health disparities in our lifetime. Finally, health disparities researcher Dr. Carmen Guerra shares how the University of Pennsylvania's Abramson Cancer Center nearly doubled the number of Black patients in its clinical trials. For more information about this series, visit https://CancerMavericks.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

China's Lehman Brothers Moment, The US-Mexico border crisis and media censorship, walkable communities, UN's Agenda 21, California Gov. Newsom's new zoning law and buildings codes. He also welcomes Richard Vague as they talk about his new book, Illustrated Business History of the United States, from The University of Pennsylvania Press, which offers a more general audience a clear-eyed view of 250 years of wealth creation and the people and personalities who drove that growth — and hold it today. As the author of A Brief History of Doom (2019) and The Next Economic Disaster (2014), Richard Vague established himself as a clear and independent voice in the ongoing conversation about the role of private sector debt in the global economy. Following a career that has spanned fields as varied as banking and energy, credit, and the arts, Richard has served since 2020 as Secretary of Banking and Securities for the Commonwealth of Pennsylvania. Richard also serves on the University of Pennsylvania Board of Trustees and the Penn Medicine Board of Trustees, and on a number of business boards. He is chair of FringeArts Philadelphia, chair of the University of Pennsylvania Press, and chair of the Innovation Advisory Board of the Abramson Cancer Center. He also serves on the Governing Board of the Institute for New Economic Thinking. Vague is the founder of the economic data service Tychos (tychosgroup.org) and the email newsletter service Delanceyplace.com, which focuses on nonfiction literature. The WEALTH TRANSFER is happening FAST! Protect your financial future now! Did you know that 25% to 40% of all dollars ever created were dumped into the economy last year???  This will be devastating to some and an opportunity to others, be sure you're on the right side of this massive wealth transfer. Learn from our experiences, maximize your ROI and avoid regrets. Free Mini-Book on Pandemic Investing: https://www.PandemicInvesting.com Jason's TV Clips: https://vimeo.com/549444172  Asset Protection, Tax Savings & Estate Planning: http://JasonHartman.com/Protect What do Jason's clients say? http://JasonHartmanTestimonials.com Easily get up to $250,000 in funding for real estate, business or anything else  http://JasonHartman.com/Fund  Call our Investment Counselors at: 1-800-HARTMAN (US) or visit https://www.jasonhartman.com/ Guided Visualization for Investors: http://jasonhartman.com/visualization  

Wafik El-Deiry, MD, PhD, FACP, is Associate Dean for Oncologic Sciences at the Warren Alpert Medical School, Director, Cancer Center at Brown University, practicing oncologist and ACS Professor. El-Deiry earned MD/PhD degrees at U. Miami, completed Medicine residency, Oncology fellowship at Johns Hopkins where he discovered CDK-inhibitor p21WAF1. He was HHMI Investigator, tenured Professor of Medicine, Genetics and Pharmacology, Associate Director for Physician-Scientist Training in Hem-Onc, and Radiobiology Program leader at Penn's Abramson Cancer Center. He was Chief of Hem-Onc at Penn State, and Deputy Director at Fox Chase Cancer Center. Dr. El-Deiry discovered TRAIL death receptor DR5, TRAIL-Inducing Compound #10 (TIC10), and founded Oncoceutics to bring TIC10/ONC201 to patients where it showed exceptional responses against glioblastoma. He has >400 publications, 5-edited books, H-Index of 120 with > 83,000 citations in Google Scholar. He is an ASCI, AAP member, Past President of Interurban Clinical Club (2013-2014), and Elected Member of Johns Hopkins Society of Scholars (2014). He won the Michael Brown Award (Penn), the Elizabeth and John Cox Award (Georgetown), and the International Kuwait Prize for Cancer. Dr. El-Deiry trained many students, fellows, physician-scientists, and continues to mentor scientists and faculty in basic and translational cancer research. Dr. El-Deiry is one of the original physician-scientists on social media who was recognized among the top 10 Oncologists in the world for impact on Twitter in 2021. Follow him @weldeiry “If you try 10 things and one of them works, you'll be successful.” From naming the WAF1 gene as an oncology fellow to becoming one of the most cited researchers in oncology, Dr. El-Deiry shares with us his unique journey in the space of cancer research. Join us as he shares anecdotes from his early career, overcoming rejections and developing a persistent yet agile mindset to make his mark in medicine. Pearls of Wisdom: 1. If you limit yourself to one attempt and fail, you will think of yourself as a failure. Try your hand at ten things. If you succeed at even one of them, then you are successful. 2. There's a fine line between believing in what you do and understanding the limitations of your idea. That's when you can decide to continue being persistent or decide to be agile and open to change. 3. Finding the right mentor is crucial. What separates a good mentee from a great mentee is their drive to keep trying different things and perpetually reaching out to their mentor to find the right answer.

To claim CME credit, visit https://i3health.com/oda-thyroid While thyroid cancer is the most common endocrine cancer, prognosis and survival rates vary widely by subtype. This episode of Oncology Data Advisor will focus on advances in the management of differentiated and anaplastic thyroid cancers. It features perspectives from two noted experts in the field: Dr. Jochen Lorch, Director of the Thyroid Cancer Center at Dana-Farber Cancer Institute; and Ms. Carolyn Grande, Oncology Nurse Practitioner at Abramson Cancer Center. This activity is supported by an educational grant from Lilly. For further information concerning Lilly grant funding, visit www.lillygrantoffice.com. Free CME and NCPD credit are available for this podcast. To claim credit and obtain further information, including faculty disclosures, visit i3Health.com/ODA-thyroid.

Dr. John Sweetenham, associate director for clinical affairs at the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern and editor-in-chief of ASCO Daily News, discusses compelling approaches in cancer care featured at the 2021 ASCO Annual Meeting, including key studies on financial toxicity, drug prices, disparities in clinical trial accrual, and the impact of the COVID-19 pandemic on cancer screening.   Transcript ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. My guest today is Dr. John Sweetenham, associate director for clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center. Dr. Sweetenham also serves as editor-in-chief of ASCO Daily News. He joins me to discuss compelling approaches in cancer care featured at the ASCO Annual Meeting, including key studies on financial toxicity, trends in oncology drug revenue, disparities in clinical trial accrual, and the impact of the COVID-19 pandemic. Dr. Sweetenham reports no conflicts of interest relating to our discussion today. Full disclosures relating to all episodes of the podcast are available at asco.org/podcasts. Dr. Sweetenham, it's great to have you on the podcast again. Dr. John Sweetenham: Thanks, Geraldine. It's good to be here. ASCO Daily News: There's been a lot of interesting research on the impact of the COVID-19 pandemic on patients with cancer. Sadly, the pandemic caused the postponement or cancellation of countless screening procedures. Abstract 6501 looks at the impact of the pandemic on stage presentation of breast and colorectal cancers. What can you tell us about this study? Dr. John Sweetenham: I think this particular study is very important because it is a confirmatory study of observations that have been made in other environments. But in this case, it's a single institution study from UC San Diego. The implication, the basis of this study, obviously, is that screening programs have really been critical in reducing death rates from certain cancers. And breast and colorectal cancer would probably be the best examples of that. And as we know, during the pandemic, many people postponed or cancelled their screening procedures. And so there have naturally been concerns about what that will do to stage at presentation, and an anticipation that we will see more patients eventually showing up for our services with more advanced stage of disease. So in this study, the workers at UC San Diego looked at their patients who had been treated in the years 2019 and 2020. And the treating clinicians used stage at presentation, which was determined by standard AJCC staging modules pulled out of their electronic medical record. And they did a pretty straightforward comparison of the stage distribution for their patients between 2019 and 2020. And they focused especially on colorectal and breast cancer because those are diseases where screening is known to have a significant impact. The interesting data from this study are that the total number of new patient visits for cancer during 2019 and 2020 were actually remarkably similar. And if you look at the stage distribution across all cancer types and compare 2019 and 2020, there really isn't very much difference. But what's disturbing is that for patients with breast cancer, they observed a lower number of patients with stage I disease, which reduced from 64% in 2019 to 51% in 2020, and a higher number of patients presenting with stage IV disease, which went from 2% to 6%. And very similar trends were seen for the patients with colorectal cancer, where they saw a decline in stage I presentations and an increase in stage IV presentations. So these are, again, confirmatory data which highlight the problem with delayed screening. The investigators mentioned that they're going to continue to follow these numbers closely and are planning to present data from their experience in 2021 as well. I think that what this does is really--it emphasizes the need for us for ongoing efforts to encourage our patients to return to care, to return to their screenings, and frankly, to get vaccinated so that they will have more confidence in coming back and returning to care. ASCO Daily News: Thank you for sharing these data. There are a lot of financial toxicities associated with cancer care. And there's an interesting study, Abstract 6504, that uses data from patients' credit reports to measure the relative risk of adverse financial events in cancer patients after diagnosis compared to individuals without cancer. Can you tell us more about this? Dr. John Sweetenham: Yes. And my first disclaimer would be that I'm certainly not a health economist. But as someone who is a non-expert in this domain, I found this to be a very interesting study which looked at the relative risk of adverse financial events in patients with cancer compared with a control group. And it did this by using data that they pulled from the patient's credit reports, which, from my perspective, is a really interesting way of looking at the financial hardship. And the way they did this was they used the Western Washington SEER cancer registry for their cases who they investigated in this study. And they used the voter registry to identify their control patients or control cases, I should say. And then they used data from one of the credit reporting agencies to look for signals for what they describe as adverse financial events in the patients with cancer compared with the population. And they were able to identify levels of severity of adverse financial effects within this analysis. So to cut to the chase here, what's interesting is they identified more than 300,000 individuals, of whom just over 84,000 were patients with cancer. And the remaining 250,000 or so were control patients. And they looked at the available line of credit for these patients, and then also looked for signs of what they described as severe, or more severe, or most severe adverse financial effects. And the most severe would have been, for example, foreclosures on homes or repossessions of homes and properties. So obviously, pretty significant and very serious adverse financial effects. And if we just look overall at their results, so for example, severe adverse financial effects, there was a highly significant difference which demonstrated that these were significantly more common in the population of patients with cancer, the same being true for both the more severe and the most severe adverse effects. And so, in a way, you could argue not surprising. But I think it put some numbers around the fact that there are long lasting effects financially for our patients with cancer, for a significant proportion of them, as a direct consequence of their diagnosis and compared in quite a robust way against a non-cancer population. And these are real life and very long term consequences, so something that we just have to keep uppermost in our minds as we're planning the financial advice and the financial navigation that we provide to our patients during their cancer journey. ASCO Daily News: Absolutely. Well, let's focus on the price of cancer drugs. Abstract 6505 looks at trends in oncology drug revenue among the world's major pharmaceutical companies. The study's authors cite a 70% increase in the number of clinical trials for cancer drugs over the past decade, and a substantial increase in the price of cancer drugs. In fact, the study found a 96% increase in sales revenue from cancer drugs among the world's top pharmaceutical companies over the past decade. So what are your thoughts about this? And why, in your opinion, is this study important? Dr. John Sweetenham: Thanks, Geraldine. Yes, I think that this study is important on a number of levels. I think when one first looks at the results of this study, it would be easy to conclude that, well, this is just one more piece of data that shows that the cost of cancer drugs is rising and is too high. And that's reflected in the extraordinary financial toxicity that we see in our patients with cancer. And you know, I think that there are elements of that which are probably true. But I do think there are other interesting observations from this. For example, as you mentioned, they demonstrated that sales revenue from cancer drugs has increased by more than 96%. And interestingly, revenues from non-cancer drugs among the same companies have actually decreased during that time. I would also mention, because it may be relevant, that although the analysis primarily included true antineoplastic drugs, they did include a number of supportive care drugs in this analysis as well, which are primarily used in patients with cancer. And so, certainly, I think in addition to the antineoplastic drugs, probably, the supportive care drugs have been part of the driver of this increase in revenue. The other interesting part of this is that during the study period, oncology revenues have grown, whereas revenues for other non-oncology drugs across all of the companies involved have remained stagnant. So what can we draw from this? First of all, as I said, I think the message about the cost of drugs is familiar to all of us and is not a new one. I think it is very interesting that there's been a 70% increase in the number of clinical trials of cancer drugs. And I think what that's telling us is that clearly, there has been enormous activity and substantial opportunity for the development of new cancer drugs. So as we look at these numbers, I think one of the positive spins to put on this is the fact that there are a lot more anti-cancer drugs coming online, a lot more trial activity. And in the long run, I think that has to be good for our patients. And we should be, to some extent, reassured by the fact that there are so many more drugs. I think also, what's interesting, although I certainly wouldn't editorialize over this, is the fact that this apparent explosion in activity and revenue around anti-cancer drugs has apparently been at the relative disadvantage of patients with other diseases, not really a thing for us to comment on that from what I classify as an editorial perspective. But I think the message for us and for our patients from this study is mixed, that, yes, there does seem to be some imbalance in terms of the amount of revenue generated out of these drugs. On the other hand, there are many of these agents now in clinical trials and on the market that weren't there a number of years ago. And overall, I think that that indicates the positive side of this story. ASCO Daily News: Well, I'd like to address a very important and timely topic, access to care. Abstract 100 reports the outcomes of a 5-year initiative of community outreach and engagement to improve enrollment of adult Black patients in clinical trials. How would you assess this initiative? Dr. John Sweetenham: I think this initiative and the results that they've produced really underlines, more than anything else, number one, the complexity that is involved in addressing this issue and the sort of multifaceted approach one has to minority accrual. And secondly, it underlines to me that there's no quick readout. One has to wait a while to see the effects of this kind of intervention. And there have been successful attempts to improve minority accrual to clinical trials. There are many ongoing initiatives. What struck me as being interested about this study from the University of Pennsylvania was the kind of multi-pronged approach they took to this. So they report that in 2014, Black residents comprised 19% of their population, [and] 16% of the cancer cases seen in the Philadelphia area. But only 11% of patients at the Abramson Cancer Center at the University of Pennsylvania were Black. And the number of Black participants who were recruited onto their treatment and interventional studies were relatively low, ranging between 8% and 13%, depending upon the type of study. So they developed a center-wide program with a number of key elements, which included tailored marketing. They had plans within each individual protocol for how they were going to enroll African American patients. They developed partnerships with faith-based organizations and conducted educational events. They provided Lyft and Ride Health to address transportation barriers. They had patient education by nurse navigators and an improved informed consent process. So they really approached this addressing several of the factors that play into the disparity in clinical trials accrual. And what they found is after 4 to 5 years of taking this approach, the percentage of Black patients seen at their center had increased to 16.2 from 11.1. And when they looked at the percentages of African American patients who they accrued onto their trials, it was really quite substantially increased. So if you remember, prior to this intervention, the range was from 8% to 13%. At the conclusion of this study, the rate was from 22% to 33%. So they had seen a 1.7 to 4-fold increase in 5 years. So I think that this persistent multi-pronged approach addressing many of the factors that play into these disparities was really interesting. And it demonstrates that to really make a significant impact on some of these disparities requires a lot of work over a long period of time. And as I said, the readout may not come immediately. It takes a while for the effects to truly be seen. ASCO Daily News: Exactly. Some great approaches there for people to look at in Abstract 100. Well, my final question relates to concerns from health insurers, that clinical trial participation can increase the total cost of care for patients. So in this study, Abstract 6513, investigators looked at the impact of clinical trial participation on total costs paid by Medicare during the oncology care model program in a large community-based practice. Can you tell us more about this study? Dr. John Sweetenham: Yes. This is an interesting study which is based on patients enrolled into the oncology care model. For those who may not be aware of this model, it's an alternative payment model which has been developed by the Centers for Medicare and Medicaid Innovation to address improvements in quality of care, as well as address issues of cost of care for patients with cancer. This study is based out of the community-based practice of 90 oncologists who practice [at] over about 30 sites of care. And what they did in this study was to link trial data and electronic medical record data with data generated from the oncology care model for patients undergoing treatment for various cancers between 2016 and 2018. And important to point out that the OCM includes patients who are Medicare beneficiaries only, so represents patients over age 65. And what they were trying to address in this study was whether the entry of patients onto clinical trials actually results in increased costs, which is, I think, some of the sort of received wisdom that's out there, that clinical trials are expensive. The OCM provides a slightly more controlled environment in which to study that and find out whether costs of care associated with clinical trials actually do overall increase the cost of care, something which clearly will be of great interest to insurers. So in addition to exploring this from the perspective of antineoplastic treatment, the group also had the opportunity to look at some non-trial episodes, and in particular, study the impact of the receipt of active treatments in the last 14 days of life as well as hospice use and hospitalizations. So these are other kind of issues which are important to us now which the OCM provides a window on. So the study was conducted and included just over 8,000 OCM episodes which met criteria for the study. And of those, 459 of the episodes included patients who were on a clinical trial. And interestingly enough, on average, episodes when the patient were on a clinical trial cost almost $6,000 less than matched non-trial episodes. And it was independent of whether it was an early phase or a late phase study. And interestingly, but perhaps not surprisingly, the primary reason for these lower costs was because of the increased drug costs. Because typically, the cost of the drug would have been covered by the trial. Interestingly, there were no differences in the rates of treatment within the last 14 days for the patients who were on the study. And there was no difference in rates of hospitalization or hospice use for the patients who were on the studies either. So the take-home message from the study was that the inclusion of patients in a clinical trial actually, overall, led to a reduction in Medicare costs for Medicare beneficiaries. And so it didn't support the concern that many third party payers have, that entry of their covered patients onto clinical trials actually cost more. Just one possible note of caution is that this was a community oncology-based practice. And it's possible that the breakout of patients on early phase versus late phase clinical trials might have been very different from what we might encounter in a more academic oncology setting. But nevertheless, I found this to be an important study which, to some extent, explodes a misconception that putting patients on studies costs a lot more money. ASCO Daily News: Absolutely. Well, Dr. Sweetenham, thanks for highlighting some really interesting studies on a range of very important issues impacting the cancer care community. Dr. John Sweetenham: Thanks, Geraldine, a pleasure as always. ASCO Daily News: And thank you to our listeners for your time today. If you enjoyed this episode, please take a moment to rate and review us wherever you get your podcasts.   Disclosures:  Dr. John Sweetenham: None disclosed.  Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In this episode, Peter Panageas SVP & President Market of IBX and Dr. Ursina Teitelbaum of the University of Pennsylvania's Abramson Cancer Center talk about how COVID-19 has accelerated the use of telemedicine. Both share their personal experiences with Telemedicine from three perspectives: the patient, the caregiver, and the doctor. And both weigh in on whether or not we think telemedicine is here to stay. Get the show notes for this episode at insights.ibx.com.

Dr Corey Langer from the Abramson Cancer Center at the University of Pennsylvania discusses recently published and emerging data on the role of immune checkpoint inhibitors in the treatment of metastatic non-small cell lung cancer without actionable mutations. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayNSCLCWT21)

Suzanne McGettigan, MSN, CRNP, AOCN®, of Abramson Cancer Center, talks about the mutually beneficial nature of peer review and gives tips on what to expect from the process and how to get started.

Katrina Armstrong, MD, is the Jackson Professor of Clinical medicine at Harvard Medical School, Chair of the Department of Medicine and Physician-in-Chief of the Massachusetts General Hospital. She is an internationally recognized investigator in medical decision making and quality of care in cancer prevention and outcomes. An award-winning teacher and a practicing primary care physician, Dr. Armstrong has served on multiple advisory panels for academic and federal organizations and has been elected to the American Society of Clinical Investigation and the Institute of Medicine. Prior to coming to Mass General, Dr. Armstrong was the Chief of the Division of General Internal Medicine, Associate Director of the Abramson Cancer Center, and Co-Director of the Robert Wood Johnson Clinical Scholars Program at the University of Pennsylvania. It, where and how: How do these three words intersect? Today, Dr. Katrina Armstrong shares her life story and experiences as she found her passion, defined the direction of her career, and reached out to mentors every step of the way. She talks about finding our “it”: the thing that lights us up. Something that gets us so excited that we feel like sharing it with everyone--even our taxi driver! And then using that to define "where" we want to go in our careers, a decision that each one of us has to take individually. Now we need to turn to our mentors for guidance. They will share the "how": the tools and experience we need to move towards our "where" and fulfill our "it"! Pearls of Wisdom: 1. The key to balance is knowing we aren't going to be perfect at it. There is magic in accepting our limitations. Because when we learn how to forgive ourselves for being imperfect, it becomes infinitely easier to forgive those around us too. 2. The goal of the patient encounter is to find some way to connect with that patient in the first five minutes. We need to remember that they are often terrified of their illnesses, of being in the hospital it's up to us to ease that for them as soon as we meet them. 3. You know you've found your “it” when you feel like you have to share it with everyone: Even your taxi driver. That's the litmus test for finding your true passion in medicine. 4. Mentees should set the ‘where' and mentors should set the ‘how'. Mentors help us figure out how to get to where we want to go. But where we want to go depends entirely on us.

For this special edition of Oncology Today, I met with Dr Kim Reiss Binder from the Abramson Cancer Center in Philadelphia to discuss recently published and emerging research on the use of PARP inhibitors in pancreatic cancer. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayPARPPanc20).

Richard Vague is Acting Secretary of Banking and Securities for the Commonwealth of Pennsylvania. Previously, he was co-founder, Chairman and CEO of Energy Plus, an electricity and natural gas supply company operating in states throughout the U.S. that was sold to NRG Energy in 2011. Vague was also co-founder and CEO of two credit card companies – First USA, which grew to be the largest Visa issuer in the industry and and Juniper Financial, the fastest growing credit card in its era.  Richard currently serves on the University of Pennsylvania Board of Trustees and the Penn Medicine Board of Trustees. He is chair of FringeArts Philadelphia, chair of the University of Pennsylvania Press, and chair of the Innovation Advisory Board of the Abramson Cancer Center.  He also serves on the Governing Board of the Institute for New Economic Thinking. Richard is also the founder of the email newsletter service Delanceyplace.com, which focuses on non-fiction literature.    He is the author of A Brief History of Doom, a chronicle of 6 major world financial crises, and The Next Economic Disaster, a book with a new approach for predicting and preventing financial crises.

Dr. David Weiner is Executive Vice President, Director of the Vaccine & Immunotherapy Center, and the W.W. Smith Charitable Trust Professor in Cancer Research at The Wistar Institute. He is also Emeritus Professor of Pathology and Laboratory Medicine at the Perelman School of Medicine at the University of Pennsylvania. In the lab, David and his colleagues are creating drugs using the same DNA codes and signals that our bodies use naturally. The drugs they are creating are natural compounds that can be given to people to prevent them from getting sick or to help them be healthier. One area of David’s research focuses on developing DNA vaccines to prevent illness. These DNA vaccines are designed to create specific proteins that trigger the immune system to respond to fight particular pathogens. David and his wife enjoy reading and going on walks with their dog Ruby. Ruby is a Shih Tzu Yorkie mix that they rescued after a recent hurricane in Puerto Rico. David received his B.S. in biology from the State University of New York at Stony Brook, his M.S. in biology from the University of Cincinnati, and his  Ph.D. in developmental biology from the University of Cincinnati College of Medicine. Afterwards, David worked as a research fellow in the Department of Pathology and Laboratory Medicine at the University of Pennsylvania before joining the faculty there. He held a joint position as Assistant Professor of Pathology and Laboratory Medicine at The Wistar Institute and the University of Pennsylvania School of Medicine from 1990-1993. David returned to The Wistar Institute in 2016 to accept his current positions. Among his many awards and honors, David has been elected as a Fellow of the American Association for the Advancement of Science and the International Society for Vaccines. He has also received the NIH Director’s Transformative Research Award, the Vaccine Industry Excellence Award for Best Academic Research Team, the prestigious Hilleman Lectureship from the Children’s Hospital of Philadelphia, a Stone Family Award from Abramson Cancer Center for his groundbreaking work on DNA vaccines for cancer immune therapy, and the Scientific Achievement Award from Life Sciences Pennsylvania. In addition, David was named a "Top 20 Translational Researchers" in 2016 by Nature Biotechnology.

A. Kate MacDougall, editor and writer, speaks with Beth Eaby-Sandy, MSN, CRNP, OCN, of the Abramson Cancer Center on data showing that women still lag behind men in areas like pay and leadership positions, and the particular challenges in oncology for women. Articles referenced in this episode: Women in Healthcare Leadership 2019, Oliver Wyman. https://www.oliverwyman.com/our-expertise/insights/2019/jan/women-in-healthcare-leadership.htmlStill a Man's Labor Market: The Slowly Narrowing Gender Wage Gap, Institute for Women's Policy Research, November 26, 2018. https://iwpr.org/publications/still-mans-labor-market/ 2017 National Nurse Practitioner Sample Survey, American Association of Nurse Practitioners, August 8, 2018. https://www.aanp.org/news-feed/2017-national-nurse-practitioner-sample-survey-resultsHow Medicine Became the Stealth Family-Friendly Profession, Claire Cain Miller, The New York Times, August 21, 2019. https://www.nytimes.com/2019/08/21/upshot/medicine-family-friendly-profession-women.html Female Physicians Reject Good Enough Miriam A. Knoll, MD, Forbes, 2019. https://www.forbes.com/sites/miriamknoll/2019/08/23/female-physicians-reject-good-enough/#1664020f63caThe Business of Health Care Depends on Exploiting Doctors and Nurses, Danielle Ofri, The New York Times, June 8, 2019. https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html What's Holding Women in Medicine Back from Leadership, Harvard Business Review, June 19, 2018. https://hbr.org/2018/06/whats-holding-women-in-medicine-back-from-leadership

The Abramson Cancer Center recently awarded a Translational Center for Excellence grant to the Ovarian Cancer Research Center. Ronny Drapkin, MD, PhD examines advances in Ovarian Cancer treatment research and what the objectives are for the Ovarian TCE.

Did you ever think you’d end up working in Africa?Neither did Dr. Lawrence Shulman. But then we never had Paul Farmer as our intern. Dr. Shulman – an oncologist who specializes in breast cancer – did.Farmer, if you don’t know, is the American anthropologist and doctor who in 1987 co-founded Partners in Health, an international non-profit that, in its own words, brings “health care to the world’s poorest families.” That means in places like Haiti and Rwanda.Which is why some eight years ago, Shulman found himself in Rwanda, as he wrote, walking “through hospital wards filled with patients with advanced cancers, who had never had a biopsy or diagnosis, and had no options for treatment.” He continued: “I knew that many of these patients would survive if they had access to the types of treatments available in the United States, and I was determined to help bring these treatment options to patients in Rwanda.”And that’s what Shulman has done. He has helped establish cancer programs there and in Haiti, and now has branched out to Botswana – places where, historically, because of delayed and late-stage breast cancer diagnoses, the chance for a successful outcome was greatly diminished.Shulman and colleagues have now trained nearly 200 rural health center nurses in clinical breast exams and evaluation, nearly 2000 community health workers in the basics of breast awareness and patient education, and multiple district hospital clinicians in breast ultrasound. As you’ll hear, the work is remarkable, and the results outstanding.More on Shulman: He is Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine in the Abramson Cancer Center at Penn. He is the former Chair of American Society of Clinical Oncology’s Quality of Care Committee, and currently is a member of ASCO’s Global Oncology Leadership Task Force and International Affairs Committee.

This JCO Podcast provides observations and commentary on the JCO article “Therapy-Related Cardiac Risk in Childhood Cancer Survivors: An Analysis of the Childhood Cancer Survivor Study” by Bates et al. My name is Joseph Carver, and I am the Chief of Staff at the Abramson Cancer Center of the University of Pennsylvania in Philadelphia, Pennsylvania. My specialty is cardio-oncology. It is universally accepted that therapeutic radiotherapy and/or anthracycline-based chemotherapy have a significant impact on the heart resulting in cardiac morbidity and mortality. High risk groups are now defined on the basis of a doxorubicin-equivalent anthracycline dose of ≥250 mg/m2 and/or total radiation dose of ≥30 Gy when the heart is in the treatment field.   It is universally accepted that therapeutic radiotherapy and/or anthracycline-based chemotherapy have a significant impact on the heart resulting in cardiac morbidity and mortality. High risk groups are now defined on the basis of a doxorubicin-equivalent anthracycline dose of ≥250 mg/m2 and/or total radiation dose of ≥30 Gy when the heart is in the treatment field.  Total dose delivered does not reflect specific cardiac exposure.  This has led to report the mean heart dose that is the percent cardiac volume within the radiation fields.  For most treated patients, discovery of anthracycline cumulative dosing is easily abstracted and straightforward. For modern therapeutic radiation, however, historical mean heart dose or other cardiac dosimetric parameters have not been traditionally reported and may be more difficult to obtain. This has led to a lack of consensus about the cardiovascular risk when the total dose is 5-year survivors who were treated for a variety of cancers at a median age of 7 years.  Evaluation occurred at a median follow-up of 20.3 years with a median attained age of 27.5 years.  Late cardiac risk was compared to 5,046 untreated siblings.  For each survivor, radiation fields were reconstructed on age-specific phantoms to calculate estimated mean heart dose and the percent of heart volume receiving at least 5 Gy (low dose) and 20 Gy (higher dose).  Doxorubicin-equivalent doses were similarly abstracted.   Toxicity parameters were any cardiac disease, coronary artery disease and heart failure.  They found a cumulative incidence of cardiac disease, 30 years from diagnosis of 4.8% (95% CI 4.3-5.2). There was a dose relationship between mean heart dose and all parameters.  Both low-moderate doses (5-19.9 Gy) to a large volume of the heart (>50%) and higher doses (≥20Gy) to small cardiac volumes (0.1-29.9%) were associated with an increased risk of cardiac disease. Heart failure drove the risk of high doses to small volumes while CAD drove the risk of low doses to large volumes.   Similarly, they reconfirm the relationship between cumulative anthracycline dosing and any cardiac disease with an increased risk for those treated at a younger age (≤ 13 years of age).  An increased relative risk for any cardiac disease was also present with any anthracycline exposure (0.1-

First on the show this week is Susan Elder, March of Dimes Senior Development Manager, and Tracy Davidson, Morning Anchor for NBC10 News Today. November is Prematurity Awareness Month, and March of Dimes is hosting their annual Signature Chefs Gala benefiting the Philadelphia area March of Dimes on November 15th.  This year they are recognizing Tracy Davidson as the Roosevelt Honoree for her years of dedication to the organization. Signature Chefs Gala brings together Philadelphia’s premier restaurants and chefs for an evening of fabulous food and fun. Find out what’s cooking and purchase tickets to fund the mission at www.signaturechefs.org/philly.   Then we meet the wonderful Jessy Kyle, a Philadelphia based jazz/soul singer, songwriter, and pianist. Jessy is also a Cancer Survivor and will be sharing her story and performing live at Philly Fights Cancer: Round 4 on Saturday, November 10th. This year’s event will feature a performance by comedy icon Jerry Seinfeld, followed by a concert from internationally acclaimed Grammy-winning pop superstars Maroon 5. The signature fundraising event of Philly Fights Cancer stands out as one of the highlights of the Philadelphia social season. This star-studded evening, which welcomes guests of all ages, honors the doctors and physicians working to eradicate cancer by showcasing the stories of survivors whose lives have been saved as a result of the groundbreaking medical advances of the Abramson Cancer Center. For more info, visit phillyfightscancer.org

In this episode, I am excited to have Donna Branca on to talk about meditation and mindfulness in the legal profession. After 13 years spent at Blank Rome as their Director of Talent Management, Donna Branca left to further develop her leadership and coaching skills. Given her extensive experience in coaching and leadership, as well as her institutional knowledge of the firm, Donna returned to Blank Rome four and a half later as the Director of Strategic Leadership. She works to help the firm leadership, partners, and associates be the best they can be.   Topics Covered Her introduction to mindfulness; how it became an instrumental part of her healing through a turbulent period, and how she utilizes it in her training at the firm. Acute stress (fight or flight) vs. chronic stress, and why it can be important to distinguish for mental well-being. The practice of meditation and the importance of seeing it as a journey rather than something to be conquered. The impact of mindfulness on one's overall success, and mindfulness in the legal profession.     Questions? Comments? Email Jeena! hello@jeenacho.com. You can also connect with Jeena on Twitter: @Jeena_Cho For more information, visit: jeenacho.com Order The Anxious Lawyer book — Available in hardcover, Kindle and Audible Find Your Ease: Retreat for Lawyers I'm creating a retreat that will provide a perfect gift of relaxation and rejuvenation with an intimate group of lawyers. Interested? Please complete this form: https://jeena3.typeform.com/to/VXfIXq MINDFUL PAUSE: Bite-Sized Practices for Cultivating More Joy and Focus 31-day program. Spend just 6 minutes every day to practice mindfulness and meditation. Decrease stress/anxiety, increase focus and concentration. Interested? http://jeenacho.com/mindful-pause/ Transcript Donna Branca: [00:00:00] We can either be in the river and getting banged around by the rocks and the currents and the everything, and if we can get to the side and climb out we might be beaten up and wet, but we can look at the river. To me, that's what we're doing when we're practicing. It's all still there, but we're seeing it with some clarity. Intro: [00:00:25] Welcome to The Resilient Lawyer podcast. In this podcast, we have meaningful, in-depth conversations with lawyers, entrepreneurs, and change agents. We offer tools and strategies for creating a more joyful and satisfying life. And now your host, Jeena Cho. Jeena Cho: [00:00:47] Hello my friends, thanks for joining me for another episode of The Resilient Lawyer podcast. In this episode, I'm so happy to have Donna Blanca. She has spent 13 years at Blank Rome as their Director of Talent Development. Donna left to further develop her leadership and coaching skills. Given her extensive experience in coaching and leadership, as well as her institutional knowledge of the firm, Donna returned to Blank Rome four and a half years later as the Director of Strategic Leadership. She works to help firm leaders, partners, and associates be the best that they can be. [00:01:21] Before we get into the interview, if you haven't listened to the last bonus episode please go check it out. I shared a six-minute guided meditation practice to work with loneliness, which I wrote about on the ABA Journal this month. So often even though we can work with others in our firm, we can have that sense of isolation and loneliness. And I found that having a regular meditation and mindfulness practice helps me to be more aware. You can learn more about Mindful Pause and the six-minute program over at JeenaCho.com, or you can also check it out in the show notes. And with that, here's Donna. Donna welcome to the show. Donna Branca: [00:02:00] Thank you. Thank you Jeena, appreciate it. Jeena Cho: [00:02:03] So let's just start by having you give us a 30-second introduction of who you are and what you do. Donna Branca: [00:02:09] Well you gave a nice introduction there. It's my pleasure to be back at the firm, having spent a great part of my career here. But I'm now in a different function and at Blank Rome building a coaching culture. We do that both to help from a leadership perspective as well as a business development perspective. So in my space, it's pretty much on the leadership side. So I work with senior leaders, but I also work with any number of our partners and associates, and I do training and coaching and one-on-one coaching, some group coaching, and then a smattering of some other things that involve leadership. So it's been great to be back, and it just seems like a good fit. Jeena Cho: [00:02:59] I know that you have a personal mindfulness practice, and I'm curious to hear how you got into practicing mindfulness and what that practice looks like for you now? Donna Branca: [00:04:19] Yeah, I've been meditating now for about 12 years. And I actually was at the firm, part one at Blank Rome; and I had some things going on, and it's actually also how I was introduced to coaching. I retained a coach for myself and we were working through some career goals, that sort of thing. And one thing led to the other and the coach actually asked me if I knew anything about mindfulness, she had just taken a course at the University of Pennsylvania. So I had zero introduction to mindfulness until then. And I was a little skeptical, but I'm curious by nature so I researched it and ultimately signed up for it, in part because I thought it might help the lawyers that I worked with. So I registered for that course, and somewhat ironically instead of starting that course the same day at the University of Pennsylvania, I woke up at the University of Pennsylvania Hospital with a diagnosis of ovarian cancer. [00:05:06] So I didn't actually get there for that course, I remember in my fog at the time saying to my husband I think you better wheel me over to that mindfulness class because I think I'm going to need it. And frankly, it became a big part of my healing and it became a big part of my life since that time. So that's pretty much how I got introduced to it. [00:05:22] I should add that I did get back to the program about a year later, and it was remarkably powerful. I found myself saying at the end of the program, my teacher Michael Baime went around the room to say what did you get from this eight-week program? And I went first, having no idea what would come out of my mouth. And what I found myself saying was that it was remarkable how I felt like I had shifted my perspective and been able to pull myself away from the thought that were yanking me around, and that frankly if I found that my diagnosis had gotten worse and that I was even looking at dying that I found a tool that would help me do that. And that was a big "aha"; I didn't realize that that was going to come out of my mouth. But it's very true, that's how profound an effect it had on me. And about nine or ten months later I did a program for them with just cancer patients, because the Abramson Cancer Center was thinking of picking up the funding for it. And that's where it really locked in for me, going through a program with people who had not been introduced to mindfulness before and were at.. we talk about ruminating about the past and worrying about the future. There's no time more than when you have a life-threatening diagnosis. And watching what it meant to these people, it really locked it into me, as to how important this can be at any point in your life. But like I said, that locked it in for me; from the standpoint of how important it was to me, and to some extent a passion and to be able to introduce other people to it when they're ready. Jeena Cho: [00:06:57] Can you say more about how mindfulness practice helped you to recover? Not necessarily recover, but how it helped you through that journey through having cancer? Because obviously there's just so much uncertainty and fear, and all of the other emotions that I would imagine would come along with having that diagnosis and the treatment. But how did it help you in the day-to-day of your illness? Donna Branca: [00:07:29] So by the time I got to it, I was post-chemo. I really wish I had a mindfulness practice before I got to that point, but where it helped me (since I was post-chemo) was in that limbo stage that you go into; where you're not treating, you're not going through an active regimen of something, and you're just waiting. And where your mind can go with that can be either dark, or you can pull yourself out of it and have it not be so dark. And be grateful for the fact that you did get the medical care that you had and whatnot, and you just vacillate back and forth. And it's as if your mind decides where it's going to go on a given day, and what the mindfulness allowed me to do was really understand how to zoom out and look at the situation and choose my response. And I try to do, the University of Pennsylvania and this program that I do host two retreats a year, I try to do at least one. And it was at a retreat where I found what I was doing, when I was able to actually look at my thoughts almost as a focus of my meditation. Which I hesitate to say to some people, because it doesn't always resonate. But it was a moment of clarity that has stuck with me. I would say that.. I'm sure you've seen this news of the kids that were in the cave in Thailand, and thinking about that really resonates with me. And to answer your question around how it helped me, I mean when you think about what they were up against and sitting in this horribly dark cave where you can't see your hand in front of your face literally, being together and learning how to get mindful in order to get through that is just astounding. [00:09:43] But to be honest Jeena, I feel and have always felt that this is not something new that we're trying to learn; it's actually something we're trying to re-learn. You know when we look at babies and we look at children, they're much more mindful than we are. Jeena Cho: [00:10:04] Right, they're always in the present moment. Donna Branca: [00:10:06] Right. And at some point, we pull away from that. So it's kind of telling that these young men and children were able to get there somewhat quickly. And I don't know, I haven't talked to them obviously but that's what I'm making up about it; that that we are able to tap into what my experience has been around mindfulness, what I've watched plenty of other people's experience (I'm sure to some extent yours) has been around mindfulness. The diagnosis, the stress, the fear of what it means; I still get emotional seven years later. What it means to your family. Like right now, I cannot just pull myself out of it and get positive about it, but literally look at the thought and make a choice as to what road I'll go down. [00:11:13] So really, I have such gratitude towards this work. I actually have a lot of gratitude towards the work you do, that's how important I think this is. So I hope I answered your question, about how it helped me get through that. And frankly it's still a journey, once you have a diagnosis like that. I mean I'm very grateful, I have a fairly good bill of health. The doctor says something else is more likely to kill me than my ovarian cancer, but when you face death that way and your own mortality, it shifts thing quite a bit. So I count on my practice to help me in all sorts of things. Jeena Cho: [00:12:01] I remember when I went through the 8 week mindfulness MBSR class for the first time, I was so struck by the range of human experience that were present in the room. There were first year (I took it at Stanford) undergrad Stanford kids and they're like, oh I don't know what I should do when I grow up and I just feel so anxious all the time. To people that were caregivers to loved ones that were dying, we also had people that had terminal illnesses. It was just the whole range, and I think that class is so impactful because it pulls you out of your own experience and you start to see human suffering happens to everyone. It just gave me such an appreciation and that ability to be a little bit softer. I think as lawyers we're so used to striving and forcing our way through things, and it makes you think no. Sometimes I guess there's a place for it, but oftentimes all it does is just aggravate the situation. To back up a little bit, can you talk a little bit about the difference between acute stress and chronic stress? Donna Branca: [00:13:27] Absolutely, and I just actually did a program yesterday for our summer associates. So if we think about the predator jumping out in front of us ready to eat us, our stress response is involuntary; it just kicks in. And our essential systems, our non-essential systems shut down. Take it back to high school, the whole stress response, right? We know this, but it serves to remind ourselves in this context. Where if we think of a predator jumping out and we hit fight or flight, and that trigger puts our system into this involuntary. Where our heart beats faster and our lungs beat faster in order for us to either fight this thing or get rid of it. At the same time, our non-essential systems shut down. So we don't need our digestion, we don't need reproduction, we don't need our immune system. We lose our ability to creatively problem-solve, because we don't have time for that in this situation. So all of that can be, once the predator is either gone or you've killed it, it automatically brings us back to homeostasis. So the relaxation response kicks in, but in chronic stress that's not happening. So if we're keeping ourselves in this constant state of chronic stress, then it does impact those non-essential systems that shut down. It does impacts digestion and reproduction and our immune system and our ability to creatively problem solve. So what we want to do there is to insert a relaxation response, in order to bring us back to homeostasis. And the relaxation response is both voluntary and involuntary, so we can actually do that. And to me, that's what mindfulness practice does. Being able to calm yourself and bring in the relaxation response, to me helps if you actually have a practice. So you are conditioned to do that, as opposed to trying to remember to settle and breathe at a time where you want to insert the relaxation response. Because when we are at chronic stress, it's hard to remember it. So that's why I think a regular practice helps me do that, and I've seen this work with people; it certainly has worked in my life. To insert something that brings me back to recovery, right? So chronic stress is really just that stress with the absence of recovery, and we can actually impact that. Jeena Cho: [00:16:14] Right. And so often we can keep that chronic stress going by re-remembering some triggering event. So you may have a hearing and the hearing didn't go your way, and rather than let it go and return your body back to homeostasis you just keep repeating the hearing over and over and over again in your head. You keep repeating what the judge said, what the opposing counsel said, and think about how unfair it was. You build up a whole narrative in your own mind, and then that just keeps your body in that elevated stress level. Donna Branca: [00:16:50] Absolutely. And we talk about how this trigger that might be a predator, this trigger can be a partner standing at your door or a law professor making a demand; it can also be an internal thought. This inner voice that we have can be a real trigger, like you just said. So we're just re-triggering and re-triggering and re-triggering when we are ruminating about that. So I couldn't agree more, I couldn't agree more. Jeena Cho: [00:17:23] Yeah, and so often our own mind is our worst enemy. I remember when I first started practicing mindfulness, I would sit to meditate (and I'd actually be curious to hear your thoughts on this) because that's what they tell you to do. Like okay, you want to let go of chronic stress and find these and find relaxations. So I would be sitting there and I'd be meditating, and I found it to be anything but relaxing. And I would just sit there the whole time (10 minutes) and I would have to force myself through it. And I was convinced that it was actually making me more anxious, that I couldn't find relaxation and ease. [00:18:03] So, have you noticed that in your own practice? And what do you say to the beginning meditators that's like no, when I sit down to meditate I actually notice more anxiety and more stress? Donna Branca: [00:18:21] Oh absolutely. I think it's a bit of a misnomer and it's unfortunate that people come into this believing that they can clear their minds, or that that's the goal. And to some extent, the opposite is true. That might be a lovely byproduct at some point of your practice, but that's not the goal. And what I tell people and what resonates with me, is what you're really doing is you're being completely with what is. And that includes your thoughts. And if you can sit and be with them, without adding more thought and just looking at them, knowing that they exist; the trick is not to add more thought. [00:19:02] And what I tell people is whatever you've decided the focus of your meditation, whether it's breathing, whether it's parts of the body, whether it's something else, that the practice is in when you've seen your mind go off. And then you say okay, not judgmentally, and you bring it back. It's in the bringing it back that's the bicep curl; it's not trying to clear your mind, it's noticing where it went and being a choice to bring it back. And it's making that choice that is building the muscle that's going to allow us to make that choice when we're really in the midst of something else. Jeena Cho: [00:19:45] Yeah, that's so true. Donna Branca: [00:19:46] There was one metaphor that my teacher used that resonated for me, which was: we can either be in the river and getting banged around by the rocks and the currents and the everything, and if we can get to the side and climb out.. we might be beaten up and wet, but we can look at the river. To me that's what we're doing when we're practicing. It's all still there, but we're seeing it with some clarity and we're just not getting re-attached to it. And to me it's just this slight separation. But at the end of the meditation, you can meditate for ten minutes and get up and say oh my gosh, I only remember one breathe. But to me, that's still.. they say (and I believe this) your meditation practice can't suck, if you just set the intention and you sit and you set the intention. [00:20:54] If you only get three conscious breaths, its still doing the work it needs to do. And not every practice is going to be like that, most aren't going to be like. But you have to be with the ones that are in order to really gain some confidence that that's true. Jeena Cho: [00:21:15] Yeah I always find it to be so interesting, often I'll have lawyers come up to me after a talk and they'll say, "You know I tried meditation once, and it just didn't work." And I'll say, well what does that mean it didn't work? And they'll literally say something like, well I downloaded one of those apps and I sat down and I did a meditation, and it just wasn't calming; I found it to be very stressful. And it's like, well if you buy a gym membership and you went once and afterward you're sore and you didn't have the perfect body (whatever you were expecting from going to the gym), you wouldn't say well that didn't work. It's a journey, it's a practice; it's a life-long practice. Donna Branca: [00:21:57] It is. And I think when we got started, we did do the eight-week program and the homework that we were supposed to do; the 45 minutes of meditation every day. And the science is now telling us that that's not necessary, and that it's more important to be consistent every day, rather than long sits now and then. And I don't know if you agree with that, but that's what I understand to be the case. But I do feel like I needed that; I needed that to jumpstart what I saw to be so true by the end of the eight weeks. I think that had I not done that, I would have been one of those people that I said yeah, I did the Headspace thing once and it didn't work. So that's for me. I also meet people that that's not true for; I meet people who are very self-taught. But again, it's usually someone who can be with how yucky it can be sometimes to sit, and still do it every day and set the intention. Whether it's five minutes, whether its 20 minutes, but I have met plenty of people who are self-taught that way. But it is a bit of a discipline, in my mind. Jeena Cho: [00:23:30] Yeah, and it's such an interesting practice because it's almost like just showing up and doing the work, showing up and meditating; that's all there is to it. And letting go of how good it was, how bad it was, how often your thoughts drifted off. And I think that's so hard especially for lawyers, because we are such perfectionists and we want to do things perfectly, and we want to do things correctly. And I think it's very distressing when you sit down and you have some expectation about how it should go, and you very quickly learn your mind is like a tornado. It's really distressing, and I think it's just sitting in the midst of that distress and saying, well I'm just going to be with that. And it took me a long time, to get out of that judging mode. And I think having an eight-week class, where I would go back every week and say, you know I'm still sucking at this. And the teacher would smile and say, "Yeah? Keep doing it.” [00:24:31] And then after a while it wasn't so distressing that I was sucking at it, it was just like okay I'm just going to do it and not worry about whether it's good or bad. And that's such an important life lesson too, because so often we do something and we have no control over the outcome. You go and argue a hearing, and you don't get to control whether you win or lose. So really the only thing that you can put your effort into is showing up and doing the thing, you know? And I think that's what meditation teaches you, to just show up and do the thing and let go of that attachment to having a certain outcome. Donna Branca: [00:25:12] Absolutely, absolutely. And I do, as far as teaching this to lawyers or working with lawyers or how this might be a tool for lawyers in particular, I feel really, really committed to that, as I know you are. With law students, I'll just give you a quick story.. I was asked by a law school to do a presentation to a group of students and professors. There was a professor who was trying to get a mindfulness curriculum in the school, and she had asked me to come. And she had told me that she was really trying to draw professors to it, because that's the buy-in she really needed. And so I said I'd be happy to bring my husband (who is a judge) because although not a meditator, he had gone to a meditation retreat for me. Because I had been asked to do lots of work at that point with various firms and whatnot, and I asked him to go to this retreat for lawyers, judges, and law professors. And he was really resistant, but I really wanted to send in a skeptic with zero experience and allow it to inform my work. Because there is such a high level of skepticism among lawyers; it's what makes you so good at what you do. It makes you so valuable to your clients, to get them out of their own way. But when he came back, he was absolutely certain that it would have a huge impact on lawyers. [00:26:59] And from his literal perspective from the bench, watching lawyers who are so often either thinking about the next thing they're going to say or what just happened and how they can strategize, as opposed to listening to the witness and the nuances, or being really present with the jurors. He went back and it was somewhat of an experimental laboratory for him to watch this happen, and he was absolutely convinced. So he came to this program with me, as well as another judge who was self-taught, who heads up the drug court. And he uses it both for himself as well as to introduce it to the people who are in his drug court. He's a huge advocate of it, but he also believes that law students can often self-medicate and otherwise, to try to get through the stress. And he really asked them to look at this as a potential tool. And it was really powerful, the professors did come. As I thought they might, having a couple judges show up as opposed to just me. And it was really impactful, really impactful. [00:28:29] And I'm proud and happy to say that the professor did get her curriculum approved. And then subsequently, I was asked to be a guest speaker at one of her classes. And it was remarkable to see the curriculum and how rich it is. My piece was on mindful leadership, which for law students to be hearing this and learning it and experiencing it first-hand, really powerful. And it was so clear that this was such an important class for these students and such growth in it, that I believe every law school should have a curriculum of mindfulness. You know, the resilience that it takes to be a lawyer, the resilience that takes to be in big law or small law. It's every day you need to be resilient. You practice, you work, and you're at odds with someone all day. And the resilience that a lawyer needs is really critical. And I believe this is such an important tool to allowing them to look at things from a growth perspective; if they can shift and remove themselves from the turmoil of what's going on in a current moment and have a mindful response makes a huge difference. Jeena Cho: [00:29:59] Yeah. I Had a conversation with a judge, and he has a deep mindfulness practice. And one thing he told me that I thought was so heartwarming was it helps him to remember and to see (he also does criminal law) that every defendant that comes through his court is an individual, and to see that person as a human being with the full scope of human experiences. And that he's more than the sum of the crime that he committed, which led him to be in this courtroom. And I just thought, what if every lawyer can bring that level of thoughtfulness to everything that they do? Because I think we can get into this way in which we try to do things in bulk, because we're so overwhelmed and we lose that humanity. Donna Branca: [00:30:59] So true. When we talk about criminal law, it makes me think about the mindfulness programs that are going on in prisons and in police departments. And how that ability to learn how to insert a pause before you react, both as a criminal or as a cop.. the world would be a bit different, if we could just insert that pause. It would have a huge impact. So there's a lot of good things. Jeena Cho: [00:31:40] Sometimes when I talk to lawyers and talk about mindfulness, they'll say well that all sounds good, but I'm afraid that it's going to make me less effective; I'm going to lose my edge, or it's going to make me go soft. And I sort of like this aggression that I have all the time. And I think they're afraid of getting in touch with their own emotions, getting in touch with their own experience. And even just that pausing, I think is really frightening for a lot of people. Even just the idea of sitting quietly with your own mind. I'm curious to know what your thoughts are on that. Donna Branca: [00:32:23] I have, I do. It comes up in coaching, and it also is true of not wanting to come into coaching necessarily. Because they don't want to get in touch with this. I don't know if you'd call me "type A", but I am best when I am working like crazy. And so I'm more of that acute stress person, or maybe used to be chronic and now has learned acute, and it makes me so much sharper. And I have talked to many partners and associates and judges who have heard that, who have a practice but have heard that, and say they know that they are a better lawyer and are less stressed. They know when they are in a conference room with adversaries, that they can just look at how getting worked up is having people not be clear and not be as focused. So the lawyers that I talk to who have a practice absolutely say it makes them a better lawyer, and there is nothing about it that has made them lose their edge; it has sharpened their edges. And when we talk about the fight or flight, if our ability to creatively problem solve actually shuts down when we're in that state, then we aren't; then we aren't at our best and we are not focused. And we are not as resilient or as mindful or as present. There's not a lawyer that I know that got soft as a result of a mindfulness practice, there just isn't. [00:34:23] Again, it's tapping into this sixth sense that we forgot we had. Right? Like there's this backpack that is full of tools on our back that we've been carrying around we forgot, that's how I see it. And I really do see it as making people sharper, better lawyers, and better leaders. I do, I do hear that. I think that goes along with the higher level of skepticism. You know Larry Richard's work, where he found that lawyers do have a higher level of skepticism and we've talked about that. So I think there's a resistance, but I would encourage people to try it. It gives more space, not less space. We also talk about they don't have the time or what I talk about is that concept of managing your energy versus managing your time; that if you learn how to manage your energy, you will get more time. That seems to resonate with people. And a mindfulness practice (or whatever practice is important to you) that is going to help you sharpen your ax is really about managing your energy and refining how you utilize your energy, rather than being a prisoner to time. Jeena Cho: [00:36:00] And both of those things, time and energy, have their limits. In terms of how much energy and how much time you can exert on any given day. Donna Branca: [00:36:14] I'd agree but for the fact that energy is renewable, time is not. So what do we need to do to renew our energy? Because you're right, it's limited. If we keep our foot on the gas pedal we'll run out of gas. So what do we need to do to renew it? Sleep helps, mindfulness helps, running helps, exercise helps. Jeena Cho: [00:36:46] It's all the basics: eating well, getting enough sleep, getting some exercise, having connections with others. All of those things I think we all know to do, but somehow it's not a priority or it ends up on the bottom of our to-do list and then it doesn't get done. [00:37:11] Donna, one question for you before we wrap things up. The name of this podcast is called The Resilient Lawyer. What does it mean to be a resilient lawyer to you? Donna Branca: [00:37:24] It means more than just bouncing back and being able to bounce back from adversity, but bouncing back better. It means when these things happen (and they do often happen, on a daily basis), things don't go the way you need them to go, you went into a courtroom and the judge is in a mood or something doesn't go your way, and it's going to happen every day. And how can you grow from that, what have you learned from that, and how does that make you a better lawyer tomorrow? I'd say that's what being a resilient lawyer means to me. When we look at the lawyers that we admire most, there is resilience there; they have learned a whole lot along the way. [00:38:27] It reminds me, if I can just throw in this last joke, where someone asks this CEO what made him so successful and he said really good decisions. And when he was asked what enabled him to make really good decisions, he said experience. And then he was asked, how do you get that experience? He said, bad decisions. So to me, that's resilience. Right? Learning from all of the stuff that goes wrong, and figuring out what that might look like and how that might have changed us and shifted things going forward. That's a resilient lawyer. Jeena Cho: [00:39:14] Thank you so much for being with me today Donna, I really appreciate it. Donna Branca: [00:39:18] Oh it is such a pleasure, it really is. And thank you for your work. Closing: [00:39:25] Thanks for joining us on The Resilient Lawyer podcast. If you've enjoyed the show, please tell a friend. It's really the best way to grow the show. To leave us a review on iTunes, search for The Resilient Lawyer and give us your honest feedback. It goes a long way to help with our visibility when you do that, so we really appreciate it. As always, we'd love to hear from you. E-mail us at smile@theanxiouslawyer.com. Thanks, and look forward to seeing you next week.

In this interview, Dr David Henry, the Editor-in-Chief of The Journal of Community and Supportive Oncology, and Dr Daniel Haller of the Abramson Cancer Center, University of Pennsylvania Perelman School of Medicine in Philadelphia, discuss recent breakthrough studies in gastrointestinal cancers.

Robert Vonderheide, Director of Pennâs Abramson Cancer Center, demonstrates how the Center prioritizes patient satisfaction as a leader in innovation to fight cancer. See acast.com/privacy for privacy and opt-out information.

Host Jeff Voigt discusses the promise and progress of cancer vaccines, T cell therapy success and limitations, and how oncologists can use these potential tools in the treatment and prevention of cancer on The Business of Health Care. Panelists: Robert H. Vonderheide, MD, DPhil, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick MD Abramson Cancer Center’s Professor in Penn’s Perelman School of Medicine. Gerald P. Linette, MD, PhD, Professor of Medicine in the division of Hematology-Oncology and Medical Director of the Sean Parker Institute of Cancer Immunotherapy in the Perelman School of Medicine at the University of Pennsylvania. E. John Wherry, PhD, Richard and Barbara Schiffrin President’s Distinguished Professor of Microbiology and director of the Institute for Immunology at Penn. See acast.com/privacy for privacy and opt-out information.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Shira Johnson, MD Guest: Robert Vonderheide, MD For years, the foundations of cancer treatment, surgery, chemotherapy, and radiation therapy were utilized with the objective of weakening cancer. But over the past several years, immunotherapy – therapies that enlist and strengthen the power of a patient’s immune system to attack tumors - has emerged as a new tool for fighting cancer. In August 2017, one such treatment approach, called Chimeric Antigen Receptor or CAR T-cell Therapy, received FDA approval for the treatment of children and young adults with acute lymphoblastic leukemia (ALL). Additionally, research is continuing to look at CAR-T therapy’s effectiveness for treating solid tumors as well. Host Dr. Shira Johnson sits down with Dr. Robert Vonderheide, Director of the Abramson Cancer Center of the University of Pennsylvania and the John H. Glick, MD, Abramson Cancer Center Director’s Professor, to talk about the potential of CAR-T therapy alongside other emerging immunotherapies in fighting cancer.

Host: Barnett Mennen, MD Guest: Angela DeMichele, MD, MSCE Penn Medicine’s Breast Cancer Translational Center of Excellence (TCE), known as the 2-PREVENT TCE is led by Drs. Lewis Chodosh and Angela DeMichele. 2-PREVENT TCE aims to address one of the greatest challenges in breast cancer treatment: the high rate of relapse and late treatment effects among breast cancer survivors. Host Dr. Barry Mennen welcomes Dr. Angela DeMichele, the Alan and Jill Miller Endowed Chair in Breast Cancer Excellence, Professor of Medicine and Epidemiology, and Co-Leader of the Breast Cancer Research Program at the Abramson Cancer Center of the University of Pennsylvania School Of Medicine.

Host: Barnett Mennen, MD Guest: Angela DeMichele, MD, MSCE Penn Medicine’s Breast Cancer Translational Center of Excellence (TCE), known as the 2-PREVENT TCE is led by Drs. Lewis Chodosh and Angela DeMichele. 2-PREVENT TCE aims to address one of the greatest challenges in breast cancer treatment: the high rate of relapse and late treatment effects among breast cancer survivors. Host Dr. Barry Mennen welcomes Dr. Angela DeMichele, the Alan and Jill Miller Endowed Chair in Breast Cancer Excellence, Professor of Medicine and Epidemiology, and Co-Leader of the Breast Cancer Research Program at the Abramson Cancer Center of the University of Pennsylvania School Of Medicine.

Host: Barnett Mennen, MD Guest: Angela DeMichele, MD, MSCE Penn Medicine’s Breast Cancer Translational Center of Excellence (TCE), known as the 2-PREVENT TCE is led by Drs. Lewis Chodosh and Angela DeMichele. 2-PREVENT TCE aims to address one of the greatest challenges in breast cancer treatment: the high rate of relapse and late treatment effects among breast cancer survivors. Host Dr. Barry Mennen welcomes Dr. Angela DeMichele, the Alan and Jill Miller Endowed Chair in Breast Cancer Excellence, Professor of Medicine and Epidemiology, and Co-Leader of the Breast Cancer Research Program at the Abramson Cancer Center of the University of Pennsylvania School Of Medicine.

Host: Barnett Mennen, MD Guest: Angela DeMichele, MD, MSCE Penn Medicine’s Breast Cancer Translational Center of Excellence (TCE), known as the 2-PREVENT TCE is led by Drs. Lewis Chodosh and Angela DeMichele. 2-PREVENT TCE aims to address one of the greatest challenges in breast cancer treatment: the high rate of relapse and late treatment effects among breast cancer survivors. Host Dr. Barry Mennen welcomes Dr. Angela DeMichele, the Alan and Jill Miller Endowed Chair in Breast Cancer Excellence, Professor of Medicine and Epidemiology, and Co-Leader of the Breast Cancer Research Program at the Abramson Cancer Center of the University of Pennsylvania School Of Medicine.

Host: Lee Freedman, MD Osteosarcoma is a relatively rare but feared disease. What exactly is an osteosarcoma and how should it be worked up and treated? Host Dr. Lee Freedman discusses this diagnosis with Dr. Kristy Weber, Abramson Family Professor in Sarcoma Care Excellence and Professor, Vice-Chair of Faculty Affairs, Department of Orthopaedic Surgery; Director of the Sarcoma Program, Abramson Cancer Center; Chief, Orthopaedic Oncology.

Host: Lee Freedman, MD Osteosarcoma is a relatively rare but feared disease. What exactly is an osteosarcoma and how should it be worked up and treated? Host Dr. Lee Freedman discusses this diagnosis with Dr. Kristy Weber, Abramson Family Professor in Sarcoma Care Excellence and Professor, Vice-Chair of Faculty Affairs, Department of Orthopaedic Surgery; Director of the Sarcoma Program, Abramson Cancer Center; Chief, Orthopaedic Oncology.

Host: Lee Freedman, MD Multiple myeloma (MM) is an incurable malignancy of plasma cells. Although there have been significant advances in the survival of this condition over the past 15 years, understanding the progression from its precursor state and developing interventions to prevent MM would be significant advances. In this segment, host Dr. Lee Freedman speaks with guest Dr. Brendan Weiss, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania at the Abramson Cancer Center.

Host: Lee Freedman, MD Multiple myeloma (MM) is an incurable malignancy of plasma cells. Although there have been significant advances in the survival of this condition over the past 15 years, understanding the progression from its precursor state and developing interventions to prevent MM would be significant advances. In this segment, host Dr. Lee Freedman speaks with guest Dr. Brendan Weiss, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania at the Abramson Cancer Center.

Host: Lee Freedman, MD Presentation of lumps and bumps are common in the primary care setting, but the appropriate approach is vital to determine whether there may be a deeper problem. A better understanding can lead to more effective treatment. Expert guest Dr. Kristy Weber discusses musculoskeletal tumors during her discussion with host Dr. Lee Freedman. Dr. Weber is the Abramson Family Professor in Sarcoma Care Excellence as well as Professor, Vice-Chair of Faculty Affairs, Department of Orthopaedic Surgery; and Director of the Sarcoma Program, Abramson Cancer Center; and Chief, Orthopaedic Oncology.