Podcasts about abraxane

DITCH YOUR DOCTOR! https://www.livelongerformula.com/wam Get a natural health practitioner and work with Christian Yordanov! Mention WAM and get a FREE masterclass! HELP SUPPORT US AS WE DOCUMENT HISTORY HERE: https://gogetfunding.com/help-wam-cover-history/ GET NON-MRNA FREEZE DRIED MEAT HERE: https://wambeef.com/ Use code WAMBEEF to save 20%! GET HEIRLOOM SEEDS & NON GMO SURVIVAL FOOD HERE: https://heavensharvest.com/ USE Code WAM to save 5% plus free shipping! GET YOUR APRICOT SEEDS at the life-saving Richardson Nutritional Center HERE: https://rncstore.com/r?id=bg8qc1 Josh Sigurdson reports on the news of Big Pharma biotech billionaire and inventor of cancer drug Abraxane, Dr. Patrick Soon-Shiong declaring that the Covid "vaccine" has caused a massive uptick in cancer. Dr. Soon-Shiong is also the owner of the LA Times which has pushed pro covid vaccine propaganda on the masses for years including just recently. This is a big admission but obviously years late. The doctor pointed out that he's seeing metastatic pancreatic cancer in children as young as 13 which is extremely unusual. Pancreatic cancer usually only affects people 70 and older. It was a shock in 1991 when Michael Landon, actor and legendary TV producer was diagnosed with pancreatic cancer at 54 years old and died within 12 weeks. That was considered young. Now, here we are 3 decades later and it's being normalized to see young teens die from the horrible ailment. Moderna had previously confirmed last year that their mRNA "vaccines" cause cancer and in an exposed coverup, Pfizer had acknowledged behind closed doors that their injections did the same. Meanwhile, the latest normalization of disease related fear continues as Bird Flu propaganda is painted all over the media with claims that bobcats are spreading it as well as cat food. This is clearly an intro to the agenda to target the food supply and inject store bought meats with modRNA while simultaneously restricting food to rations. This is something the WEF has proclaimed they want to do so don't be surprised if we shift in that direction fast. In this video, we break down the latest propagandist claims and the real solutions before our eyes. Stay tuned for more from WAM! Get local, healthy, pasture raised meat delivered to your door here: https://wildpastures.com/promos/save-20-for-life/bonus15?oid=6&affid=321 USE THE LINK & get 20% off for life and $15 off your first box! SIGN UP FOR HOMESTEADING COURSES NOW: https://freedomfarmers.com/link/17150/ Get Prepared & Start The Move Towards Real Independence With Curtis Stone's Courses! GET YOUR WAV WATCH HERE: https://buy.wavwatch.com/WAM Use Code WAM to save $100 and purchase amazing healing frequency technology! GET ORGANIC CHAGA MUSHROOMS HERE: https://alaskachaga.com/wam Use code WAM to save money! See shop for a wide range of products! GET AMAZING MEAT STICKS HERE: https://4db671-1e.myshopify.com/discount/WAM?rfsn=8425577.918561&utm_source=refersion&utm_medium=affiliate&utm_campaign=8425577.918561 USE CODE WAM TO SAVE MONEY! GET YOUR FREEDOM KELLY KETTLE KIT HERE: https://patriotprepared.com/shop/freedom-kettle/ Use Code WAM and enjoy many solutions for the outdoors in the face of the impending reset! BUY GOLD HERE: https://firstnationalbullion.com/schedule-consult/ PayPal: ancientwonderstelevision@gmail.com FIND OUR CoinTree page here: https://cointr.ee/joshsigurdson JOIN US on SubscribeStar here: https://www.subscribestar.com/world-alternative-media For subscriber only content! Pledge here! Just a dollar a month can help us alive! https://www.patreon.com/user?u=2652072&ty=h&u=2652072 BITCOIN ADDRESS: 18d1WEnYYhBRgZVbeyLr6UfiJhrQygcgNU World Alternative Media 2025

In today's episode, we had the pleasure of speaking with Rachna Shroff, MD, MS, FASCO, about the phase 3 SWOG S1815 trial (NCT03768414) evaluating the addition of nab-paclitaxel (Abraxane) to gemcitabine and cisplatin in patients with newly diagnosed, advanced biliary tract cancer. Dr Shroff of the interim clinical affairs director, the associate director of Clinical Investigations, and co-lead of the Gastrointestinal Clinical Research Team, at The University of Arizona Cancer Center. She is also a professor in the Department of Medicine, chief of the Division of Hematology/Oncology, medical director for the Oncology Service Line, and associate dean for Clinical and Translational Research at The University of Arizona College of Medicine in Tucson. In our exclusive interview, Dr Shroff discussed the rationale for this research, key efficacy and safety data from the trial, and the potentially wide-reaching future implications of these findings.

As owner of the historic Los Angeles Times newspaper, Dr. Patrick Soon-Shiong has said its endorsement of Los Angeles Mayor Karen Bass was a mistake, suggested that his newsroom should add AI “bias meters” to ensure objectivity, and vocally supported RFK by saying Kennedy “knows more about the science than most doctors.” His push to diversify the LA Times' political viewpoints led to multiple resignations by editors and columnists, who were uncomfortable with his intention to balance the paper's opinion section with more centrist and conservative writers. Dr. Patrick Soon-Shiong is a physician, surgeon, and biotech entrepreneur who has pioneered treatments for diabetes and cancer. In 2018, he became the owner of the Los Angeles Times. He serves as Executive Chairman of ImmunityBio and holds over 675 worldwide patents. In 1993, he performed UCLA's first whole-organ pancreas transplant and developed Abraxane, an FDA-approved cancer drug. Soon-Shiong is Chairman of NantWorks, recipient of the 2016 Franklin Institute Bower Award, minority owner of the Los Angeles Lakers, and healthcare advisor to Botswana's President. Read the LA Times at https://latimes.com and follow Dr. Soon-Shiong at https://x.com/DrPatSoonShiong 「 SUPPORT OUR SPONSORS 」 Find out more about the brands that make this show possible and get special discounts on Dr. Drew's favorite products at https://drdrew.com/sponsors  • FATTY15 – The future of essential fatty acids is here! Strengthen your cells against age-related breakdown with Fatty15. Get 15% off a 90-day Starter Kit Subscription at https://drdrew.com/fatty15 • PALEOVALLEY - "Paleovalley has a wide variety of extraordinary products that are both healthful and delicious,” says Dr. Drew. "I am a huge fan of this brand and know you'll love it too!” Get 15% off your first order at https://drdrew.com/paleovalley • THE WELLNESS COMPANY - Counteract harmful spike proteins with TWC's Signature Series Spike Support Formula containing nattokinase and selenium. Learn more about TWC's supplements at https://twc.health/drew 「 MEDICAL NOTE 」 Portions of this program may examine countervailing views on important medical issues. Always consult your physician before making any decisions about your health. 「 ABOUT THE SHOW 」 Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (https://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. Learn more about your ad choices. Visit megaphone.fm/adchoices

Amplia Therapeutics Ltd (ASX: ATX) CEO and managing director Chris Burns​​​​ joins Proactive's Tylah Tully to discuss a preclinical research collaboration the company has entered into with Next&Bio, a drug screening company based in Seoul, South Korea. This collaboration aims to evaluate the effects of Amplia's focal adhesion kinase (FAK) inhibitors in combination with kRas inhibitors, a class of drugs under development for pancreatic cancer treatment. Next&Bio, a subsidiary of Hk Kolmar Holdings, specialises in drug screening using patient-derived cancer cells cultivated under conditions that replicate the tumour environment. These models allow accurate testing of potential drug efficacy, particularly in pancreatic cancer cases with oncogenic mutations. The collaboration will test Amplia's FAK inhibitors, such as narmafotinib (AMP945), against pancreatic cancer cells harbouring kRas mutations. Narmafotinib, Amplia's selective and potent FAK inhibitor, is currently in a Phase 2a trial evaluating its safety and efficacy in combination with gemcitabine and Abraxane®. The collaboration also investigates potential synergistic effects with kRas inhibitors, which could open new therapeutic opportunities for pancreatic cancer. Burns highlighted the significance of testing the company's FAK inhibitors in patient-derived cell systems to explore new commercial applications for combination therapies in pancreatic cancer. #ProactiveInvestors #AmpliaTherapeutics #ASX #NextAndBio #FAKInhibitors #PancreaticCancer #DrugDevelopment #OncologyResearch #kRasInhibitors #CancerTherapy #Narmafotinib #PrecisionMedicine #CancerCells #Amplia #CancerResearch #ClinicalTrials #ASXNews #Pharmaceuticals #OncogeneResearch #MedicalInnovation #FAK #TargetedTherapy

In today's episode, supported by Corcept Therapeutics, we had the pleasure of speaking with Premal Thaker, MD, MS, about the use of the selective glucocorticoid receptor modulator relacorilant (CORT125134) in patients with ovarian cancer. Dr Thaker is the David G. and Lynn Mutch Distinguished Professor of Obstetrics and Gynecology, as well as the director of Gynecologic Oncology Clinical Research and the interim chief of the Division of Gynecologic Oncology at the School of Medicine at the Washington University in St. Louis and the Siteman Cancer Center in Missouri. In our exclusive interview, Dr Thaker discussed the rationale for combining relacorilant with nab-paclitaxel (Abraxane) in patients with platinum-resistant ovarian cancer, striking phase 2 data (NCT03776812) with this combination in this population, and what the future has in store regarding the phase 3 ROSELLA trial (NCT05257408).

In this exclusive interview, Chadi welcomes Dr. Patrick Soon-Shiong, a Chinese immigrant who grew up under apartheid in South Africa and rose to become one of the world's most successful physician executives. Now the CEO of ImmunityBio, Dr. Soon-Shiong opens up about his remarkable journey. He shares what inspired him to pursue medicine, his entrepreneurial ventures, his move to the United States, and the story of his first investment. He discusses creating the groundbreaking chemotherapy drug Abraxane, which led to the formation of Abraxis, later acquired by Celgene, now part of BMS. He also expounds on his most recent FDA-approved drug, Anktiva, for bladder cancer. With complete candidness, Dr. Soon-Shiong reflects on his challenging upbringing, the discrimination he faced, and how he overcame these obstacles to achieve great success. He and Chadi explore life lessons, leadership styles, and a range of topics including Kobe Bryant, Gavin Newsom, COVID-19, the first pancreatic transplant, the acquisition of the Los Angeles Times, and his public feud with his brother. This 2024 podcast episode offers an unparalleled glimpse into the life of a highly public and inspiring figure and is one you'll want to listen to more than once and share with everyone you know. Read more about Dr. Soon-Shiong. https://immunitybio.com/our-founder/ Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on YouTube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA

What began as an obstruction of Matthew Rosenblum's bile duct became a diagnosis of Stage Four pancreatic cancer, of which he learned via his cellphone.  After two clashes with chemotherapy and two surgical procedures, Matthew leads a healthy lifestyle.  Going forward, he wants to be an advocate for others diagnosed with pancreatic cancer.  This is his story.

Ep. 30 Problems with Chemo. Part 2 of the cancer series with my wife Amy, as we follow her progress during chemotherapy. This week we see how her body reacted to a new replacement drug Abraxane and if the steroids were the cause of her extreme panic attacks after the first treatment. We also take some time to go over some of the very nice messages and a handful of questions from the comment sections. Part 1 on Episode 29, we discovered she had a severe reaction during her first chemo treatment to the drug Taxol and then things got worse later in the week as her body then had an issue with all of the steroids used during that treatment. Follow the Tossing Salad Podcast on all major podcast platforms as well as on Youtube, Tiktok, Instagram and Threads. --- Send in a voice message: https://podcasters.spotify.com/pod/show/tossingsaladpodcast/message Support this podcast: https://podcasters.spotify.com/pod/show/tossingsaladpodcast/support

Oncology is a rapidly evolving medical field. So how do you keep up with all the advances and updates that are delivered through publications, conferences, and social media? This ASCO Education podcast explores how three oncologists in various settings and stages of their career manage this issue. Our moderator Dr. Adriana Alvarez, a medical oncologist at Cleveland Clinic in Ohio is joined by Dr. Sharad Goyal, a professor and division chief of Radiation Oncology at George Washington University in Washington, DC; Dr. Shruti Patel, an oncology fellow at Stanford University in California; and Dr. Banu Symington, a medical oncologist at Memorial Hospital of Sweetwater County in Wyoming, and adjunct professor in the University of Utah College of Nursing. Each will describe what they do to keep up to date on research advances and guidelines (3:25), how they find time to stay current in their field (7:25) and how they follow developments outside of their area of concentration (13:57).  The speakers have no relevant disclosures.  Resources: Podcast: Cancer Topics - Burned Out? Here's What You Can Do About It (Part 1)  Podcast: Cancer Topics - Burned Out? Here's What You Can Do About It (Part 2)  Podcast: Cancer Topics - Burnout in Oncology: Trainee Perspective  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 on the podcast page.  Dr. Adriana Alvarez: An oncologist recently described that while sitting on a couch to write an article, by the time he finished his first paragraph, he received six notifications on his iPhone from WhatsApp, Twitter, and other messages. He knows what the dilemma is; you can shut down your phone, but you become worried about missing an urgent call or important update. The oncologist knows that social media is a place to follow friends and colleagues, to discover new presentations, and even debate about them. However, he understands the overload of information that is part of the rapidly evolving field of oncology. On any given day or week, there are research advances and updates in the management of cancer being shared through journal publications, conference presentations, newsletters, social media, and other methods. How does one keep up to date with these advances in oncology?  I'm Dr. Adriana Alvarez, a medical oncologist at Cleveland Clinic in Ohio. In this ASCO Education Podcast, we will examine what various oncology professionals at different stages in their careers and working in different practice settings, namely academic versus community and urban versus rural, are doing to manage the large amount of information influx regarding advances in oncology.  Joining me are Dr. Sharad Goyal, a professor and division chief of radiation oncology at George Washington University in Washington, DC; Dr. Shruti Patel, an oncology fellow at Stanford University; and Dr. Banu Symington, a medical oncologist at Memorial Hospital of Sweetwater County in Wyoming, and adjunct professor in the University of Utah College of Nursing.  Let's start. One of the first questions I have here is how you can describe your current field of focus in oncology. Dr. Patel? Dr. Shruti Patel: My current clinical focus in oncology is in thoracic and gastrointestinal malignancies, while my research interests include clinical trials, liquid biopsy, and diversity, and equity and inclusion.  Dr. Sharad Goyal: My current clinical and research focus is on breast cancer, radiation therapy, as well as radiation therapy with respect to neuro-oncology in the neuro-oncology space. Dr. Adriana Alvarez: What about you, Dr. Symington? Dr. Banu Symington: I'm a general oncologist, medical oncologist, in an extreme rural, I'm considered a frontier practice. I have a special interest in eliminating the social disparity that is represented by rurality, and I'm interested in clinical trials. We are the only Wyoming Cancer Center that opened clinical trials. Dr. Adriana Alvarez: Well, it's all wonderful to hear about you and know a little bit about what your focus of work is, and we come from a variety of backgrounds. How do you feel like you keep up to date with the clinical practice, the research parts with new drugs approval in oncology? You are still in training Dr. Patel. How do you do that? Dr. Shruti Patel: As a millennial, it may come as no surprise that I primarily stay up to date on clinical practice guidelines via Twitter on my phone. I find Twitter to be the best place to learn new information. Just because you don't just get information about the new approvals, but typically experts in the field will weigh in on the trial design, their thoughts on whether it truly will replace the current standard of care or what situations they might use the new approval for, which can really be helpful, especially as a fellow in training. It's helpful context beyond just the information that you get from the approval itself. And then, I also learn about the applications of these new guidelines in the clinic with my mentors, because I am, of course, lucky enough to still be in training where I can gather that information from my attendings. Dr. Adriana Alvarez: Dr. Goyal, what is your preferred method of keeping up to date and learning more about the new treatments and research in your area of interest?  Dr. Sharad Goyal: As opposed to Dr. Patel, I am not part of social media in medicine. Actually, I'm not a part of any social media, whether it's personal or work-related. So I tend to be a little more “old school” with respect to how I ingest information. So, in terms of clinical practice guidelines and new drug approvals, which is somewhat peripheral to my field in radiation oncology, I tend to rely on NCCN guidelines and attendance at tumor boards to receive that information from my colleagues in medical oncology. I believe that with any patient that I see with a malignancy, I do tend to refer to the NCCN guidelines on a regular basis. And if it's a malignancy that I do not see, I have to reference PubMed, UpToDate, and the NCCN guidelines to determine the best course of treatment for that patient. Dr. Adriana Alvarez: What about you, Dr. Symington? Being in the rural area, I can see that you have a variety of situations. How do you keep up to date? Dr. Banu Symington: I guess I'm midway between Doctors Patel and Goyal. I do not follow Twitter, but I belong to a 5000-member online hematology/oncology support group, and we post questions, and local thought leaders will reply. I am in such an isolated location. I don't get the stimulation or the benefit of walking down the hall to a colleague to say ‘What would you do?' So I am affiliated with the Huntsman and the University of Utah. I've made an effort to join every organ-specific tumor board so that I can hear discussions by disease thought leaders about how they're going to take care of each type of cancer and hearing that week after week, I do absorb it.  Medical oncology is a challenging field because things move so rapidly. I took an 18-month, mostly Sabbatical, as I functioned as a chief of staff at a larger hospital. And in that 18-month period, where I volunteered in a clinic, immune checkpoint therapy arose, and targeted therapies for lung cancer arose and I felt like Sleeping Beauty. I went to sleep in one world, and I woke up in a completely different world of oncology. And it was hard to get back into the drift until I connected with colleagues. I'm an avid reader. I don't sleep much. So I am a member of AMA, ASCO, and ACP, so I get all the print journals. And I have a disorder, an obsessive-compulsive disorder, that makes me have to look through every single journal I get. So print and tumor boards and colleagues.  Dr. Adriana Alvarez: So we are very busy, and the work that we do, the clinical work, trying to keep up to date and training and all that, how do you schedule time to do this, to learn about the research advances and to keep going? Dr. Goyal, how do you find the time? Dr. Sharad Goyal: In general, I do think that in my realm, in my head, I think that there are three processes that have to occur when I incorporate research into my practice. So number one, I have to learn about it. Number two, I have to determine if that's going to help change my practice. And then number three, if I do end up changing practice, I have to implement it. And that involves dealing with my staff. So I'm going to delve into each of those in a little bit more detail. So learning about the advance typically, I learn about things through CME activities. So in one of my roles in our cancer center, I help organize our grand rounds and some oncology-specific courses. Being involved in the organization, helping find speakers really keeps me engaged not only in the organization process, but also in the learning process because I have a vested interest in making sure that the trainees and other faculty that attend my courses are learning and are happy.  Dr. Adriana Alvarez: To organize all these, do you schedule time during your job, outside work hours? Dr. Sharad Goyal: Yes, that is part of my job, which extends outside of work hours. Dr. Adriana Alvarez: Sounds good. Dr. Symington, well, you mentioned that you don't sleep much, you keep up to date, looks more at night. But do you find the time in between patients or during your workday to keep up to date, or is more like a solitude type of time?  Dr. Banu Symington: I forgot to mention a resource that I feel like people should know about, MedNet, which is presented daily with three clinical cases and thought leaders mentioning what they would do. They often introduce research ideas that are not adopted into practice. Since I read, I read about new innovative treatments, but I am not an early adopter, so I wait until they become an NCCN guideline before I would adopt it. So that might be different from Dr. Goyal, who's in an academic center. But I see patients five days a week, 10 hours a day, so it has to be all scheduled outside of those hours. It's fortunate that my kids are grown, and I don't sleep much.  Dr. Adriana Alvarez: What about you, Dr. Patel? On the go, I can imagine. I remember not long ago, being fellow and a millennial, so I guess on your iPhone. Dr. Shruti Patel: Even though I'm a fellow, I do like sleep. And now that I'm in my research years, I actually get sleep, which is lovely. I can't say that I schedule time to learn about research advances, but rather it's– Usually, I take the train to work, and so I'm scrolling on my Twitter on the Caltrain down to Palo Alto, monitoring for medical news or updates. Really, that's how I gather information. I also partake in CME activity, creating CME educational materials on Twitter as well. And so that's another way in which I learn because if I'm creating the information, then I have to go through the trials and go through all of these things, side effects. And so it's a really great way, additionally, for me to learn. But none of that stuff is really scheduled. It's kind of really when I have time, on my to-do list, usually outside of business hours. Part of the job is staying up to date with things outside of business hours. And I think we all knew that when we signed up for the job. And it's only gotten more as all of these advances are kind of coming out at us like drinking out of a fire hydrant. Dr. Adriana Alvarez: The most recent moment that you found new information related to your practice, how did you learn about it? Not about everything that you do, but the last time, the most recent one that you did that. Dr. Goyal? Dr. Sharad Goyal: I recently referenced the NCCN guidelines. I was treating a gentleman with male breast cancer, and he told me he had some half-brothers and that they were going to get tested, but he was inquiring about the screening guidelines for men with BRCA mutations, and I had to look that up. I knew what they were for women, but I actually did not know what they were for men. Dr. Adriana Alvarez: What about you, Dr. Symington? Dr. Banu Symington: So last Thursday morning at 7:00, I joined the Huntsman Tumor Board for Breast. And one of the breast-specific oncologists actually said something that defies the NCCN guidelines, but it sounded like it made sense. He said he regularly gets PET scans for staging lymph node-positive HER2-positive breast cancer because he finds, and apparently the breast cancer community finds, that other scans can give you a false-negative result. And there are enough patients with metastatic disease in the lymph node-positive setting that he recommended PET scans for staging of HER2-positive breast cancer patients but not for ER-positive breast cancer patients. So that was just five days ago. Dr. Adriana Alvarez: Wow. And what about you, Dr. Patel? When was the most recent time that you found something that was good information for your practice?  Dr. Shruti Patel: Yeah, as a fellow, I love learning about new information when I'm able to learn how to integrate it into the practice with someone that's more experienced than I am. So, of course, I've already mentioned that Twitter can be a great place. But also a few weeks ago, I was attending GI ASCO up in San Francisco, and they presented the latest results from NAPOLI-3, which was a phase 3 study looking at first-line liposomal irinotecan 5FU and oxaliplatin versus gem-Abraxane. And they presented that it was shown to improve overall survival compared to gem-Abraxane in first-line metastatic pancreatic cancer. And I was actually sitting next to my clinic mentor at the time, and during the break, I got to hear about his thoughts on whether this is going to be integrated into clinical practice, given that the control arm was gem-Abraxane, and not FOLFOXIRI. And we ended up discussing it again during our weekly GI trials meetings, just when we're thinking about opening new trials and what the control arm should be. And so I just thought that was like a new piece of information. Thought about it in the clinic, thought about it in the trial meeting, and it was pretty cool. Dr. Adriana Alvarez: Great. So different settings, different ways to gain information. So, Dr. Symington, you have to see a little bit of everything. So you have to be an expert in everything. And I wonder how you, Dr. Goyal, and Dr. Patel, that you are kind of more subspecialized. How do you usually follow advances in other cancers that are not in your particular area of interest or just focus on your disease group? I'm going to let Dr. Goyal go first. Dr. Sharad Goyal: Thank you. So I find that I tend to go to conferences to learn about advances outside of my disease focus. I prefer going to the educational sessions at major conferences like ASTRO or ASCO to keep up on things. On a more local level, I do find when I cover tumor boards for my colleagues that I do have to prep their patients and learn about different treatment paradigms within those disease sites. And in doing so, I feel like I'm able to gain really a deeper understanding about oncology in general, and I do very much appreciate that. Dr. Adriana Alvarez: And Dr. Patel, well, you're in training, so you have to see a little bit of everything, even though you have the focus of your specialty that you are looking forward to do. But do you follow those too, as well? Other areas that might not take your interest right away but you want to be updated? Dr. Shruti Patel: That's exactly it. I have to have a working knowledge of all the areas of oncology that are not my focus area. But really, for the most up-to-date information, the reality is that there are so many new advances in all of these disease types that I find myself leaning on my colleagues. If I come across a lymphoma patient on consults, I'll usually reach out to my lymphoma specialized colleagues, whether that's my co-fellows or attendings, just to kind of run the patient by them, get their insight, get their input, because they're just a lot more up to date on those things than I am. But really, regardless of the subspecialty within oncology, I do think that understanding the basics of all the oncology subspecialties is important in medical oncology. Because most of us will, or are, will for me because I'm a fellow, will be spending time on the inpatient service, which is not tumor type specific, and you really do have to make decisions for patients. And while, of course, you always have your colleagues to rely on and call on, some of those decisions are being made in the middle of the night. And so having a working knowledge of all of them, I think, is important. Dr. Adriana Alvarez: We are lucky to live in a time that we have so many options, right? As a practicing oncologist myself, I rely also on all the resources that you're mentioning. The fear I have sometimes is, okay, I'm relying on the NCCN guidelines, but what if I'm missing something? The fear of missing something, right? It's like if I'm not on Twitter or in another social media; I'm missing the most recent data, that may affect my patient care or things like that. But if I have to ask one of you, if you have to pick one, what would be your preferred method or format of receiving updated information if you have to decide where you could go for it? What about you, Dr. Symington? Dr. Banu Symington: So, although I have made the case that I love reading, I actually absorb information better if someone is talking to me. So if I had the freedom to take time off, I would prefer to hear it at one-day specialty seminars where a thought leader is describing their work. That is not what I do in practice, but that would be my preferred way of getting new information.  Dr. Adriana Alvarez: Dr. Goyal? Dr. Sharad Goyal: I'm very much aligned with Dr. Symington in that. I prefer a less active role in the learning process, and I prefer to be spoken to. My preferred method is via podcast, but I also do prefer the in-person or virtual learning through a conference as well. Dr. Adriana Alvarez: What about you, Dr. Patel? Dr. Shruti Patel: I promise you that Elon Musk is not paying me to say all of this because I've probably mentioned Twitter in every single answer. But my preferred method, as you guys probably can guess, is Twitter. It doesn't require too much dedicated time. Information is delivered in small doses. Like I said, I do it on my commute, so it makes me feel like my commute is actually part of my work, which is just wonderful. I do like to attend these smaller meetings to be kind of, like both Dr. Symington and Dr. Goyal said, to be spoken to and really learn additional information. I would say that I don't necessarily always get that experience at the bigger meetings where the focus is more networking. But ‘Best of ASCO', those are kind of some types of meetings where the information is kind of told to you. It's distilled down into bite-sized pieces and really understandable. Dr. Adriana Alvarez: Well, all amazing experiences. And I'm glad that we have different points of view, different settings, different career paths. Someone mentioned before is that we're always learning. I feel like here; everybody's very humble to recognize that we're on the learning curve all the time and that we have a real interest in our patient care. Because we are trying to catch the moment, try to make sure that we deliver the best care to our patients, like keeping up to date and listening to the new information. Dr. Goyal, any advice for your colleagues in terms of how to best keep up to date? Dr. Sharad Goyal: My personal philosophy is that as a physician, the learning never stops. And if you do stop learning, maybe you should find a different field. During the pandemic, I started scheduling time with colleagues, friends in my field, and I would set up a meeting with them via our assistants every two or three months. And we would not only socialize but we would kind of catch up on the current state of affairs in our field. And it was an opportunity to also network, and it was very helpful, especially during COVID. It really helped me gain some normalcy and kind of keep me attached to the field of radiation oncology during that time. Dr. Adriana Alvarez: How do you navigate clinic work, keeping up to date, and work-life balance? Dr. Goyal? Dr. Sharad Goyal: Like Dr. Symington, I probably work about 50 hours a week in the office, so I tend to work from 7:00 to 5:00, and I'm out of the office at 5:00 on the dot. I have two small children at home, and I want to see them at least for two hours in the evening before they go to bed. As a radiation oncologist, we take HomeCall, and there are very few emergencies, so I have the weekends to not only spend time with my family but also catch up on any work that needs to be done.  Dr. Adriana Alvarez: I'm so glad to hear that. Congratulations on your family.  Dr. Symington? Dr. Banu Symington: Well, I rescue small dogs, so at the moment, I have five small dogs, and they get a walk a day when weather permits. We're in the middle of a blizzard in Wyoming, so weather hasn't been permitting for the past four days, so the love and attention of those dogs keep me grounded. I also regularly go to the gym. I dread it every time I go, but I go at least four times a week, and I leave the gym and leave some of my problems behind. When I was younger, people would comment on the fact that I was slender and didn't need to go to the gym and would ask me why I did it, and I would say it's so I don't beat my children. That was obviously a joke, but I could shed the problems of the day by running on the treadmill or using the StairMaster. So I guess that's how I keep work-life balance.  Dr. Adriana Alvarez: What about you, Dr. Patel? Dr. Shruti Patel: I would say that my work-life balance has improved greatly in the last eight months since I started the research portion of my fellowship. I'm not writing papers at 2:00 a.m. anymore, so that's like a huge upgrade. But really, I think, prioritizing when you're at work, you're at work, but then when you're at home, really trying to prioritize the things that are important to you. I am currently in my parents' home, while I'm recording this podcast, I get to spend time with them. I get to spend time with my family, my friends. I like to make time for those things because they provide me joy. I think a huge part of our work is being there for people in really, really tough times in their life, and that can be extremely emotionally draining, even though it's exactly what we want to do. And I think making sure that you have things outside of work that really provide you a lot of joy is extremely important. And so I think now that I have the time to do it, I really am trying to capitalize on it. Dr. Adriana Alvarez: Well, I really want to thank you, all of you, Dr. Goyal, Dr. Patel, and Dr. Symington, for a lively discussion. I learned a lot from you and a little bit about your personal life. Thank you for sharing that and sharing how you navigate to be a physician in oncology.  So this ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncology well-being and professional development. If you have an idea for a topic or guest you would like to see on the show, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, visit education.asco.org. Thank you very much.   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.              

Journal Review in HPB – Surgical Outcomes of the SWOG S1505 Trial Description: Neoadjuvant chemotherapy remains a controversial topic for resectable pancreatic adenocarcinoma. This randomized trial examines surgical and clinical outcomes from peri-operative regimens, mFOLFIRNOX and gem-Abraxane. The HPB Behind the Knife team dives into the specifics of the trial design and findings, as well as sits down with the Principal Investigator Dr. Syed Ahmad himself to ask about the behind-the-scenes decision-making and the investigations yet to come.  Links to Papers Reviewed in this Episode Surgical Outcome Results from SWOG S1505: A Randomized Clinical Trial of mFOLFIRINOX Versus Gemcitabine/Nab-paclitaxel for Perioperative Treatment of Resectable Pancreatic Ductal Adenocarcinoma Ann Surg. 2020 Sep;272(3):481-486 https://pubmed.ncbi.nlm.nih.gov/32740235/ Efficacy of Periopertive Chemotherapy for Resectable Pancreatic Adenocarcinoma: A Phase 2 Randomized Clinical Trial JAMA Oncol. 2021 Mar;7(3):421-427 https://pubmed.ncbi.nlm.nih.gov/33475684/  Guest:  Syed Ahmad, MD (@SyedAAhmad5) is a Professor of Surgery and Chief of the Division of Surgical Oncology at the University of Cincinnati College of Medicine, and the Director of the UC Cancer Center. He is the surgical chair of SWOG, and a co-Principal Investigator of the SWOG S1505 study in addition to numerous other national trials for pancreatic cancer. Hosts: Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at William Beaumont Army Medical Center Connor Chick, MD (@connor_chick) is a PGY-4 General Surgery resident at Brooke Army Medical Center Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-3 General Surgery resident at Brooke Army Medical Center Other References from this Episode FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer N Engl J Med. 2018 Dec 20;379:2395-2406 https://www.nejm.org/doi/full/10.1056/NEJMoa1809775 APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma J Clin Oncol. 2019 May 20;37:no. 15 suppl:4000. https://ascopubs.org/doi/10.1200/JCO.2019.37.15_suppl.4000 Operative Standards in Cancer Surgery: Pancreatoduodenectomy: Superior Mesenteric Artery Dissection American College of Surgeons. 2020 Jun 18. https://www.facs.org/quality-programs/cancer/acs-crp/oscs https://www.youtube.com/watch?v=bs8xlCr5XyE The AHPBA Podcast  The Americas Hepato-Pancreato-Biliary Association https://podcasts.apple.com/us/podcast/the-ahpba-podcast/id1501441845   Please visit behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  

Dr. Patrick Soon-Shiong is a renowned transplant surgeon and owner of the Los Angeles Times. His career is fascinating, from surgical training at UCLA and inventing the cancer-fighting drug Abraxane to his 2018 acquisition of the LA Times, which is now focusing much of its attention on social injustice and the coronavirus pandemic.As Dr. Soon-Shiong discusses the medical research now underway to treat COVID-19 more effectively and the effort to find a vaccine, he delivers a sober assessment on how the virus affects the human body.This podcast is for general information and education only and is provided as a courtesy to the clients and friends of City National Bank. It is compiled from data and sources believed to be reliable, however City National Bank does not warrant that it is accurate or complete. Opinions expressed and estimates given are those of the speaker as of the date of the podcast with no obligation to update or notify of inaccuracy or change.

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 world’s leading professional organization for doctors who care for people with cancer. 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. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. The 2019 ASCO Annual Meeting, held May 31 to June 4, brought together physicians, researchers, patient advocates, and other health care professionals from around the world to present and discuss the latest research in cancer treatment and patient care. In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients. First, Dr. Lynn Henry will discuss 3 studies that explored new treatment options for women with breast cancer, including a study on immunotherapy for triple-negative breast cancer and 2 studies on treatment for hormone receptor positive, HER2-negative breast cancer. She also discusses research on the effects of a low-fat diet in women diagnosed with breast cancer, and a study on whether pregnancy after breast cancer increased the risk of recurrence.   Dr. Henry is an Associate Professor and Interim Division Chief of Oncology in the Department of Medicine at the University of Utah and Director of Breast Medical Oncology at the Huntsman Cancer Institute. She is also the Cancer.Net Associate Editor for Breast Cancer. Dr. Henry: Hi. My name is Dr. Lynn Henry. I'm a medical oncologist who specializes in treating breast cancer at the University of Utah. Today, I'm going to discuss research on breast cancer that was presented at the 2019 ASCO Annual Meeting in Chicago. In particular, I'm going to focus on the results of some clinical trials that directly impact how oncologists treat patients with breast cancer. First, I'm going to give just a very brief overview of the types of breast cancer and then talk about some research that was presented on triple-negative and hormone-receptor-positive breast cancer. Then I'm going to briefly review findings related to diet and breast cancer as well as pregnancy after breast cancer in women with BRCA mutations. As a quick reminder, there are multiple kinds of breast cancer. Some breast cancers are called hormone-receptor positive or estrogen-receptor positive, and those are stimulated to grow by estrogen. We treat those cancers with anti-estrogen treatments or anti-hormone treatments to block estrogen or lower the estrogen level in the body. Other breast cancers are called HER2-positive. These are often more aggressive cancers. But because they have extra copies of HER2, they often respond to treatments that block HER2. And finally, there are breast cancers that don't have hormone receptors or HER2, and these are called triple-negative breast cancer. So first, I'm going to focus on this type, triple-negative breast cancer. Until recently, most of the time, we treated triple-negative breast cancer with chemotherapy because we hadn't found other drugs that worked very well. There's a new type of drug, however, called immunotherapy that tries to use a patient's immune system to help fight the breast cancer. Early in 2019, the FDA approved a new treatment for triple-negative breast cancer that is a combination of a chemotherapy called Abraxane and a new immune drug called atezolizumab or Tecentriq. The combination increased the length of time until cancer progressed or grew. Overall, the treatment was fairly well tolerated. But we did learn that in order for the treatment to work, the cells surrounding the cancer have to have at least a small amount of a very specific protein called PD-L1. So at this recent ASCO meeting, we heard an update about this treatment. In the trial, the patients whose cancers had the PD-L1 protein and who got the combination treatment lived 7 months longer than those who got just the chemotherapy, which was an increase from 18 months to just over 2 years. This is an important first step towards finding a better treatment for this difficult type of triple-negative breast cancer. And this treatment is currently available to patients. Additional clinical trials are going on now to try to find even better combinations of chemotherapy and immune therapies to treat this type of cancer. So next, I'm going to talk about hormone-receptor-positive breast cancer. There were two trials of this type of cancer that had important results presented at the ASCO meeting. First, I'll focus on the treatment of early-stage node-negative breast cancer that is hormone-receptor positive and HER2 negative. The Oncotype DX test is a test we commonly run on tumors of this type to help determine whether treatment with chemotherapy is likely to be helpful. For this test, if your tumor has a score over 25, then chemotherapy is generally recommended in addition to anti-hormone therapy. If you have a score under 11, then chemotherapy is not recommended and a patient should receive only anti-hormone therapy. But for those with scores between 11 and 25, it was unclear how beneficial it was to receive chemotherapy. Last year, the results of the TAILORx trial were reported. And that showed that for women over the age of 50, if their tumor had a score between 11 and 25, they were not likely to get benefit from chemotherapy. However, it turned out it was a bit more complicated for women aged 50 and under. For those with scores between 11 and 15, chemotherapy was not likely to be beneficial. However, for those who score 16 to 25, chemotherapy might be beneficial. So we got some answers but not everything. At this recent ASCO meeting, additional information was reported to help guide treatment decision making for this middle group of women aged 50 and under. So for women whose scores were at the higher end, 21 to 25, chemotherapy was found to be likely to be beneficial. However, in that middle group, the 16 to 20 group, chemotherapy might be beneficial but generally only for women with higher risk cancers, meaning larger cancers or higher grade. This information is helpful because it provides more information for oncologists and for patients when they are discussing whether or not chemotherapy should be included as part of their treatment. So switching gears a little, still staying with premenopausal women and hormone-receptor-positive HER2-negative cancer, but now thinking about metastatic breast cancer, so cancer that has spread. We now have additional information about treatment with an anti-hormone therapy plus an additional drug called the CDK4/6 inhibitor. We've routinely been recommending this treatment combination because it leads to a longer time before the cancer progresses. But until now, we didn't know if it actually allows women with this type of cancer to live longer. The results of the MONALEESA-7 trial, which looked at the combination of an anti-hormone therapy plus the drug called ribociclib, showed that women who received the combination instead of anti-hormone therapy alone live almost 30% longer. So looking at women 3 and a half years after they started treatment, just over 70% of the women who were treated with ribociclib plus anti-hormone therapy were alive compared to just under half of women treated with anti-hormone therapy alone. So these results reinforce that this is an excellent first approach to treatment of premenopausal women who have newly diagnosed, hormone-receptor-positive HER2-negative metastatic breast cancer. So in addition to studies looking at these specific types of breast cancer, there were 2 other interesting studies that were applicable to breast cancer more generally. So there was a large study that was reported that looked at whether having a low-fat diet reduced the likelihood of developing triple-negative breast cancer. So in this study, postmenopausal without cancer were randomized to either a low-fat diet or their usual diet and followed for many, many years. Over time, some of these women developed breast cancer with no difference between those who followed the low-fat diet or the regular diet. However, in this new report, they looked specifically at the women who developed breast cancer who were enrolled in this trial. Fewer women died from their breast cancer if they ate the low-fat diet, especially if they had preexisting high cholesterol, diabetes, and obesity. These findings suggest that having a low-fat diet may actually reduce the risk of dying overall and also specifically from breast cancer. Now, these need to be validated, and we don't quite understand why this would be the case. But in general, it seems like having a low-fat diet, avoiding high cholesterol, diabetes, and obesity is a good thing. And then finally, 1 question that comes up often is whether it is safe to have a baby after the diagnosis of breast cancer. This is especially concerning for patients who have a mutation in genes called BRCA1 or BRCA2 since those mutations greatly increase their risk of developing both breast and ovarian cancer and also leads to the diagnosis of breast cancer at an early age. In addition, patients with these mutations are often recommended to have their ovaries removed at a young age. So in this study, patients who became pregnant did so about 4 and a half years after they were diagnosed with breast cancer. There was no apparent increase in miscarriage, preterm birth, or birth defects compared to what would be expected in women without cancer. And in the patients, there was no increase in the risk of breast cancer recurrence compared to those who did not become pregnant. And in fact, those who became pregnant were slightly less likely to have their cancer return, especially those who had mutations in BRCA1. So while there are some limitations to the study, the findings are reassuring that there does not appear to be an increase in risk of breast cancer returning in these patients with BRCA mutations who become pregnant after breast cancer diagnosis. So overall, as you can see, there's a lot of exciting research going on across all the different subsets of breast cancer. The results of many important clinical trials were reported at the recent ASCO meeting, and there are many more trials ongoing that will hopefully result in the approval of multiple new effective treatments for breast cancer. In addition, there's research going on examining the impact of treatment on patients with breast cancer and trying to improve the lives of those living with breast cancer. Clinical trials are critical for the development of these new treatments. Well, that's it for this quick summary of this important research from ASCO 2019. Overall, we continue on a fast track in breast cancer, with many new and exciting therapies being actively studied and research helping support our patients do better than ever before. Stay tuned to Cancer.Net for future updates from upcoming breast cancer conferences. Thank you very much. ASCO: Thank you, Dr. Henry. Next, Dr. Ezra Cohen will discuss several studies that looked at using immunotherapy and targeted therapy to treat different types of head and neck cancer. Dr. Cohen is Associate Director of Translational Science and leads the Solid Tumor Therapeutics research program at Moores Cancer Center at UC San Diego Health. He is the Cancer.Net Associate Editor for Head and Neck Cancer. Dr. Cohen: Hi. I'm Dr. Ezra Cohen from UC San Diego Moores Cancer Center. Today, I'm going to talk about research on head and neck cancer that was presented at the 2019 ASCO Annual Meeting. I think the most impactful presentation at the meeting was a follow-up on the KEYNOTE-048 study, which implemented the drug pembrolizumab, an anti-PD-1 antibody in first-line recurrent metastatic head and neck cancer. These were patients who were treated with curative intent or presented with metastatic disease, and either way, either had recurrence or eventually developed metastases. The first-line standard of care for these patients used to be the so-called extreme regimen, which involved platinum, 5-FU, and cetuximab. This was validated in an earlier phase III study that was conducted about 10 years ago and was the approved first-line regimen for these patients. In KEYNOTE-048, this extreme regimen was tested against either pembrolizumab alone or pembrolizumab, platinum, and 5-FU, in other words, substituting cetuximab for pembrolizumab in one of the experimental arms. We'd initially seen the interim analysis data at last year's ESMO meeting, but this year, we have the final analysis presented at ASCO. And what we saw was that both experimental arms actually achieved an improvement in overall survival compared to the extreme regimen. Interestingly, for pembrolizumab alone, this occurred in patients whose tumors expressed some level of PD-L1. That was evaluated by something called the composite score and takes into account both stromal and tumor cell staining of PD-L1. In fact, even at a very low level—that is CPS greater than or equal to 1—pembrolizumab monotherapy was superior to the extreme regimen with respect to overall survival. For all patients, the regimen of pembrolizumab plus chemotherapy was superior to the extreme regimen irrespective of PD-L1 staining. What we saw at this year's ASCO meeting was that, in fact, first, the higher the expression of PD-L1, the greater the benefit one derived from pembrolizumab either as monotherapy or in combination with chemotherapy. And in patients who had higher levels of PD-L1 and received both pembrolizumab and chemotherapy, the overall survival was quite remarkable with a hazard ratio of just higher than 0.6. In fact, we now have FDA approval in the United States for pembrolizumab monotherapy with tumors that have some expression level of PD-L1—that is CPS greater than or equal to one—or for all comers in patients who either the CPS status is unknown or patients whose tumors don't express PD-L1. Beyond KEYNOTE-048, we saw interesting data in first-line recurrent metastatic using a regimen of taxane, platinum, and 5-FU compared to the same extreme regimen that we just mentioned. That regimen turned out to be much better tolerated with fewer adverse events but with no improvement in overall survival, giving us a regimen that we could substitute for the extreme regimen if one wanted to, realizing that it does not involve immunotherapy, and for some patients, this may still be an appropriate treatment. Beyond the first-line recurrent metastatic studies, we saw a few interesting trials looking at targeted therapy in head and neck cancer but specific subsets. The first was in patients whose tumors expressed HER2 at very high levels—that is HER2 amplified—and had salivary ductal carcinoma. We've known that a proportion of salivary ductal carcinoma patients' tumors amplify this gene, HER2, similar to breast cancer and some other malignancies and that trastuzumab may, in fact, be effective. Well, in this study conducted by the Memorial Sloan Kettering Group, an antibody-drug conjugate trastuzumab emtansine was employed as a single agent in these patients whose, again, tumors amplified HER2. And what they saw was a remarkable 90% response rate. Now, this was only in 10 patients, so the study is small, but I think it's safe to say that this drug appears to be quite effective in patients with HER2-amplified salivary ductal carcinoma. Along those lines, in the subset of thyroid cancer patients whose tumors either mutate or have a RET fusion, the gene RET, there appeared to be very high efficacy for a novel agent that targets the RET oncogene. This was in both patients with medullary thyroid cancers that often have a RET mutation or in papillary thyroid cancers whose tumors often have a fusion of the same RET gene. Again, underscoring the idea that if we can target a driver even in a relatively small subset of patients, the benefit may be quite large. Along those lines, we had seen prior data for track inhibitors in patients who have in track fusions. And again, this applies to subsets of head and neck cancer patients that have either salivary gland cancers or thyroid cancers. Lastly, we continue to see emerging promising data of combinations with immunotherapy, and 2 highlights from ASCO were pembrolizumab with cetuximab showing a response rate of over 40% in a small group of patients and pembrolizumab with a TLR9 agonist called SD-101 showing about a 30% response rate. Of course, these data are very early and uncontrolled, and so we have to follow these stories further along to see if, indeed, these early signs of efficacy turn out to validate. But the idea that further combinations of immunotherapies eventually making their way to larger studies and hopefully approval is now well enforced in head and neck cancer. Thank you very much for your attention and hope you enjoyed the ASCO 2019 Annual Meeting. ASCO: Thank you Dr. Cohen. Next, Dr. Charles Loprinzi will discuss new research on ways to prevent or treat nausea and vomiting caused by cancer treatment. Dr. Loprinzi is a medical oncologist and the Regis Professor of Breast Cancer Research at the Mayo Clinic. He is also the Cancer.Net Associate Editor for Psychosocial Oncology. Dr. Loprinzi: Hello, I'm Charles Loprinzi, Regis Professor of Breast Cancer Research at Mayo Clinic. I'm going to be talking today about chemotherapy-induced nausea and vomiting. Now, chemotherapy can cause a lot of nausea and vomiting. That's well known, for years and years, by many people. It's not all types of chemotherapy, but some chemotherapy drugs cause a lot of nausea and vomiting, and others cause little to none. It's not as big a problem now as it was decades ago when we didn't have good drugs to try to prevent nausea and vomiting. Many drugs over the time have been developed for trying to prevent this nausea and vomiting problem. Examples of the drugs that cause a lot of nausea and vomiting are Cisplatinum, and Adriamycin and cyclophosphamide is a combination that is oftentimes used for patients with breast cancer. So in the past, we have developed many, many drugs for this. Three of the drugs that have commonly been used for the last many, many years for treatment or prevention of nausea and vomiting associated with chemotherapy are corticosteroid medications like Dexamethasone. It's quite cheap. It's got some side effects, but relatively cheap. Then there's a group called 5-HT3 receptor antagonists. I didn't make up that name, but that's the long name for it. They're relatively expensive, some more expensive than other ones. And then there's another group called NK1 receptor antagonists, and they can be quite expensive, sometimes being hundreds of dollars for each dose that's given to try to prevent nausea and vomiting related to chemotherapy. So a couple years ago, 2016, there was a report in the New England Journal of Medicine, which is a prominent journal for us in the business, that looked at a drug called olanzapine. It's a relatively cheap drug. It's a drug that was developed for psychosis-type problems, given for long term in those patients. But it had been noted that if it's given for just a few days, it seems to markedly improve or decrease the instance of nausea and vomiting, or if people were having nausea and vomiting, it appears actually to help and reverse that particular problem. So this trial looked at 10 milligrams of this drug for 4 days, given before chemotherapy, and then for 3 more days after that. Patients who were on this study got the 3 drugs that I talked about before with the olanzapine or with the placebo. And it noted that it improved things by quite a bit. The patients who had what we call a complete response, which means no vomiting and no need to take extra medications because of nausea and vomiting, improved from 41% of the patients who were on the placebo, to 64% who were on the olanzapine, a 23% improvement. And if we looked at a different endpoint there, the number of patients who had no nausea during the five days after chemotherapy, it was 22% in the group that got the placebo and improved to 37% in the group that didn't. So it was a good result in that area. One of the problems with this drug is that it can cause some sedation, cause some drowsiness for some patients. Most patients, not much, but some patients, it's a problem. So most trials that have been done in the past use this 10-milligram dose. And what we learned at ASCO in 2019, our main meeting that we have once a year, was that people looked at a 5-milligram dose and had looked at 5 milligrams instead of the 10 milligrams. And what it showed is that the results seemed to be quite similar to what was seen with 10 milligrams. They did the study quite the same as what had been reported in the previous trial and the results looks similar. They didn't compare 5 milligrams versus 10 milligrams, which would've been nice because then we would have better information along that line. They did note that there was drowsiness that some patients had, and it looks similar to what was seen with the 10-milligram dose. But these data support, but don't prove, that giving 5 milligrams does look like it's good in this particular setting. So data from this year also supported that instead of giving the drug during the day when getting the chemotherapy, sometimes, people take it at bedtime, and there, the drowsiness is not as big a problem because you want to be drowsy at bedtime. So it's not proven that it works as well at bedtime, but it suggests that that actually is the case. Data from this year also supported that if you looked at those 3 drugs I mentioned before and just took out that 1 really, really expensive one, the NK1 receptor antagonist, and put the olanzapine in there instead, that very cheap medication, that that looked like that one with the olanzapine did better than the very expensive one. Not a whole lot better; they looked similar, but a little bit better in that setting, and it was a whole lot cheaper. This was also seen in a publication that came out a couple of years ago which showed the same sort of result. Again, not proof that it's beneficial, that it's okay to do that, but it looked better. So the next obvious question that comes up then is when you have these 4 drugs that you give, the 3 drugs I mentioned before and this fourth one, what about if you take away that more expensive one and see how they do there? So there was a trial at the ASCO meeting that suggested that the addition of that expensive medications didn't provide a whole lot more benefit. Right now, there is a trial going on across the United States, with about 800 patients who are scheduled to go on this trial, and it's approving about 30 patients a month, which is a pretty good accrual rate, which is looking at this particular question where people would get the 4-drug regimen versus 3 drugs where they take away the expensive intravenous medication. So, in summary, 35 to 40 years ago, when I started my cancer career, when I was about 10 years old, most patients had a lot a trouble with nausea and vomiting with drugs like Cisplatinum. Now, this a minority of patients who have a lot of problems, and we're continuing to find new things that will make things better along this line. Thank you for your attention. ASCO: Thank you Dr. Loprinzi. Learn more about these topics and other research presented at the 2019 ASCO Annual Meeting at www.cancer.net. If this podcast was useful, please take a minute to subscribe, rate, and review the show on Apple Podcasts or Google Play. And stay tuned for additional Research Round Up podcasts coming later this summer. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/support.

An interview with Dr. AloK Khorana from Cleveland Clinic on "Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update." This guideline update adds another treatment regimen to the options for patients with resected pancreatic adenocarcinoma who did not receive preoperative therapy.  Read the full guideline at www.asco.org/gastrointestinal-cancer-guidelines  See all of ASCO's podcasts at www.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. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello, and welcome to the ASCO Guidelines Podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Alok Khorana from The Cleveland Clinic, lead author on "Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update." Thank you for being here today, Dr. Khorana. Thank you for having me. So this guideline was first published in 2016. And then we saw an update in 2017. And now we've just updated it again. So can you tell the listeners what has prompted these updates? In the world of pancreatic cancer, this has been an evolution in adjuvant treatment, which is sort of a surprise, because we've been treating pancreatic cancer in a very similar fashion over the past several decades. And between the 1990s and until just a few years ago, there hasn't really been much progress in terms of what to do with pancreatic cancer patients after they've had their cancer resected. It's pretty clear that these patients should not have just the surgery, that they should have additional treatment after the surgery. And for decades, the standard treatment after surgery was either 5-fluorouracil or gemcitabine, but most oncologists are opting for gemcitabine. The two recent updates of the ASCO Guidelines reflect two large randomized trials that have been published in this area. The first changed-- added a new standard of care, which was a doublet adjuvant therapy with gemcitabine and capecitabine. And the reason for this most recent update is the publication of a large randomized trial of adjuvant FOLFIRINOX for patients with pancreatic cancer that was published in December 2018 in "The New England." And we felt that the results were so compelling that we needed to update the guidelines so oncologists and practitioners would have the most current data to help them make decisions for patients. So for our listeners who may not now, can you tell us what changes have been made to the recommendations in this newest version of the guideline? So this is a guideline on a potentially curable pancreatic adenocarcinoma, which is we are saying these are resectable pancreatic cancer patients. And the guideline update changes primarily one recommendation, recommendation 4.1, which is a listing of additional adjuvant therapy options. As I mentioned earlier, the most common monotherapy option used to be the gemcitabine 5-fluorouracil. And that recently changed to doublet therapy. And we've kept those recommendations, but we've added the modified combination regimen of 5-fluorouracil, oxaliplatin, and irinotecan, which is known as the FOLFIRINOX regimen. And we are making this the preferred regimen for patients in the absence of concerns for toxicity or tolerance. We are still keeping the recommendations for the doublet therapy with gemcitabine capecitabine as well as monotherapy with gemcitabine alone or fluorouracil with cholanic acid. But those are not the preferred regimens, because the data for FOLFIRINOX is much better than prior regimens. Having said that, there are concerns about using such an aggressive regimen and in patients who have undergone a major surgery. So patients have not recovered from operation, then it's reasonable to consider one of the other regimens. But the update primarily focuses on adding adjuvant FOLFIRINOX as the preferred option in the adjuvant setting. And how has this guideline and its updates affected care for patients with pancreatic adenocarcinoma? I think since the results of this trial, the PRODIGY 24 trial came out of post-operative FOLFIRINOX. Almost every oncologist I know that focuses on treating patients with pancreatic cancer has suddenly added its use in patients that respected pancreatic cancer who are healthy enough to tolerate adjuvant FOLFIRINOX therapy. So it's definitely a practice-changing landmark paper. The results of the study were really quite impressive. The use of adjuvant therapy with FOLFIRINOX led to much longer survival than we've seen in any trial of adjuvant therapy of pancreatic cancer, almost 54 months-- or actually just over 54 months, almost 55 months-- in patients who are randomized to the modified FOLFIRINOX group and about 35 months in the gemcitabine alone group. The overall survival at three years was 63% in FOLFIRINOX and nearly 49% in the gemcitabine group. So that's a big difference at three-year survival as well. The one thing clinicians should be aware of is that this adjuvant therapy trial used a modified dose of FOLFIRINOX. They initially started off at the full those, which is 85 milligrams per meter squared of oxaliplatin, 400 mg per meter squared of leucovorin, and 180 milligrams per meter square of irinotecan. But the dose of iriniotecan was reduced part way through the study to 150 milligrams per meter squared, along with, of course, the conventional 2.4 grams or 5-fluorouracil over 46 hours. This modification of the irinotecan dose from 180 down to 150 is what many patients on the study received and was the more tolerable regimen and allowed the study to be completed. So the Guidelines Panel felt quite strongly that when using FOLFIRINOX in the adjuvant setting, we should stick with this modified dose, which is a lower dose of irinotecan at 150 milligrams per meter squared. And I think it's important that clinicians be aware of this distinction. And so taking this into account, many of us have made this recommendation to patients who are healthy enough to tolerate adjuvant FOLFIRINOX. And the hope is that this guideline will inform this ongoing practice as it changes in response to new data. And finally, what trials or new research are you keeping an eye on that may prompt an update for this guideline in the future? The results of another large adjuvant therapy trial are expected, hopefully at ASCO this year. This trial is the APAC trial that utilizes gemcitabine and nab-paclitaxel or Abraxane. This doublet combination is quite widely used in patients with metastatic pancreas cancer, particularly those patients for whom we feel FOLFIRINOX may not be appropriate because of their performance status or functional status. And the hope was that the doublet combination would also have good success in the adjuvant therapy setting and perhaps be a better option than the gem-cape doublet. There has been a press release from the sponsor of that trial, and it looks like the trial was not successful, although the way the press release is worded is rather confusing. So we wait for the full results of that trial to be presented at ASCO before we have an understanding of whether that is an appropriate regimen to use or not in the adjuvant setting. So that's certainly one large trial that many of us have been looking forward to complete sort of the set of ongoing adjuvant therapy trials in this setting. Great. It sounds like there's some really exciting things happening in pancreatic cancer right now. And I look forward to seeing this guideline evolve with the research. So Dr. Khorana, thank you so much for coming on the podcast today and summarizing the Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update. Thank you, Shannon. And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go to www.asco.org/gastrointestinal-cancer-guidelines. And if you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.

In this podcast interview, we speak with neuroscientist and physician Leanna J. Standish, ND, PhD, LAc, FABNO, about her naturopathic oncology research. Standish has been involved in original research at Bastyr University since 1987, where she continues to teach and serve patients. We discuss the research she's currently working on—the Canadian US Integrative Oncology Study (CUSIOS)—and its focus on understanding how integrative oncology care affects outcomes for people with certain advanced cancers. In addition, we discuss the use of psychedelic drugs like psilocybin in cancer care—especially for people who have a history of trauma. About the Expert Leanna J. Standish, ND, PhD, LAc, FABNO, is a neuroscientist and physician living in Seattle. She has faculty appointments in the University of Washington School of Medicine Radiology Department, the University of Washington School of Public Health, and Bastyr University. She is working toward obtaining approvals to conduct ayahuasca clinical studies in the United States. She uses functional magnetic brain imaging to study brain-to-brain communication and the ‘entangled minds’ hypothesis. As a physician she specializes in naturopathic oncology, with special interest in the treatment of stage 4 cancer. Standish earned her PhD in neuroscience/biopsychology from the University of Massachusetts in 1978, her ND from Bastyr University in 1991, an MS in acupuncture and Oriental medicine from Bastyr University in 1994, and became board-certified in naturopathic oncology in 2006. Transcript Tina Kaczor: Hello, I'm Tina Kaczor, Editor-in-Chief here at the Natural Medicine Journal. I'm talking today with Dr Leanna Standish about ongoing original research in naturopathic oncology. Dr Standish is a neuroscientist and naturopathic physician with a master's in acupuncture and Oriental medicine and board certification in naturopathic oncology. She's been involved in original research at Bastyr University since 1987, where she continues to teach and serve patients. Dr. Standish, thank you so much for joining me. I want to go- Leanna Standish: Hi, can I just say hi to everybody and especially you, Dr Kazcor, and just express how delighted I am to talk to all of you. Kaczor: Yes, and so yeah, it's very exciting to have you one on one to get to know a little bit of what's going on in the front lines of research specifically. What prompted this was your update at the recent oncology conference. The Oncology Association of Naturopathic Physicians had their annual conference in February where you spoke. I'd like you to kind of start at the beginning. What was really compelling is some of the research on both non-small and small cell lung cancer as well as breast cancer studies. So, if you could kind of update us about a little bit of what ... update us on what's going on with your research in those areas. Standish: Yes. Well, since 2009 working at Bastyr University with Paul Anderson, we started collecting data on survival outcomes in our advanced cancer patients and have a big enough database that we can start summarizing survival outcomes, which is I think of great interest to both patients and their physicians. What we found, our first study was in breast cancer, stage 4 breast cancer, that our median overall survival in our patients, they were 54 consecutive women with breast cancer. The median overall survival is 47 months. When I first got those data, I was very upset because it means that half of my patients were dead at 47 months. But then I thought, well, how does that compare to other studies that were being published at the same time that we were doing our work? What we found is that the best study that we could find in terms of median overall survival in stage four breast cancer was an Abraxane trial that happened in the early part of the 2000s. Just getting some tea here, hold on. That study showed a median overall survival of 36 months. So the conclusion to me was yeah, this is an uncontrolled study. The kinds of patients that we see are the kind of people that are very proactive. They may be survivors just in their very being, but in any sense that you can think about this, that those are pretty good results in advanced cancer. Then we did a similar study in advanced non-small cell lung cancer, and that was with 18 consecutive patients, stage 3 and 4, and the median overall survival there was 43 months. Then we surveyed the literature and did a systematic, I should say systematized review to find that the median overall survival for all the chemotherapy drug trials and even the new immunotherapies that were coming out in just the last say 5 years, the median overall survival of all those studies when averaged together was only 13.3 months. It's kind of astounding to me how poor results in advanced cancer continue to be. That's the summary. Just one more thing I want to say is that this is why we started the Canadian and US study of integrative oncology outcomes. This is 12 clinics all over Canada and the United States that are doing what we call advanced naturopathic oncology, and we're tracking survival and treatment data from 400 people. That probably will be published, it will probably be at 2 years before that study is published. Kaczor: Are there any intermediate points where you've looked at that data? Do we have any idea of what's gong on with that study? Standish: Which study do you mean? CUSIOS? Kaczor: Yeah, that last one you just mentioned, which I think you called- Standish: Yeah, we called CUSIOS, so Canadian US Integrative Oncology Study. What we know is that we've been able to recruit. We're about 85% done recruiting the 400 patients. We have a good diversity of the patients that we recruited for, which was stage 4 breast cancer, stage 4 colorectal cancer, and stage 3 and 4 pancreatic cancer, and stage 3 and 4 ovarian cancer. We wanted to narrow our study to those 4 conditions. We're recruiting. We're able to collect death data, and the most exciting and problematic thing is what do you compare our naturopathic oncology survival data to? Here I've just talked about a breast cancer study, 53 women, their median overall survival is 47, but what does that mean? Compared to what? Right now there is a tremendous amount of intellectual work going on at Bastyr University and also at Canadian College to figure out what the best statistical method is, and fortunately we've been able to collaborate with some very sophisticated big data scientist with statistical ability that have access to this marvelous database in Canada. We will be able to use the SEER database too, and what we're doing is trying to figure out how to match naturopathic oncology cancer patients to patients that are just like them in these registries and then watch them over time with the hard endpoint of date of death. We're also of course very interested in quality of life. We're also interested of course in what therapies each patient got, not only what they were recommended, but also what therapies they received. For example we're tracking Dr Gurdev Parmar's clinic where they're doing locoregional hypothermia. Another clinic is using mistletoe therapy intensively. Another clinic, such as ours at the Ames Institute in Seattle, we're focusing now on the utilization of what's being called metabolic therapy, which is the idea of the cliché is starving cancer using FDA off label drugs that is all the rage these days, very interesting approach. We're using intravenous vitamin C along with chemotherapy. We've sort of abandoned the idea that as a monotherapy it does much. We're starting to explore the safe use of quercetin as a botanical medicine that really needs to be given intravenously to be bioavailable. But I think the most important thing we're doing is taking seriously the idea that trauma, childhood trauma in particular, is a risk factor for development of cancer. And I'm referring of course to the famous ACEs study, Adverse Childhood Events study, that linked in a dose-dependent way the number of adverse childhood events like neglect, foster child, abandonment by parents, alcoholism, violence, etc., war, that the number of these events is correlated with the risk of cancer later in life. And so we at Ames Institute are saying well okay, if that is an important causal feature of why we get cancer, then let's get to that. We're using now psychedelic assisted psychotherapy to be able to do the deep work that is required to help people heal from posttraumatic stress disorder, which not only can come from childhood, but just the very experience of having cancer, being diagnosed with cancer, going through cancer treatment produces posttraumatic stress disorder. What we're hoping is all these therapies combined are going to improve the median overall survival of our patients. That's what we're doing here in my clinic. Kaczor: Tell me a little bit more about this. Is this low-dose psychedelics? I think we're talking about it here in Oregon from a state level. I think there's going to be actually some kind of referendum vote to see if we can legalize such things here, so I'm curious about this. Standish: Yes. The initiative that will be happening in Oregon in 2020 is about permitting psychotherapists, certified licensed and fully trained psychotherapists, to utilize psilocybin in the treatment of posttraumatic stress disorder and also in end-of-life care. That's very exciting. But in the meantime, right now there are no legal psychedelic drugs available for physicians with 1 exception, and that is ketamine. Ketamine is a drug that comes from anesthesia. It's been very well studied as both an anesthetic, but in low doses, it produces a state of consciousness that some people would describe as psychedelic with a dissolution of the sense of self, a connection with higher realities, a connection with one's ancestry, an ability to do deep work in the presence of a physician and a nurse who are overseeing the treatment. What we've found is a 3-hour ketamine session that's led and facilitated in an excellent way can help enormously relieving the depression and the anxiety that is part of all of our lives, but especially if you've been diagnosed with cancer, and especially if you have the kind of trauma in your childhood that is a risk factor for cancer. Kaczor: Is there already clinical data on the use of this? Standish: On what? I'm sorry, clinical data on what? Kaczor: On ketamine or psychedelics being used in this fashion. Standish: No. What there is, this is translational science, and the reason I love naturopathic oncology is that we are people who take science and translate it into other domains of medicine. We know without a doubt now that the state of consciousness, emotional states and brain states associated with those emotional states, have direct effect on the autonomic nervous system, which has direct effects through a cascade of physiology and biochemistry that affects the behavior of cells in the tumor bed. And there's tons of work on that. Is there work on the use of psychedelics for healing cancer? No, but it will be coming, and I hope that we can show some leadership in that area here in Seattle because I think it's an extremely important area. The reason psychedelics might be important too is that most of them have very strong serotonergic effects. What we've found in immunology is that the kinds of cells that are involved in the immunological response to cancer, T-cells in particular, are loaded with serotonin receptors. It is not a far stretch to imagine that one of our future immunotherapies will be psychedelics, and there's now kind of a rage around doing low dose psychedelics, all of which are considered by the drug enforcement agency to be controlled substances, but there's huge interest in this field. Most of us have probably seen Michael Pollan's new book How to Change Your Mind. Kaczor: Yes, yeah. It's a fascinating read. It definitely had more data behind the use of it for emotional states than I had ever realized before reading that book. So let me ask you this because our listeners are often clinicians themselves. Sometimes they are the lay public. In any case, if people want to look further to see if they are appropriate to enter a study or they have patients that might be appropriate, because what I hear you saying is some of these tough-to-treat cancers, whether it's stage 4 disease or lung cancer in stages 3 and 4, they're tough to treat, and we all want to help our patients as best we can. So where would someone go to find you or one of the other 14 clinics involved in CUSIOS study? We'll put a link here with the podcast, but otherwise, where do we find you? Standish: Oh, okay. Yes, please to go the Bastyr University website, and look at the research, and then look for CUSIOS [https://bastyr.edu/research/studies/canadianus-integrative-oncology-study-cusios-advanced-integrative-oncology]. Everything is updated there. It's also listed on the national NIH clinical trials .gov site, and all the clinics are listed there [https://clinicaltrials.gov/ct2/show/NCT02494037]. Kaczor: That's great, and I think what we have is more of a full whole-systems research, outcomes-based research is what I hear you saying. All of these are taking into account large plants, not single agents, which is why we often have weak data when we use single agents in our medicine. Kudos for mastering the complexity of figuring out how to get this data going and inform us. Standish: Yeah, I think that one of our fundamental hypotheses is that natural medicines, those that are known and those that are not known yet, have a potential when they're used in the correct sequence and at the right time and in the right patient who has the right genetics and the right epigenetics at the time that you see them, that our therapies have a chance of really extending high quality life and making cancer into what we hoped for AIDS in the old days as a chronic manageable condition. I think that that day is coming, and we're certainly not there yet. That's for sure. Kaczor: Yeah, yeah. I'm excited because I think that we can track the data much better than we have been able to, so that's certainly helps our cause as well. I thank you for carving out some time in your day and speaking with us today and updating us on what's going on. It's all very exciting, and thank you for all of your ongoing work. Standish: Okay, thank you, Tina. Thanks, everybody. See you soon.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, raises the question of whether to use immune checkpoint inhibitors as first-line treatment of lung cancer, alone or in combination with chemotherapy.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Dr. Jack West, Swedish Cancer Institute, reviews the choices for a first-line chemotherapy regimen based on a squamous histology.

Today in FirstWord:

HER2 inhibitors have been successfully used to combat breast cancer, but research has shown that a small percentage of lung cancer patients have a HER2 mutation as well. Dr. Leena Gandhi talks about the role that HER2 drugs may play to fight lung cancer.

HER2 inhibitors have been successfully used to combat breast cancer, but research has shown that a small percentage of lung cancer patients have a HER2 mutation as well. Dr. Leena Gandhi talks about the role that HER2 drugs may play to fight lung cancer.

HER2 inhibitors have been successfully used to combat breast cancer, but research has shown that a small percentage of lung cancer patients have a HER2 mutation as well. Dr. Leena Gandhi talks about the role that HER2 drugs may play to fight lung cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr. Colin Weekes, pancreatic cancer specialist from the University of Colorado, reviews novel approaches, including nab-paclitaxel with gemcitabine, in advanced pancreatic cancer.

Dr Erica Mayer discusses the EMILIA trial at the ASCO 2012 Annual Meeting, Chicago, with ecancer. The EMILIA trial involves TDM1, a new class of immuno-conjugates, in conjunction with traditional trastuzumab and maytansine. TDM1, in combination with maytansine, originally too toxic for clinical use, and trastuzumab, directly targets the tumour and release cyto-toxins, at a higher concentration, into the tumour. As the drug targets the tumour specifically, toxicity to the patient is dramatically lower than intravenous chemotherapy. Response rates with the treatment are 30 to 40 with little toxicity presenting. The trial used patients who had already been through treatment with trastuzumab and had the ultimate goal of moving towards FDA approval. Dr Mayer also discusses her presentation 'Systemic Challenges with Neoadjuvant Therapy' and costly drugs versus paclitaxel as first line therapy for locally advanced or metastatic breast cancer. A phase III randomised trial found that weekly administration of either of two newer and significantly more costly agents, nanoparticle albumin bound (“nab”) paclitaxel (Abraxane) and ixabepilone (Ixempra), was not superior to standard weekly dosing of paclitaxel as first-line therapy for locally advanced or metastatic breast cancer.