Podcasts about Fred Hutchinson Cancer Research Center

Le port du soutien-gorge a suscité des débats quant à son éventuelle association avec le cancer du sein. Cependant, les données scientifiques actuelles ne soutiennent pas l'hypothèse d'un lien causal entre le port de soutien-gorge et l'augmentation du risque de cancer du sein. Origine de la controverse En 1995, le livre Dressed to Kill de Sydney Ross Singer et Soma Grismaijer a suggéré que le port de soutien-gorge pourrait entraver la circulation lymphatique, entraînant une accumulation de toxines dans le tissu mammaire et augmentant ainsi le risque de cancer du sein. Cette hypothèse a suscité une attention médiatique considérable, mais elle n'était pas étayée par des preuves scientifiques solides. Études scientifiques et conclusions Des recherches ultérieures ont examiné cette hypothèse. Une étude de 2014 menée par le Fred Hutchinson Cancer Research Center a analysé les habitudes de port de soutien-gorge chez plus de 1 500 femmes ménopausées, dont certaines atteintes de cancer du sein et d'autres non. Les résultats n'ont montré aucune association significative entre le port de soutien-gorge et le risque de développer un cancer du sein, indépendamment de la durée quotidienne de port, de la présence d'armatures ou de l'âge auquel le port de soutien-gorge a commencé. De plus, des institutions reconnues, telles que la Société canadienne du cancer, affirment qu'il n'existe aucune preuve scientifique sérieuse démontrant un lien entre le port de soutien-gorge et le cancer du sein. Facteurs de risque avérés Il est essentiel de se concentrer sur les facteurs de risque établis du cancer du sein, tels que : - Âge avancé : Le risque augmente avec l'âge.- Antécédents familiaux : Une histoire familiale de cancer du sein peut accroître le risque.- Facteurs hormonaux : Une exposition prolongée aux hormones œstrogènes, que ce soit par des cycles menstruels précoces ou une ménopause tardive, peut augmenter le risque.- Mode de vie : La consommation d'alcool, le tabagisme, l'obésité et la sédentarité sont des facteurs de risque modifiables. Conclusion Les recherches actuelles ne soutiennent pas l'idée que le port de soutien-gorge augmente le risque de cancer du sein. Il est crucial de se concentrer sur les facteurs de risque avérés et de ne pas se laisser distraire par des hypothèses non fondées. Pour réduire le risque de cancer du sein, il est recommandé d'adopter un mode de vie sain, de participer aux programmes de dépistage appropriés et de consulter régulièrement des professionnels de la santé. Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode, we speak with Dr. Eneida Nemecek, a pediatric oncologist specializing in bone marrow transplants and cellular therapies. Dr. Nemecek provides an in-depth look at the science behind these treatments, the process patients go through, and the challenges faced by both patients and caregivers. She emphasizes the importance of caregiver well-being, particularly sleep, and discusses a PCORI study on stress management for caregivers. The episode concludes with a rapid-fire Q&A session covering key terms and concepts in the field. This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features these PCORI studies (Study #1 & Study #2) by Mark Laudenslager, PhD. Key Highlights: 1. Bone marrow transplant involves replacing a patient's immune system with a healthier one, either from a donor or the patient's own modified cells. 2. Caregiver quality of life, especially sleep, is crucial for patient outcomes in bone marrow transplant cases. 3. CAR-T therapy is a form of cellular therapy where white blood cells are engineered to attack specific targets, offering new treatment options for certain cancers. About our guest: Dr. Eneida Nemecek is a Professor of Pediatrics and Medical Oncology and Associate Director of Clinical Research at the Knight Cancer Institute-Oregon Health & Science University (OHSU) in Portland, Oregon. Native from Puerto Rico, she completed her Pediatric residency at Case Western Reserve University in Cleveland, OH and Pediatric Hematology/Oncology fellowship at the Fred Hutchinson Cancer Research Center in Seattle, Washington. She has a Master in Epidemiology and Clinical Research from the University of Washington and a Master in Healthcare Business Administration from OHSU. Dr. Nemecek is an established clinical researcher with over 20 years of experience in trials ranging from investigator-initiated early phase to large, multicenter studies funded by a variety of mechanisms.  Her research focuses on bone marrow and cellular therapies, experimental oncology therapeutics and health services research addressing disparities in access for underrepresented groups. She has served in leadership roles in steering committees for several national cooperative research groups.  She has also held elected leadership positions as director, trustee or committee chair in multiple professional organizations. The Your Cancer GPS™ platform is coming! Step-by-step subway maps that guide you through the entire cancer experience. Learn more here!⁠ Key Moments: At 14:40 “Sleep is healthy. If you are the one caregiver of a patient and you get sick because you're stressed and not getting enough rest, then you get affected and your patient gets affected too. It's a very important part of our health. Eat, sleep, get some time for yourself. Those are all things that just need to happen. The way that we're designing medicine today, sometimes we forget that the caregiver is kind of a patient. If we lose that person, we are in serious trouble. I can tell you multiple examples about when that has happened and how difficult it is for the medical team and for the family.” At 28:03 “I think it's really important to remind ourselves that the brain, our psychosocial life, is part of our health. I think sleep, exercise, diet studies, anything that can improve the life of people should be studied in a very organized setting, just like you study drugs, if we're going to do this well.” Disclaimer: All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only.  This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Prostate cancer is the second most common cancer in men, according to Fred Hutchinson Cancer Research Center. And Edmonds's most famous traveler Rick Steves recently announced his own prostate cancer diagnosis. Rick is here to tell us how his traveler's mindset is influencing his treatment journey. Seattle City Council Budget Information: https://seattle.gov/council/issues/demystifying-the-budget-process-x151133 And we want to hear from you! Follow us on Instagram at SeattleNowPod, or leave us feedback online: https://www.kuow.org/feedback We can only make Seattle Now because listeners support us. You have the power! Make the show happen by making a gift to KUOW: https://www.kuow.org/donate/seattlenowSee omnystudio.com/listener for privacy information.

In recognition of HIV Vaccine Awareness Day on  May 18th, Dr. P and Louis Shackelford discuss the search for an HIV vaccine. Louis Shackelford is the Director of External Relations in the HIV Vaccine Trials Network (HVTN) Leadership and Operations Center at Fred Hutchinson Cancer Research Center in Seattle, WA. As External Relations Project Manager, Louis' primary focus is implementing stakeholder engagement strategies in HIV vaccine clinical trials domestically and globally.   

You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, members of the Cancer.Net Editorial Board discuss the latest research, innovations, and discussions taking place across the field of genitourinary cancers, including prostate cancer, bladder cancer, kidney cancer, and testicular cancer. This podcast is led by Cancer.Net Associate Editor for Genitourinary Cancers, Dr. Petros Grivas. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine and a professor in the clinical research division at the Fred Hutchinson Cancer Research Center. He is joined by Dr. Neeraj Agarwal, Dr. Shilpa Gupta, Dr. Tian Zhang, and Dr. Timothy Gilligan. Dr. Agarwal is a Professor of Medicine, and a Presidential Endowed Chair of Cancer Research at the Huntsman Cancer Institute at the University of Utah. He directs the Genitourinary Oncology Program and Center of Investigational Therapeutics at the Huntsman Cancer Institute. He is also the Cancer.Net Specialty Editor for Prostate Cancer. Dr. Gupta is the Director of the Genitourinary Medical Oncology Program at Taussig Cancer Institute and Co-Leader of the Genitourinary Oncology Program at Cleveland Clinic. She is also the Cancer.Net Specialty Editor for Bladder Cancer. Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center. She is also the Cancer.Net Specialty Editor for Kidney Cancer. Dr. Gilligan is a Medical Oncologist, Associate Professor of Medicine, and Vice-Chair for Education at the Cleveland Clinic Taussig Cancer Institute. He is also the Cancer.Net Specialty Editor for Testicular Cancer.  View full disclosures for Dr. Grivas, Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan at Cancer.Net. Dr. Grivas: Hello. I'm Dr. Petros Grivas. I'm a medical oncologist in Seattle, a professor at the University of Washington and Fred Hutchinson Cancer Center. I'm really excited and thrilled today to host wonderful superstars in the field of GU Medical Oncology who will share insights about the highlights of kidney cancer, prostate cancer, and bladder, urothelial, urinary tract cancers that happened in 2023. And this highlight aims to inform our great audience about what are the clinically relevant insights, what patients should be aware, what patients should ask for when they go to the clinic, or overall, how they can be most well-informed and have the necessary tools to improve their care and feel well-supported in regards to education. So without further ado, we're going to cover in first prostate cancer, a very important update in this year. So all the people out there that are interested in hearing about prostate cancer will find this very, very useful and insightful. I'm very excited to host Professor, Dr. Neeraj Agarwal from University of Utah. Neeraj, do you want to introduce yourself? Dr. Agarwal: Of course. It's such an honor to be here. My name is Dr. Neeraj Agarwal. I'm a professor of medicine and director of genitourinary oncology program at the University of Utah Huntsman Cancer Institute. Dr. Grivas: Neeraj, thank you so much for accepting the invitation and being with us. I would like to ask you, what's your take on the current state of genetic testing in patients with prostate cancer? And when we say genetic testing, maybe you can clarify the distinction between germline and somatic and comment on both if you could. Thank you. Dr. Agarwal: Of course, a very important topic. I must tell you that it is very clear from all the guidelines that in patients with advanced prostate cancer or metastatic prostate cancer, meaning when prostate cancer has spread to different parts of the body, both germline testing to look for hereditary mutations in the DNA repair genes and testing for the same genes inside the tumor tissue are considered standard of care. So, a patient with advanced prostate cancer should have germline testing and somatic tumor tissue testing to look for mutations that can predispose them to have prostate cancer, and if they have genes in the tumor which can be targeted by the current approved drugs, like drugs which are already approved right now or which are in clinical trials. Unfortunately, less than 50% of patients in many areas of the country and in the world, less than 20% of patients are being tested. And even more, unfortunately, patients are less likely to be tested are those who are not well-resourced, who are not living in rich countries, if you will. They are poor- or low-resourced countries. Even with high-income countries, within those countries, patients who are living in relatively not-so-affluent neighborhoods, they are less likely to be tested. From racial perspective, patients who are Black or who are Hispanics are less likely to be tested. Based on how many drugs are out there in the clinic and emerging through clinical trials. And the fact that we can use many of these mutations for prognostication, to inform survival, to inform aggressiveness of the disease. It is not only to treat those patients, but also how to monitor the disease. The genetic testing is very important. Dr. Grivas: Thank you so much, Neeraj. It's very insightful. And I think you did a great job outlining the clinical relevance for both the patient in terms of treatment decision-making and therapy options, especially for advanced prostate cancer, as well as the broader family and implications for cancer prevention and cancer screening for the broader family members. So definitely a very important topic. Neeraj, the other question I have, if you could tell us more about this class of medications called PARP inhibitors. If you can comment on the currently approved PARP inhibitors, either as a single agent, what we call monotherapy or combination therapies for patients with prostate cancer in the United States, and who is eligible to receive those therapies? Dr. Agarwal: And this is such a nice segue to talk about PARP inhibitors as we were just talking about genetic testing of prostate cancer. So, PARP inhibitors are a class of drug which are instrumental, critical in treatment of patients who harbor mutations in those DNA repair genes. And two monotherapies, meaning using these PARP inhibitors as single agents have been already approved in the United States and several other countries. These are olaparib or rucaparib. Olaparib is approved after patients have had disease progression on novel androgen-blocking therapies or androgen blockers such as enzalutamide or abiraterone or apalutamide. And these PARP inhibitors such as olaparib or rucaparib can be used for those patients as single agent if they have these DNA repair mutations. Now, last year, we saw several combinations of PARP inhibitors with these androgen or novel hormonal therapy, as we call them. And these include abiraterone plus olaparib, abiraterone plus niraparib, and talazoparib plus enzalutamide from various phase 3 trials. Now, I'd like to bring to your attention that these PARP inhibitor combinations are approved with different indications in the United States and in the European Union. And they continue to get approved in various other countries. So the combination of abiraterone and a PARP inhibitor, whether it is olaparib or niraparib, they are approved for patients who have new metastatic castrate-resistant prostate cancer, and they have BRCA1 or BRCA2 mutations in the cancer cells or they have germline BRCA1 and BRCA2 mutations. Enzalutamide and talazoparib combination is approved in the United States for patients with metastatic castration-resistant prostate cancer with BRCA1 and BRCA2 mutations, but also several other DNA repair gene mutations. And that's a big difference as far as approval is concerned in the U.S. In the European Union, for our patients who are listening from European Union, the combination of abiraterone and olaparib and enzalutamide and talazoparib are approved for patients with metastatic castrate-resistant prostate cancer where chemotherapy is not clinically indicated, regardless of whether they have mutations in the DNA repair genes or not. And the combination of abiraterone and niraparib is only approved for patients with metastatic castrate-resistant prostate cancer with BRCA1 and BRCA2 mutation. So I just wanted to outline the different indications in the United States and in the Europe. Dr. Grivas: Thank you so much, Neeraj. So eloquent and very relevant to multiple patients globally, as you pointed out, with some differences in terms of the regulatory approval and availability of those agents in different countries. So great insights. Maybe we'll ask you 1 more question again since we are doing the highlights of the year. Another very important area of therapeutic development has to do with these novel agents that target the prostate cancer cells, and we call them theragnostics as a broader term. And I will let you explain what that means maybe in lay terms for our audience. And specifically, if you can comment on the recently presented PSMAforetrial at the ESMO meeting in Madrid with lutetium-177 PSMA. What are the implications of these results for our patients, and what is the role of lutetium therapy in this particular therapy setting? Dr. Agarwal: Of course, very important and pertinent topic indeed. As our patients may know that lutetium-177 therapy, or simply speaking, lutetium therapy, has already been approved for patients with metastatic castrate-resistant prostate cancer who have had disease progression on this novel hormonal therapy and a chemotherapy with docetaxel or cabazitaxel. And this indication is already there in the U.S. and in various other countries. And patients are eligible to receive lutetium therapy as long as their disease has progressed on docetaxel or one of the taxane chemotherapy and a novel hormonal therapy. Now, in the European Society of Medical Oncology meeting, Dr. Oliver Sartor presented the data on PSMAfore trial where lutetium therapy was used before chemotherapy. In this trial lutetium therapy was compared with another novel hormonal therapy after disease progression on 1 novel hormonal therapy. And there was approximately 6-month improvement in progression-free survival, meaning there was a delay in disease progression by 5 to 6 months in patients who were receiving lutetium therapy. And at the time of the report, there was no improvement in overall survival, with the caveat that 84% patients who were receiving novel hormonal therapy, actually, they switched over to lutetium therapy after disease progression. So, overall, survival data may not be met. Having said that, we already know that lutetium therapy is an effective therapy, and it has a definitive role in treatment of our patients with metastatic castrate-resistant prostate cancer. Dr. Grivas: Thank you, Neeraj. That's very, very important data. And I'm so glad we have many more therapy options for our patients with prostate cancer. So involvement and accrual in clinical trials, I'm sure you will agree, is a very important and high priority. And I always encourage people with prostate cancer to ask about clinical trials that are relevant to their situation. Dr. Agarwal: Yeah. I'd just like to add a point regarding lutetium therapy that there was a phase 2 trial in from Australia which compared lutetium therapy with cabazitaxel therapy after disease progression and docetaxel chemotherapy. And efficacy of both agents were not very different. So just wanted to make that point. Dr. Grivas: Thank you, Neeraj. It's a very important point. And obviously, always want to think about pace and preference, convenience, distance from the cancer centers, all the relevant points, how we can individualize suggestions or recommendations for our patients. Thank you so much, Neeraj, for your wonderful input, insights, and all the work you do in the field. Dr. Agarwal: Thank you very much for having me. Dr. Grivas: Of course, of course. And now we're going to transition to a different cancer type. We're going to talk about bladder cancer and urothelial cancer in general, urinary tract cancer. And we're delighted and excited to have Dr. Shilpa Gupta from Cleveland Clinic, who's a professor there of oncology. Shilpa, I want to introduce yourself? Dr. Gupta: I'm Shilpa Gupta. I'm a genitourinary medical oncologist and the director of the GU Program at Cleveland Clinic. I'm really excited to be doing this podcast with you all. Dr. Grivas: Thank you, Shilpa. You have done amazing work in the field, pushing the field forward. You are part of those transformative studies. I will ask you in the beginning where I'm going to focus my first question for people who have advanced or metastatic bladder cancer or urinary tract cancer or upper or lower tract. And we saw really exciting, impressive data at the recent ESMO Congress in Madrid a couple of months ago. And I know you were there and were enjoying to see the improvement in patient outcomes that comes with better quality of life for patients in the last several years. And the question I have for you, if you want to summarize the key data in the first-line treatment, patients who have no prior treatment for metastatic urothelial cancer, what are the key data we showed at the ESMO meeting? Dr. Gupta: Thank you, Petros. As you said, this is a really exciting time for both patients as well as the physicians treating bladder cancer because of all the new developments which we've seen after decades. So at ESMO 2023, we saw the key data from the EV-302 trial, which was a phase 3 trial, which randomized patients to the standard of care, platinum-based chemotherapy, gemcitabine-cisplatin or gemcitabine-carboplatin, versus a novel drug, which is an antibody-drug conjugate called enfortumab vedotin and the immunotherapy pembrolizumab. And the primary endpoint was to see if patients lived longer and this delayed progression. And we saw that in this the progression-free survival, we saw that it was 12.5 months with enfortumab vedotin and pembrolizumab compared to 6.3 months, which means that the risk of progression or death was decreased by 55% with this new combination. And the benefit was seen across all the various factors, especially patients with liver metastases, visceral metastases, whether or not they had contraindications to receiving cisplatin or not or PD-L1 expression. So this is the first time we saw such a remarkable benefit with any treatment that beat platinums. And the overall survival was also doubled: 16 months in chemotherapy versus 31.5 months with this combination. So the risk of death was reduced by 53%. And we also saw that the overall response rates were 68% with this compared to 44% with chemo. And 29% of patients had complete responses. And this was really remarkable because we have not seen such data before. And in the same session, we also saw another phase 3 trial that was presented, which was the Checkmate 901 trial, in which the investigators tested whether the addition of immunotherapy called nivolumab to the standard of care, gemcitabine and cisplatin was better than gemcitabine and cisplatin alone. So this was a study only looking for patients who can receive cisplatin. So patients were randomized to 6 cycles of gemcitabine cisplatin versus nivolumab, gemcitabine cisplatin for up to 6 cycles. And after that, they continued nivolumab maintenance every month for up to 2 years. And in this, the primary endpoint of overall survival was also met, although the difference was not as huge as the other study. It was 18.9 months with chemotherapy versus 21.7 months with the combination. And progression-free survival was also improved by just 0.3 months with the combination. And the objective response rates were higher with the combination, 57% versus 43%, and there were 21% complete responses. So the bottom line is that both these trials showed us that the frontline treatment is not going to be just platinums anymore moving forward. We will have the option of the enfortumab vedotin and pembrolizumab for all comers, patients who can get platinums, and nivolumab and gemcitabine cisplatin for patients who are cisplatin eligible. Dr. Grivas: Thank you, Shilpa. Wonderful summary. Really, really exciting time to see the field moving forward and translate those results to longer life for our patients. In that context, I will also ask you—I asked Neeraj before about genetic testing in prostate cancer. I will ask you a similar question about genetic testing in bladder cancer. Again, reminding the audience about the distinction between germline testing, which is the DNA we are born with, and somatic testing, which is the cancer-specific genomic changes. Could you comment on the importance of genetic testing in bladder cancer? Dr. Gupta: Yes. Absolutely, Petros. Genetic testing in urothelial cancer is very important because for the first time a few years ago, we saw a drug targeting the fibroblastic growth factor receptor or FGFR alterations. This drug is called erdafitinib. It is the first targeted therapy to be approved in urothelial cancer. It is only seen in up to 20% of patients who harbor these alterations for whom this option may be viable. And we saw initially that erdafitinib was approved in patients who harbor these alterations in the phase 2 BLC2001 trial where it showed response rates of 40% and encouraging progression-free survival, and overall survival. And then we also saw in a phase 3 trial called the THOR trial where patients who harbored these alterations by genetic testing, erdafitinib was much better than chemotherapy, prolonged survival by almost 4.2 months compared to chemotherapy. So unless we are testing, we won't find this. So it is really important to test all our advanced disease patients so we are not depriving them of this additional targeted therapy. Dr. Grivas: Thank you, Shilpa. Very important message for our patients to definitely discuss the value of genetic testing. And if we think about therapy implications, specifically genomic changes, DNA changes in these FGFR-2 and FGFR-3 genes are very relevant and important for potential therapy with this agent called erdafitinib. Shilpa, a quick comment. We saw data from THOR cohort 2 comparing erdafitinib with this inhibitor of this FGFR that we just talked about compared to pembrolizumab, which is an immunotherapy drug inhibiting a checkpoint of the immune system. Could you quickly comment on that? And I think both options are available for our patients and sometimes just comes down to the sequence based on a particular patient case. Dr. Gupta: So Petros, as we had thought that patients who harbor these alterations in their tumors, they may benefit from using targeted therapy before immunotherapy. That was the premise of the cohort 2 of the THOR trial, that patients will do better if they received erdafitinib first after progressing on 1 prior line of therapy, which is not an immunotherapy. So patients were randomized to erdafitinib versus pembrolizumab. Of course, all of them had to have the FGFR alterations. The primary endpoint was overall survival. Initially, like I said, the study assumed that there'll be 46% improvement in overall survival with erdafitinib over pembrolizumab. However, the study was a negative study. There was no difference in the overall survival. And what that means for our patients is that erdafitinib right now is positioned for patients who've had prior platinums and immunotherapies. So erdafitinib should not be used before immunotherapy. So I think this is the first study that really settles the question of sequencing for our patients. And I think the message is that in a patient's journey, they should be getting all these therapies. We just now know that it's better to use pembrolizumab before erdafitinib and not vice versa. Dr. Grivas: Thanks, Shilpa. And then really, really interesting to see these trials being reported. And as you said, individual discussion with the patients and the response rate may be another factor to consider. If someone wants to have a more rapid control of the cancer of the disease, we may potentially think about an agent with high response rate and vice versa. So I think to your point, individual decisions. And I think patients asking those questions is very important in the clinic to help select the right patient for the right treatment for the right patient. Dr. Gupta: Yeah. Absolutely, Petros. They did see that the response rates were 40% with the erdafitinib versus 21% with the immunotherapy. So using that information can sometimes guide us if a patient has high disease burden. Dr. Grivas: Thank you, Shilpa. That was very insightful. And thank you for all you are doing for the patients and the field in general. You really, really have helped the field move forward. So congratulations and thank you. And we're going to transition to another superstar in the field of GU cancers. Very excited to host Dr. Tian Zhang. Dr. Zhang is in UT Southwestern in Dallas. Tian, you want to introduce yourself? Dr. Zhang: Hi, Petros. Thank you so much. Tian Zhang, I'm a GU medical oncologist and associate professor at UT Southwestern Medical Center in Dallas. Dr. Grivas: Wonderful. Thanks, Tian. Again, the same comments. All the work you're doing in the field is tremendous. Thanks for joining us today. Tian, we saw some very interesting data at the ESMO meeting. And since we're doing the highlights of the year, I think the predominance of the data we saw at the ESMO meeting was about this drug called belzutifan, where I will ask you to enlighten us what exactly this is. And particularly, we saw 3 different trials. I would probably ask you to focus more on the LITESPARK-005. What was the trial design and what was the primary goal of the study? When patients go on this drug, what they should be aware in terms of side effects? And what was all this discussion that the take-home message at the end of ESMO regarding belzutifan? Thank you. Dr. Zhang: Sure. We'll parse that one at a time. Belzutifan, I hope many of our audience knows is a small molecule inhibitor of the HIF complex, a hypoxia-inducible factor complex, which is implicated in the development of kidney cancers. And this biology actually contributed to the Nobel Prize in 2019. Understanding the structure of the HIF complex and how to target it. For a long time, HIF was thought to be un-targetable. And so the fact that there were small molecules identified actually here in Dallas at UT Southwestern that inhibits the dimerization of the HIF complex is really novel and shows us the bench-to-bedside translatability of these preclinical discoveries. And so there were a couple of molecules that were discovered here on campus and they paved the way for what became molecules that have now made it to clinic, in particular belzutifan. And so we've had belzutifan now approved for Von Hippel-Lindau Syndrome over the last 2 years or so. So many of us are familiar with using this drug in the clinic. It's an oral agent that's able to target the HIF complex and block it and really control the spread of clear cell kidney cancers, in particular in Von Hippel-Lindau disease.  LITESPARK-005, the trial that you're alluding to, there was a registrational trial for belzutifan across other kidney cancer populations. And this trial was the 1 that made, I think, the biggest impact of the 3 trials that were presented at ESMO this year.  LITESPARK-005 was a phase 3 trial of patients who had metastatic or locally advanced clear cell kidney cancer who had progressed after prior systemic therapies, not more than 3 prior lines. And they were randomized to either belzutifan at the 120 milligrams daily dose or everolimus at the 10 milligrams daily dose. And the primary endpoint was delay of progression. So progression-free survival as well as overall survival. So we saw the primary endpoint of these was met for progression-free survival. There was about a 26% risk reduction for progression for patients treated with belzutifan versus those that were treated with everolimus. The objective response rate I would highlight is also significant for the patients treated with belzutifan. There was actually a 3.5% complete response rate and objective responses. So including partial responders was about 23%. I would say that patients who are treated with belzutifan need to be aware of the side effects of anemia and also hypoxia [low levels of oxygen in the body]. And in fact, higher grades of anemia can occur in up to a third of patients and higher rates of hypoxia. So low oxygen saturations can occur in up to 10% or so of patients. And so that's really important when we're thinking about those toxicities and how we might hold or support the side effects with growth factors, for example, for the anemia. Otherwise, it's quite well tolerated as a single agent. As you alluded to, there was 1 controversial aspect of this particular trial because the control cohort was treated with everolimus. And everolimus as a single agent may not be what people use at this point in the refractory setting. But it is an acceptable approved treatment option for patients in the refractory kidney cancer setting, and therefore, it was chosen as the control cohort. And belzutifan did improve compared to a known standard of treatment. So I think that's really important to add to our armamentarium in refractory disease. Dr. Grivas: Wonderful, Tian. Thank you so much for a really, really comprehensive and detailed review. We'll have to see whether it will be available for patients with advanced clear-cell kidney cancer. To your point, it's already available for patients with this condition that you mentioned, the Von Hippel-Lindau genetic condition. So it's great to see more options available for our patients. Maybe I'll ask you another quick trial to comment on Tian, and I'll ask you individual questions to make it easier, to your point, for the audience to follow. And I'm referring to the RENOTORCH trial. This was conducted in China, and I think it was practice-changing there. Could you tell us the study design? Dr. Zhang: RENOTORCH was another phase 3 randomized trial. It was conducted all in China of patients with unresectable metastatic clear cell kidney cancer, no systemic prior therapy, and also intermediate- and poor-risk disease by IMDC criteria. So these were all first-line metastatic disease, and patients were randomized to either toripalimab, which is their PD-1 inhibitor, plus axitinib versus sunitinib. So this is a trial design that mirrors many of our prior trials in the first-line metastatic setting that have led to approvals of VEGF IO [immunotherapy] combinations. But this is the first one that was carried out purely in the Chinese population and important for the Chinese population to gain access to these types of combinations. Dr. Grivas: Thank you, Tian. Very important to see this global approach, as you mentioned, oncology and see trials from different countries. What were the main findings of this trial? Dr. Zhang: Sure. The primary endpoint was progression-free survival of the 2 cohorts. And they randomized about 420 patients. About 80% per cohort had intermediate-risk disease. And the combination of axitinib with toripalimab did improve progression-free survival. So it had a 35% risk reduction for progression over time. So it did meet its primary endpoint. Dr. Grivas: Thank you, Tian. It's great to see progress in the field. As I mentioned, new agents, positive trials. Could you comment a little bit on the side effect profile and the significance of this trial for our patients worldwide? Dr. Zhang: Sure. When we're talking about VEGF IO combinations very similarly as to the prior trials that we've seen in the toxicity profiles, we're thinking a lot about the immunotherapy toxicities of rashes and colitis [inflammation of the colon], endocrinopathies [hormone problems], as well as the rare inflammatory reactions of the liver, lungs, or kidney, but also added in the small molecule effects of hypertension, hand-foot syndrome, and mucositis [mouth sores] and taste changes. So very important to think through those side effect profiles as our patients are being treated with these combinations. Dr. Grivas: Thank you so much, Tian. Great to see, again, this progress made worldwide. And I think it speaks to the idea of how we can have equitable healthcare delivery across the globe, right, and have agents accessible in different parts of the world. Dr. Zhang: Absolutely. In fact, I would just add that the Chinese population haven't actually had access to drugs like cabozantinib. And this is their first phase 3 grade 1 evidence for a combination of VEGF with IO combination. So it's really important that these trials are carried out in the populations where we try to find the effect and see that the consistent benefit is there so that those patients have access to all of these treatment options. Dr. Grivas: Thank you, Tian. I appreciate your wonderful insights and all your amazing contributions in the field and your research. It's really, really inspiring to see. And I'm going to transition now. Last but not least, we're having the honor of hosting professor, Dr. Tim Gilligan, who is in Cleveland Clinic, and Tim is a world-known expert in urinary cancers, including testicular cancer. Tim, would you like to introduce yourself? Dr. Gilligan: Yes. Hi. So I think you just did. Tim Gilligan, an oncologist at Cleveland Clinic. I chaired the NCCN panel on testis cancer and edit the UpToDate sections on testis cancer with their help. Dr. Grivas: Fantastic. Thanks, Tim, for being with us today. And all the work you have done for our patients with GU cancers, testicular cancer, and a lot of work is being done with the NCCN and other guidelines. And you are co-chairing the NCCN guidelines, to your point. Tim, a lot of discussion is happening nowadays across cancer types regarding the role of what we call biomarkers, which are potential features that can help us select patients for the right treatment or help us estimate the prognosis, how long people live. Could you comment a little bit on this biomarker called microRNA in patients with testis cancer? How do you envision this being developed in the future? Is it ready for prime time or not yet? Dr. Gilligan: And that's an important question. It's not ready for prime time yet, but we are making progress. There are a couple of areas where it could be very useful. So for example, in stage I testicular cancer, we tell patients to go on surveillance because they're usually cured with orchiectomy [surgical removal of the tumor and testicle], but there is a risk of relapse, and that risk of relapse is highly variable. And our current risk stratification systems for predicting who's going to relapse, who has stage 1 disease, are helpful, but they're far from perfect. And so there was data presented this year that mRNA may be more accurate at predicting for men with stage I non-seminomas who's destined to relapse. And so the implication of that would be if you are positive for mRNA, this particular mRNA for non-seminoma and you have stage I disease, normal scans, normal markers, you could identify a high-risk group of patients who maybe should get a cycle of BEP chemotherapy rather than waiting. If you know they're going to relapse, you're going to have to get them 3 cycles of BEP, why not just treat them right away? Or maybe RPLND [retroperitoneal lymph node dissection] could be helpful in that setting. We don't know. But we would need to do studies validating that approach. There is data showing that it does predict relapse, but it's not at the point of saying, "Are the patients really going to do better with immediate treatment and which treatment is going to be best for them?" But I thought that was an important finding and really an example of how we think we're going to use it, which is to find relapse a lot earlier and so that we can give a less toxic treatment. And the benefit of that is that we know more and more that chemotherapy is toxic and resulted in second cancers. For men who get multiple cycles of cisplatin-based chemotherapy, or if they get radiation therapy, they're at higher risk of dying of other cancers than the general population. So if this could help us find early relapses, treat it more gently, less aggressively, have late, less toxicity, and the same cure rate. That would be great. So we're not there yet, but I think we're going to get there. Dr. Grivas: Thanks, Tim. Very, very helpful to know. So this microRNA 371 that we talk about is not ready for prime time, but you definitely see promise for the future, and more trials, more studies are being done. Again, illustrating the importance of clinical trials that can help us evaluate the added value of a particular biomarker, including this particular microRNA that we talked about. Dr. Gilligan: Before you change the subject on getting to crude biomarkers, there was also an interesting abstract showing that for stage I seminoma. If we actually use our current markers, we may be able to predict much more accurately. And it'll be interesting to see if that changes. They looked at the variables of lymphovascular invasion, invasion of the hilum of the testis, whether or not preoperative markers were elevated, LDH, and beta HCG. What was interesting to me about that paper was that this is about 900 patients. It was pretty large. That if you had all 4 risk factors, the relapse rate was about 64%. Whereas your average relapse risk for stage I seminoma is about 15%. We put everyone on surveillance. If we started if that model is persuasive to the community and starts getting used, then maybe patients with those 4 risk markers who most of whom are going to relapse, according to this data, maybe you want to treat those people and not put them on surveillance. So that'll be interesting to follow up on too. Dr. Grivas: Thanks, Tim. And you are referring to currently available blood tests, right, that can be used, and we use them in clinical practice. So we just put them together, try to get a sense of the chance of cancer coming back, what we call recurrence, and how long people may live. That can help us make a therapy decision. Thank you, Tim. This is very, very interesting. And I'm glad to see the progress in the field. I think you alluded to that before, but there is a trend discussing when we have a removal of the testicle for a patient with testis cancer, what to do next, depending on the stage, those markers that the blood tests you told us about. What about the role of surgery for removal of lymph nodes, for example? And do you see a trend going forward that in many selective cases, certain scenarios, we may potentially select surgery as opposed to chemotherapy or radiation to avoid these potential complications down the road? And if so, which are those patients who may benefit from surgery? Dr. Gilligan: Yeah, an important question. I think surgery, there's been a growing interest in using surgery rather than chemotherapy in order to avoid late effects. So retroperitoneal lymph node dissection (RPLND) is the most obvious example of that. There is data now showing that most patients with stage II seminoma can be cured with retroperitoneal lymph node dissection. We used to treat those patients with chemotherapy or radiation, but as I've noted, both of those are associated with an increased risk of second cancers down the line. So there are papers on both sides of the Atlantic showing that you can cure most people. However, it is important to note that the relapse rate after surgery is significantly higher than the relapse rate after chemotherapy or radiation. If you take a stage II patient and treat them with chemotherapy or radiation, you're going to cure well over 90% of them. Whereas the relapse risk with surgery, depending on what you find at surgery, is going to be higher. So on average, it's going to be in the realm of 20%, maybe as high as 30%, depending on which paper you look at. And if you take patients who have PN2 disease, so a lymph node is 2 centimeters or bigger, 25% or more of those patients are relapsing after surgery. So it's important for patients to understand that this treatment has the benefit of avoiding chemotherapy for most patients, but it also has a higher risk of relapse than the old treatments. We still think it's attractive because if you can avoid chemotherapy in 3 out of 4 patients or 4 out of 5 patients, that's a benefit to those patients. And also, if you go in and find a significant amount of cancer at surgery, you can give 2 cycles of chemotherapy right away and almost eliminate the risk of relapse, which is less chemo than they would be getting upfront, which would be 3 or 4 cycles. So one of the emphasis now is really trying to avoid late toxicities if we can. You sometimes see that even in the metastatic setting in terms of resecting residual masses and situations where we maybe in the past would have thought about second-line chemotherapy. I think people are more thinking about opportunities to use surgery instead to try to limit the quantity of chemo that we're giving. Those are much trickier decisions than the stage II decisions, but definitely a growing interest in surgery rather than chemo. Dr. Grivas: Thank you so much. It's really, really exciting to see that testis cancer was really transformed in the past with developments of therapies like chemotherapy, radiation therapy, and surgery. And it's great to see this evolving down the road. And I think all of the above that you mentioned evolves through the conduction of clinical trials. And as I mentioned before, I think it's so important to give the opportunity for patients and families to review clinical trial options. I think it's critical to try to help them, but also help other patients, the community, the society in general. So I always try to underline the importance of clinical trials across the board. And on that note, I think we had such a successful year, 2023 across GU cancers. It's so great to see the progress being made. All of us are looking forward for more exciting research being done in 2024 and beyond. And on that note, I want to thank so much Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan for wonderful insights and all the great work they're doing in the field of GU cancers. As the editor for the GU Cancers for the wonderful Cancer.Net, I'm so proud of this team and really, really looking forward to further podcasts like this and how we can better serve the educational mission for ASCO, working with the wonderful staff at Cancer.Net. Thank you so much, all of you, for your time today and all you are doing. Dr. Gupta: Thank you, Petros. Dr. Zhang: Thank you, Petros. ASCO: Thank you, Dr. Grivas, Dr. Agarwal, Dr. Gupta, Dr. Zhang, and Dr. Gilligan. You can learn more about new research in genitourinary cancers at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

In the next installment of ASTCT's Titans of Transplant series, Dr. Stephanie Lee is interviewed by Dr. Jennifer Saultz. Dr. Lee shares her journey from Seattle to becoming a professor at Fred Hutch Cancer Center. The conversation highlights early motivations, challenges faced during fellowship, and the influence of her father's advice to always strive for the best. They also discuss Dr. Lee's groundbreaking work in chronic graft-versus-host-disease research, collaborative efforts, FDA-approved treatments, and the evolving landscape in the field. The Titans of Transplant series seeks to recognize, celebrate and chronicle the physicians, researchers, pharmacists, nurses, social workers and more who were on the frontlines of the early days of transplant. About Stephanie Lee, MD, MPH Dr. Stephanie Lee (@StephanieLeeMD) is a hematologist and physician scientist who is Professor and Associate Director at the Fred Hutchinson Cancer Research Center. Dr. Lee works to improve the lives of blood stem cell transplant and bone marrow patients by better understanding the chronic form of graft-versus-host disease. Dr. Lee is the former President of the American Society of Hematology. About Jennifer Saultz, D.O. Dr. Jennifer Saultz (@jennifernsaultz) is an Assistant Professor of Medicine and physician scientist in the Adult Transplant and cellular therapy program at Oregon Health & Science University. Her research focuses on augmenting NK cellular therapy in myeloid malignancies. She is also a member of the ASTCT Content Committee.

At AfricArXiv, we have been working with ScienceOpen since 2020 as one of our affiliate repositories, having set up a collection for African Languages and COVID-19 in Africa. You can easily request journal-independent Peer Review on your submitted works within their system. Stephanie will tell us what else they are doing to support African research dissemination. She is also joined by Andrew Joseph, a Digital Publisher at Wits University Press, South Africa. Stephanie Dawson ORCID: 0000-0002-2298-2 Stephanie Dawson grew up in northern California and studied Biology at Yale University. She then worked at the labs of Susan Parkhurst at the Fred Hutchinson Cancer Research Center in Seattle WA and Ralph Rupp at the MPG Friedrich Miescher Laboratory, Tübingen, Germany before changing fields and getting a PhD in German Literature from the University of Washington under Jane Brown. From 2001-2012 she worked in various positions at the academic publisher De Gruyter in Berlin in the fields of biology and chemistry in both journals and book publishing. In 2013 she took on the role of managing director for ScienceOpen GmbH in Berlin. Andrew Joseph ORCID: 0000-0002-1486-1018 Andrew Joseph is the Digital Publisher at Wits University Press, and his publishing experience has largely been in academic and reference publications. Andrew has worked with most major European and US academic publishers including Springer Nature, Macmillan, Elsevier, Taylor &Francis, Wiley, and SAGE. He is closely involved with standards development and implementation, especially for metadata, persistent identifiers (ORCiD), and XML workflows for scholarly publishers, and serves on advisory boards and committees for Crossref, the Open Access Data Trust Exchange, CoalitionS and the ONIX International Steering Committee. Andrew currently serves as Chair of the Scholarly Publishers Committee for the Publishers Association of South Africa and chairs the South African National Metadata Users Group – a cross-industry metadata standards group.  About the webinar series This webinar was co-organized by ⁠UbuntuNet Alliance⁠ and ⁠Access 2 Perspectives⁠ as part of the ⁠ORCID Global Participation Program⁠. ⁠ORCID⁠ is the persistent identifier for researchers to share their accomplishments (research articles, data, etc with funding agencies, publishers, data repositories, and other research workflows. ⁠AfricArXiv⁠ is a community-led digital archive for African research communication. By enhancing the visibility of African research, we enable discoverability and collaboration opportunities for African scientists on the continent as well as globally. Find more podcast episodes here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://access2perspectives.pubpub.org/podcast⁠⁠⁠⁠⁠⁠ Host:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Dr Jo Havemann⁠⁠⁠⁠⁠⁠⁠⁠⁠, ORCID iD ⁠⁠⁠⁠⁠⁠⁠⁠⁠0000-0002-6157-1494 ⁠⁠⁠⁠⁠⁠⁠⁠⁠ Editing: ⁠⁠⁠⁠⁠⁠⁠⁠⁠Ebuka Ezeike⁠⁠⁠⁠⁠⁠⁠⁠⁠ Music:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Alex Lustig⁠⁠⁠⁠⁠⁠⁠⁠⁠, produced by⁠⁠⁠⁠⁠⁠⁠⁠⁠ Kitty Kat ⁠⁠⁠⁠⁠⁠⁠⁠⁠ License:⁠⁠⁠⁠⁠⁠⁠⁠⁠ Attribution 4.0 International (CC BY 4.0)   ⁠⁠⁠⁠⁠⁠⁠⁠⁠ At Access 2 Perspectives, we guide you in your complete research workflow toward state-of-the-art research practices and in full compliance with funding and publishing requirements. Leverage your research projects to higher efficiency and increased collaboration opportunities while fostering your explorative spirit and joy. Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://access2perspectives.pubpub.org⁠⁠⁠⁠⁠⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/access2perspectives/message

When Preston Singletary was growing up in Seattle in the 1970's and '80's, he dreamed of being a professional musicians. But when he went over to hang out with his buddy after school. Singletary's life took a different path. His friend, Dante Marioni's dad Paul was part pf Seattle's thriving art glass movement, and young Preston found himself drawn to the art form.  More than 40 years later, Singletary has become one of the world's most famous glass artists, pioneering techniques that allow him to replicate Northwest Indigenous designs, and to transmit the stories of his Tlingit ancestors.  Co-hosts Marcie Sillman and Vivian Phillips paid a visit to Singletary's studio, located in the middle of the Seattle campus of the Fred Hutchinson Cancer Research Center to talk about craft and legacy and the importance of cultural stories.

30. Can Estrogen Cause Breast Cancer?    I loved this interview with my naturopathic oncologist, Dr. Laura James. She is a wealth of information and was a great support to me during my breast cancer battle.   We discussed estrogen's role in breast cancer and how too much can be problematic. According to Dr. James, excess estrogen (we pick up a lot of additional estrogen from using plastic and cosmetics) may encourage cancer growth. However, she states that the "jury is still out" on whether estrogen causes cancer.   We also talk about consuming soy products (spoiler alert, I eat soy!) and if some soy products are better than others.   We also discussed a few products I use and that Dr. James recommends for those gosh-darn hot flashes!   Her website is a powerful resource for anyone fighting breast cancer or trying to avoid it! Visit LauraJamesND.com.   For the Hot Flash supplement created by Dr. James, visit her website above or click here!     About Dr. Laura James: Dr. Laura James is a naturopathic oncologist in private practice in Bellingham, WA. She is trained in safely managing complementary and alternative therapies for cancer patients undergoing conventional cancer treatments.    She provides complementary medicine consultations regarding whole foods nutrition, botanical medicine, nutritional supplements, and lifestyle modifications to attain optimum health during cancer treatment and after. She founded Red Cedar Wellness Center, an interdisciplinary integrative health clinic for adults in Bellevue, in 2002, and acted as medical director through 2018.     Dr. James has a bachelor's degree from Tufts University in Boston, and her naturopathic medicine doctorate from Bastyr University in Seattle. She is a Fellow of the American Board of Naturopathic Oncology. She has served on the Board of Team Survivor Northwest, and as adjunct faculty at Bastyr University's Center for Natural Health. She collaborates with major medical institutions around the Puget Sound area regarding implementation of integrative medicine programs for cancer patients. She is a sought-after speaker for local and national organizations, including the Seattle Cancer Care Alliance, Fred Hutchinson Cancer Research Center, Evergreen Healthcare, Overlake Hospital Medical Center, Cancer Lifeline, and the Susan G. Komen Foundation.    This episode is sponsored in part by ButcherBox. I love using Bison! It's very nutrient dense and contains conjugated linoleic acid (I know, what the heck does that mean?), which means Bison has anti-inflammatory properties. Here are the other reasons why I love using Bison in place of ground beef: Higher amounts of omega three fatty acids. More b12, zinc, iron, and selenium than beef. Some studies show it's got four times the vitamin E compared to beef. Lower in calories and cholesterol. It is lower fat, so it will cook faster than ground beef. My friends at BB are offering a deal that they've never offered to anyone! I had to say "pretty please" a couple of times, and guess what? It worked! I can't tell you how long they will offer this deal to me, but here it is:

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today's episode, our guests will discuss new research in gynecologic cancers [2:06], multiple myeloma [9:15], and head and neck cancer [16:03]. First, Dr. Lan Coffman discusses new research in ovarian cancer, uterine cancer, and cervical cancer. Dr. Coffman is a physician-scientist and gynecologic oncologist at the Magee-Womens Research Institute and Foundation, and assistant professor in Hematology-Oncology at the University of Pittsburgh School of Medicine. She is also the 2023 Cancer.Net Associate Editor for Gynecologic Cancers. You can view Dr. Coffman's disclosures at Cancer.Net. Dr. Coffman: Hi, my name is Lan Coffman. I'm a physician-scientist at the University of Pittsburgh. I'm a medical oncologist that specializes in gynecologic cancers, and I'm happy to discuss research that was presented on gynecologic cancers at the 2023 ASCO Annual Meeting. I do have a relevant disclosure. I participated in one of the trials I'm going to discuss, a trial called MIRASOL. I was the site principal investigator at University of Pittsburgh. I think there were a lot of interesting studies to highlight, and I wanted to focus on studies involving ovary cancer, endometrial cancer, and cervix cancers as the main sites that we study in the gynecologic oncology world. So when we talk about ovary cancer, I think there was one really impactful study that was presented at ASCO this year, and it was called MIRASOL. And again, this is the study that I also participated in at our hospital at University of Pittsburgh. So it was a large study, so a randomized phase 3 study looking at a drug called mirvetuximab, which is an antibody-drug conjugate. So basically, it's an antibody against a protein that is expressed on ovarian cancer cells and the protein's called folate receptor-alpha. And that antibody basically carries a little poison. And so it's kind of like a Trojan horse. This antibody goes, finds that protein on the tumor cells, and then delivers that poison. And so this drug has been studied and actually was presented last year in a different trial called SORAYA, which showed that it had activity, meaning the drug helped to kill ovarian cancer cells, and actually led to the first approval of this drug in ovary cancer. So this trial was the confirmatory trial, so enrolling more patients to see, actually, is it better than standard-of-care chemotherapy? So this was in women with ovarian cancer that had come back and was platinum resistant, meaning the cancer started to grow within 6 months from the last platinum-based therapy. Women were eligible if they had high expression of this folate receptor-alpha, and they had to have a couple of prior lines of therapy. And then they were randomized, so kind of chosen out of a hat to either be treated with mirvetuximab or with investigator's choice chemotherapy. So one of the chemotherapies we'd use standardly. And so that would be something like taxol, or liposomal doxorubicin, or topotecan. And basically, this study was comparing how well does mirvetuximab work compared to chemotherapy. And importantly, it showed that it improved survival, both progression-free survival, so how long it took before the disease started to grow again, but probably more importantly, actually improved overall survival, so how long a woman lived. And actually changed overall survival from about 16 and a half months compared to 12 months with chemotherapy. And so this was really important and demonstrated that mirvetuximab does actually impact women with ovarian cancer and actually helps women live longer. And that's really hard to do in this setting. And the other nice thing about this trial was that not only did it work well, but there are actually lower side effects with it, and so less women actually had to discontinue their treatment, and they had less what we call adverse events, or basically bad things that had happened from the treatment themselves. So just telling us that this drug is actually well tolerated. Women feel well on it, even when their cancer is shrinking. So I think that was one of the most impactful studies in ovary cancer. Moving on to endometrial cancer. We recently had 2 studies, one called RUBY and one called GY018 that looked at using immunotherapy in combination with chemotherapy in endometrial cancer. And what was presented at ASCO was some follow-up from this RUBY trial, which was basically validating that this combination of adding immunotherapy actually helped. To give you a background, traditionally, women that have endometrial cancer that is advanced staged, meaning spread outside of the uterus itself or has come back, we treat it with chemotherapy. But this study added an immunotherapy called dostarlimab in combination with our standard chemotherapy and actually showed that women were living longer with this, at least in that progression-free survival. We're still waiting on final evaluation. But at ASCO, what they reported was another independent blinded review of the data to show that even when we're really carefully looking at this data, it looks like immunotherapy helps women with endometrial cancer live longer. They also presented quality-of-life data showing that women actually feel better with the addition of the immunotherapy. So I think this is practice changing. And again, this data has been coming out over the last year or so, but I do think this will change the way in which endometrial cancer is treated. And then the final thing I wanted to discuss would be in cervix cancer. And while there wasn't a lot of new data presented here in terms of kind of paradigm shifts or large changes, we did have final survival [data] from the KEYNOTE-826 presented, which is also using immunotherapy along with chemotherapy in cervix cancer. And so this was in women that, again, had advanced-stage cervix cancer. So it was a cervix cancer that had moved beyond the cervix itself or cervix cancer that had come back and was treated with chemotherapy along with another immunotherapy called pembrolizumab. And this was the final survival data that confirmed that the immunotherapy did help women live longer. The survival data was impressive with about a 10-month improvement in overall survival. So how long a woman lived. And so that was really confirmatory of the previous trials. So again, that emphasizes that immunotherapy is moved towards the standard of care in cervix cancer as well. I can't hit all the highlights of the impressive research coming out of ASCO 2023, this is a brief summary of some of the critical studies in gynecologic cancers. ASCO: Thank you, Dr. Coffman. Next, Dr. Sagar Lonial discusses new research in multiple myeloma. Dr. Lonial is a professor of Hematology and Medical Oncology at Winship Cancer Institute at Emory University, where he also serves as Department Chair. He is also the 2023 Cancer.Net Associate Editor for Myeloma. You can view Dr. Lonial's disclosures at Cancer.Net. Dr. Lonial: Hello, I'm Dr. Sagar Lonial from the Emory School of Medicine and the Winship Cancer Institute in Atlanta, Georgia. And today I'm going to discuss some of the really exciting research in the context of multiple myeloma that was presented at the 2023 ASCO Annual Meeting. In terms of my conflicts of interest, I have enrolled patients on many CAR T trials as well as bispecific trials from all of the different companies involved here. So, I do have some engagement with those trials. And one of the studies that I may talk about at the end came from our institution. So I was an investigator on that study as well. When I think about some of the really exciting work that was presented at ASCO this year, there are really 2 big categories of trials that I think were most exciting. And the first is CAR T-cells and moving them earlier and earlier in the disease state. And what we saw at ASCO this year was the CARTITUDE-4 study, which was a randomized phase 3 trial comparing CAR T-cells versus standard treatment in the context of first or second relapsed multiple myeloma. And this was a really important study for us to hear because we know that CAR T-cells are highly effective in the later lines of therapy. A big question at this point is, "Does their efficacy hold up in earlier lines of therapy? And how does it compare in a randomized setting against what we might normally use in that clinical context?" And what I think we were really excited to see at ASCO this year was that CAR T-cells appear to be superior to standard treatment in the context of that randomized phase 3 trial. Now, there were a few patients who were randomized to CAR T-cells who didn't get to the CAR T-cell infusion because their disease progressed in that interval. And that is a challenge that many of us deal with on a regular basis when we think about using a CAR T in a patient. But in general, the treatment was available for almost all patients. And the analysis of benefit as measured by a longer remission duration for the patients who received CAR T cells versus those who didn't was really done on what we call an intent to treat basis. And what that means is if you were randomized to the CAR T arm, even if you didn't get the CAR T, which again was a very small number of patients, you were still evaluated as if you got a CAR. And what I think that tells us is that even taking into account some of those patients who may not get there, there still was significant clinical benefit. And this is really important data for us to have insight into. We've seen this with cilta-cel in CARTITUDE-4. We'd seen similar kinds of findings in KarMMa using ide-cel as the CAR T-cell, although it does appear that the remission duration, at least when you're comparing across trials, appears to be a little bit longer for cilta-cel than what we've seen with ide-cel. But nonetheless, it suggests that even in the context of early relapse, there may be some benefit for CARs over standard therapy. Now, does this mean that CARs are going to replace standard therapy in terms of early relapse? I don't think we know the answer to that right now. I think there's a lot of information that we need to look at to really feel comfortable making that step. The other big set of data I think that we were all very excited about to see at ASCO this year were the T-cell engagers or the bispecifics. And what we saw from a number of different bispecifics was that the efficacy data looks like it continues to hold up. But what to me was really quite exciting was the idea that the T-cell engager could be highly effective even if a patient had seen prior BCMA-directed therapy. And what this means to me is that perhaps if you're progressing on a CAR T-cell, you still may have a pretty reasonable chance at a response, again, to a BCMA-directed therapy with a bispecific. The other way around may not necessarily be the same. And so I think what we learned at this meeting is that the bispecific or T-cell engagers clearly could have activity in the context of prior BCMA-exposed therapy. And I think, as a field, we need to think more about how we define what it means to be resistant to a BCMA-directed therapy. So that I think was really important and exciting and will have relevance in our daily clinical practice. We also saw updates on a different non-BCMA-directed target. So we saw updates on GPRC5D-targeted bispecifics, also known as talquetamab. What I think was really exciting here is we saw a very high overall response rate, modest infectious complications compared to what we've seen with BCMA-directed therapy.   Finally, what I want to wrap up with was a very small study addressing what I think is a pretty significant unmet medical need. And that was a trial from Dr. Nooka at my institution, where we evaluated a combination of carfilzomib with pomalidomide and dexamethasone, or KPD. And we used that specifically as maintenance in the high-risk group. And what we learned from that evaluation is that it appears for patients with high-risk disease that KPD maintenance is better than either carfilzomib and len [lenalidomide] or even bortezomib and lenalidomide, which historically has been what we're using. But there remains an unmet medical need patient population, particularly the double-hit patient population, that even with KPD still didn't have a great outcome overall. So more work for us to do down the road. But certainly, food for thought for many of those other patients that perhaps don't fit into that double-hit classic category. So I think what I've given you is a nice sort of overview of many of the exciting data that were presented at ASCO 2023. Again, go to the website to see additional ones. And thank you again for listening to this brief summary of research in myeloma updates from the 2023 ASCO Annual Meeting. ASCO: Thank you, Dr. Lonial. Finally, Dr. Cristina Rodriguez discusses new research in treating head and neck cancer. Dr. Rodriguez is a medical oncologist at Seattle Cancer Care Alliance, an Associate Professor in the Division of Medical Oncology at the University of Washington, and an Associate Member for solid tumor clinical research at the Fred Hutchinson Cancer Research Center. She is also the 2023 Cancer.Net Associate Editor for Head and Neck Cancers. You can view Dr. Rodriguez's disclosures at Cancer.Net. Dr. Rodriguez: Hello, my name is Cristina Rodriguez, and today I'm going to discuss some new research focusing on head and neck cancer that was presented at our annual ASCO 2023 meeting. As part of my disclosures, my institution receives research funding from CGEN. My takeaway from this meeting was there were a few major themes represented by the research. One of them was research on uncommon cancer types, such as nasopharyngeal cancer and salivary gland cancer. The other major theme and what was exciting for me was research on groups that were typically not represented in clinical trials in head and neck cancer. These include elderly or frail patients with many other comorbid illnesses that might have excluded them from clinical trials. Another theme was research in areas outside the developed world. In other words, resource-restricted countries. There was some exciting research coming out of that. And finally, a few new agents, novel agents that looked to have activity in patients with head and neck cancer that are going to be studied further. So with that, I'm going to start with talking about research that came out of France, presented by Dr. Fayette. This was a clinical trial that focused primarily on the frail elderly population. A group that might make very difficult for one to enter clinical trial because of many different illnesses or not being fit enough. And this group, out of France, looked at a combination of immunotherapy and a gentler lower dose chemotherapy called carboplatin and paclitaxel. Interestingly, in this group, there was very encouraging results, including 71% of patients having an objective response or a reduction in the size of their tumor, and very few patients, less than 5% of patients, having toxicity that required permanent discontinuation of the drug. So I thought this study was particularly interesting and gives us physicians and patients who are in this situation some more options to use when we're in the treatment of head and neck cancer. The next study that I thought was particularly interesting came out of India and was presented by Dr. Kothari. The special thing about this study was that it asked the question of the efficacy of a very low-cost combination for patients with recurrent or metastatic head and neck cancer. It's a combination that we don't tend to use here in the United States, one that involves methotrexate, celecoxib, and erlotinib. This particular clinical trial was carried out in several sites in India, and it randomized patients to this low-cost oral regimen versus physician's choice. In other words, any type of treatment that might involve immunotherapy or antibody therapy. The main issue here being that sometimes many of these therapies are not easily accessible to patients in low-resourced situations. The investigators observed an overall survival advantage, what that means is more patients lived longer when they use the low-cost oral regimen, which was much more practical, much easier for patients to take, and had more success in improving and prolonging the lives of patients. So I thought that that was a particularly important observation. And we forget a lot of times when we're practicing in the United States that a lot of our practice patterns here may not be applicable to low-resource settings. And I think it's very exciting that research is being carried out to answer questions that are relevant to this area. The third abstract that I thought was particularly intriguing was one presented by Dr. Glenn Hanna from Dana-Farber. And it looked at a new drug called BCA101. BCA101 is an antibody that has 2 functions. It inhibits EGFR, or epidermal growth factor receptor, very commonly overexpressed in head and neck squamous cell carcinomas. And it has a dual function, which is it modulates TGFβ, which is an immunosuppressive cytokine within tumor cells. This drug was combined with pembrolizumab in this small study and offered to patients who have never received treatment for recurrent or metastatic head and neck cancer. There was a lot of enthusiasm for this drug because in the 33 patients enrolled in the trial, 48% of them had an objective response, meaning a reduction in the size of their tumor. Anemia was one of the more common side effects that were noted. But the efficacy of this agent in this population, these patients expressed PD-L1 or had a CPS score of 1, was enough to support further study of this drug and a larger clinical trial is going to be carried out looking to see if this drug will have similar efficacy or better efficacy in a larger population. Finally, the last abstract is one that was presented by Dr. Swiecicki. And it was an interesting abstract to me because it examined the activity of another novel agent not FDA-approved for head and neck cancer, called enfortumab vedotin. This is a class of drugs that belong to a group called antibody-drug conjugates. This is an antibody that's directed toward the target called Nectin-4 and has a small chemotherapy payload that's attached to the antibody. Unlike Dr. Hanna's study, this study was a small phase 2 trial that focused on patients who've previously been treated in the recurrent or metastatic setting and are now receiving this drug either as their second or third option after they developed recurrent or metastatic disease. 46 patients were enrolled in this trial, and 24% of patients had an objective response or reduction in the size of this tumor. Although that number doesn't seem very high, it is an encouraging signal because in patients who previously received treatment for head and neck cancer, we tend to see very poor response rates. So this is encouraging given the population that was studied. Another 32% of these patients had what's called stable disease or no significant change in the size of their tumor. So that too is quite encouraging. This drug is going to also move on for further study in head and neck cancer. So I thought that these themes really brought about a lot of excitement for me for the future of treatments in patients with head and neck cancer, not only in developed countries but also in resource-restricted environments. And I look forward to next year and more work being done in these areas. And I'd like to thank you for listening to this brief summary of developments and head and neck cancer presented in the 2023 ASCO Annual Meeting. ASCO: Thank you, Dr. Rodriguez. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

Are you confused by all the claims about the “best” diets, what foods to avoid, and the never-ending list of nutritional fads highlighted in books and headlines? We are too. And in today's episode, we're going to do something about it.Welcome to the Catalyst 360 Podcast. Today's guest is Dr. Mario Kratz, the founder and director of Nourished by Science, an evidence-based resource I have a feeling everyone is going to be tapping into after hearing this episode. Dr. Kratz has been on the faculty in the Departments of Epidemiology and Medicine as well as the Nutritional Sciences Program at the University of Washington and intimately involved at the Fred Hutchinson Cancer Research Center in Seattle, Washington. He now focuses his time providing trustworthy, rigorous, and evidence-based information about nutrition, health, and chronic disease for those – like us - who share his passion for science and a healthy lifestyle.Catalyst 5 weekly tips here Info re earning your health & wellness coaching certification, annual Rocky Mountain Coaching Retreat & Symposium & more via https://www.catalystcoachinginstitute.com/ Best-in-class coaching for Employers, EAPs & wellness providers https://catalystcoaching360.com/ YouTube Coaching Channel https://www.youtube.com/c/CoachingChannel Contact us: Results@CatalystCoaching360.comTwitter: @Catalyst2ThriveWebsite: CatalystCoaching360.com

Dr Terence Friedlander from the UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco, California, and Professor Petros Grivas from the Fred Hutchinson Cancer Research Center in Seattle, Washington, discuss available and novel treatment strategies for metastatic urothelial bladder cancer, moderated by Dr Neil Love.

Dr Terence Friedlander from the UCSF Helen Diller Family Comprehensive Cancer Center in San Francisco, California, and Dr Petros Grivas from the Fred Hutchinson Cancer Research Center in Seattle, Washington, discuss available and novel treatment strategies for metastatic urothelial bladder cancer moderated by Dr Neil Love. CME informationa and select publications here (https://www.researchtopractice.com/InsideTheIssue2023/mUBC).

The most revered sports figure in Seattle is Frederick Charles "Hutch" Hutchinson. He was the first to achieve national renown and is regarded as a true hometown hero for both his achievements off the field and his bravery and demeanor in public. He was a standout from his earliest days on the Rainier Beach sandlots and hailed from a baseball-loving family who lived in wealthy circumstances. In Franklin High School, in semi-pro baseball, and with the Seattle Rainiers minor league team, he excelled as a catcher, pitcher, and outfield. His 10-year pitching career with the Detroit Tigers was cut short by World War II service in the U.S. Navy. Later, he managed the Tigers, St. Louis Cardinals, and Cincinnati Reds, among other teams.His 1961 Cincinnati Reds won the National League pennant but fell to the dominant New York Yankees 4-1 in the World Series. In 1964, the Reds were once more in contention when Hutchinson received a lung cancer diagnosis. He passed away at the age of 45 on November 12, 1964. Over his career, he received numerous awards. He was selected Seattle's Athlete of the Century by the Seattle Post-Intelligencer in 2000. One of the top three humanitarian honors in Big League Baseball is the Hutch Award, which was established in 1965. His older brother and mentor, Dr. William B. Hutchinson, left a lasting legacy with the establishment of the Fred Hutchinson Cancer Research Center in Seattle, a famous research center.A special thank you goes out to Al Hirsch for providing the music for the podcast, check him out on YouTube.Find merchandise for the podcast now available at:     https://washington-history-by-jon-c.creator-spring.comIf you enjoy the podcast and would like to contribute, please visit: https://www.buymeacoffee.com/EvergreenpodIf you have any questions, episode ideas you'd like to see explored, or just have a general comment, please reach out at Historyoftheevergreenstatepod@gmail.comTo keep up on news for the podcast and other related announcements, please like and follow:https://www.facebook.com/HistoryoftheevergreenstatepodcastFind the podcast over on Instagram as well: @HISTORY_EVERGREENSTATEPODCASTYou can also find the podcast over on YouTube:http://www.youtube.com/@historyoftheevergreenstatepodThank you for listening to another episode of the History of the Evergreen State Podcast!

In this episode, I am joined by Dr. Chris Damman, Chief Medical & Scientific officer at UR Labs, and Marc Washington the Founder & CEO of Supergut. We discuss gut health and why it's essential for overall health. They explain that the gut is not just about digestion but a portal to whole health. They also discuss how what we eat and breathe can affect our gut and body health. The episode highlights the importance of understanding gut health and how healthcare professionals should incorporate this information into patient care.   Show notes:  [00:01:01] Gut health and whole health. [00:04:34] Gut health and total health. [00:07:45] The gut and immune system. [00:12:23] Gut health and nutrition decisions. [00:15:11] Four F's of Longevity. [00:19:03] Probiotics and Gut Health. [00:24:51] Different types of fiber. [00:28:00] Blood sugar spikes and fiber. [00:31:11] Chronic conditions and mind-body connection. [00:36:10] Double burden of disease. [00:40:23] Gut health and interconnectedness. [00:43:46] Following your passions.   More About Dr. Damman: Chris Damman is Chief Medical & Scientific officer at UR Labs.  Prior to joining UR Labs, he was Initiative Lead of Gut Health in the Enteric and Diarrheal Diseases team at the Bill & Melinda Gates Foundation.  He holds an M.D. from Columbia University and an M.A. in Molecular Biology & Biochemistry from Wesleyan University.  He moved west to complete his residency in internal medicine and fellowship in gastroenterology at the University of Washington.  Chris continued on at the University of Washington with a joint appointment in the Division of Gastroenterology and The Fred Hutchinson Cancer Research Center.  He maintains an academic appointment with the University of Washington with research interests focused on investigating the role of diet and microbiome-directed therapies as treatments for inflammatory bowel disease.  Past research activities have included early drug discovery work at Pfizer's Discovery Technology Center in Cambridge, MA and epidemiological surveillance work characterizing Plasmodium drug resistance genes at the Armed Forces Research Institute of Medical Sciences in Bangkok, Thailand. Outside of work, Dr. Damman likes to spend his time running, cooking, eating, and spending time with his wife and three daughters.    More About Marc: Marc Washington is the Founder & CEO of Supergut. His background spans a wide variety of consumer health businesses, including serving as the CEO of Irwin Naturals, a $100M+ supplements company and leading producer of soft-gel herbal formulas sold in over 90,000 retail outlets; President & COO of Beachbody, a $1B+ nutrition and fitness company with products including Shakeology health shakes, P90X, and the Beachbody-on-Demand digital platform; and working 9 years at The Wonderful Co, a $4B agriculture and food & beverage holding company, where he served in a variety of roles including CFO (corporate), EVP Sales (Teleflora), and Direct of Strategy & Operations (FIJI Water). Marc's deep experience in the wellness industry inspired him to found Supergut to help people regain control of their health by harnessing the powerful science of the gut biome. Marc holds an M.B.A. from Harvard Business School and B.S. from Princeton University.  Marc's areas of expertise: Entrepreneurship, Health & Wellness, Gut Health, Metabolic Health, Nutrition, Prebiotic Fiber & Resistant Starch, Food As Medicine, Nutrition & Public Health, Multicultural Health Disparities, Diversity & Inclusion   Resources from this Episode:  Website Our recently peer-reviewed and published clinical study SuperGut on Instagram SuperGut on TikTok SuperGut on Twitter   Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram   Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio      

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In this podcast, Cancer.Net Specialty Editor Dr. Petros Grivas talks to Dr. Marianne Dubard-Gault about what people with bladder cancer should know about genetics and genetic testing, including what information genetic testing can provide, how it can inform bladder cancer treatment, and what to expect when meeting with a genetic counselor. Dr. Grivas is a medical oncologist at Seattle Cancer Care Alliance, clinical director of the Genitourinary Cancers Program, and professor at the University of Washington School of Medicine. He is also an associate member of the Clinical Research Division at Fred Hutchinson Cancer Research Center. Dr. Dubard-Gault is the medical director of the Cancer Genetics Program at Fred Hutchinson Cancer Research Center and an assistant professor at the University of Washington School of Medicine.   View disclosures for Dr. Grivas and Dr. Dubard-Gault at Cancer.Net. Dr. Grivas: Hello, I'm Dr. Petros Grivas. I'm a medical oncologist and serving as the clinical director of the Genitourinary Cancers Program and professor at the University of Washington Fred Hutchinson Cancer Center. I'm very excited and thrilled today to discuss with one of the amazing leaders in the field of cancer genetics, Dr. Marianne Dubard-Gault, who is my colleague here at UW Fred Hutchinson and has been such a wonderful human being and advocate for her patients and also really a key opinion leader in the field of genetics and the implementation in patient care. Dr. Dubard-Gault, welcome, and I will let you introduce yourself. Dr. Dubard-Gault: Thank you very much, Dr. Grivas, and it's a pleasure to be here. So thank you for the invitation. I am Dr. Marianne Dubard-Gault. I am a trained oncology doctor and a trained genetics doctor, and my focus now, as Dr. Grivas mentioned, is in the cancer genetics world where I help people either get genetic testing in the first place and/or their family members have interventions for their screening and early detection. I'm also an assistant professor at Fred Hutchinson Cancer Center in Seattle, Washington, and then at the University of Washington on the other side. And I lead the Cancer Genetic Survey Center at Fred Hutchinson Cancer Center. And I have no disclosures. Dr. Grivas: Thank you so much, Marianne, and again, thank you for helping our patients. And I'm really, really excited today because it's a very important topic, not frequently discussed. And I really, really wanted to make this happen, and thanks to Cancer.Net for helping us getting the word out there. I have no relevant disclosures in this topic. My disclosures are listed on the ASCO website. And Marianne, I will start us off by asking you, just for the audience to set the stage, can you define what we call “genetics”? What exactly are we referring to? Dr. Dubard-Gault: Yes, that's actually very important. That's probably the first thing that happens in the clinic when we talk to patients is, what is genetics anyway, right? So genetics is the study of the DNA or the genetic makeup that we all have. And that makes a person who they are, right? So looking into the genetic makeup to make sense of it and inform treatment or other interventions. Dr. Grivas: Thank you much, Marianne. And I think it's so important again for our patients to understand the definitions here. So let me ask you, can you define the difference between a genetic mutation versus genetic alteration? How would you explain that to a patient? Dr. Dubard-Gault: I think about them in a similar way. So, to me, a genetic mutation or alteration is a spot in your DNA. So there's a long stretch of letters, and there's a spot in there that either was copied or wasn't copied properly over. And so that leads to a command that kind of not being executed properly. And so an example of that would be if I gave you the 2 words “red” and “bed,” those 2 words would mean totally different things in your mind. And so if you were supposed to hear “red” and you heard “bed,” then downstream will be a different outcome. Dr. Grivas: Thank you so much, Marianne. And this is very important because for the audience as you pointed out nicely, the genetic code, the DNA translates a message, alright, that becomes a protein and eventually a function of the cell. So if that code, if that message is misspelled, it can lead to different altered and changed-up protein for the cell. That has implications and can potentially predispose someone to cancer. So if we can also help the audience understanding the differences between what we call “somatic genetic mutations” and “germline mutations.” Dr. Dubard-Gault: Absolutely. And this is also something that comes up every time because they're part of the same groups of things overall, right? So somatic means tissue or tumor. And germline, or hereditary, sometimes you'll hear that word interchangeably means inherited or hereditary or part of the genetic makeup or the code that you were born with. So different parts of our body have different genetic mutations. And that is why even with 2 identical twins, they won't have the same moles on their skin, or they won't have the same medical conditions, even if they have exactly the same genetic code. And it's exactly the same for a person who has a tumor, right? The DNA or the genetic makeup they were born with will stay exactly the same as they grow older, but the genetic makeup their tumor has as the tumor grows can change and make more or have more mutations. So testing different parts of the body will help tease out which ones of the mutations are located where? Is it in a tumor only? Is it in the genetic makeup you were born with or is it part of that transition between the 2? Dr. Grivas: Thank you, Marianne. I think this is great when we explain to the patients what exactly mutations, alterations, means, and the difference between a somatic tumor testing, as you said, mostly to help define treatment options. And what you very nicely discussed are germline testing, looking at hereditary predisposition to cancer that can impact the patient and also family members and the broader family. And one kind of take-home message may be for our audiences, when someone is about to see an oncologist or their provider, is greatly helpful if they can do quote-unquote "their homework" and try to understand and delineate and capture as much as possible regarding the family history. And sometimes it's hard, especially when you go to distant relatives, cousins, nephew, nieces, it's more difficult, but it can help a lot and inform that discussion and whether a referral to a genetic counselor or geneticist is relevant. So that's what we try to do with nurse navigation these days to help inform people with cancer before their appointment how they can maximize to capture that information, it can be helpful to them and for the provider. And the next question, Marianne, is how common are these genetic germline mutations in people with bladder cancer? Dr. Dubard-Gault: I think the answer is still out there. We don't have the complete answer today. We don't know all the genes that are implicated in bladder cancer today. So given that, we probably don't have the full or complete answer as to how many people with bladder cancer would have it. But kind of to get close to the answer, as close as we can possibly be today, I think it depends on the group of patients with bladder cancer that you test, but I would probably give a 1 in 10 people with bladder cancer would have an inherited genetic mutation. Dr. Grivas: And that's very helpful Marianne. And of course, varies, of course, across the different scenarios and the family history as you mentioned, the age of cancer diagnosis. And sometimes it's interesting in patients with urothelial carcinoma, cancer in the upper urinary tract, like renal pelvis, kidney problems, or ureter, there seems to be some higher frequency of germline mutations in that as opposed to bladder cancer. Of course, it can happen in that scenario, but seems to be some higher frequency in the upper tract cases, is that right? Dr. Dubard-Gault: I agree. Not all cancers are created equal, right? In the bladder, that's probably also true. So depending on where it starts, the type of cells that are involved, and how the person was born with certain genetic predispositions, it may very well affect how all of these are linked together in one line of event versus maybe something that happened randomly or occurred that we don't have a one specific answer or a combination of answers. Dr. Grivas: That's a great point. And obviously, there are the huge impacts that we discussed to help prevent cancers in the bladder family. Cancer prevention mode, I call it, when I explain to the patients before they see you. And also, some patients are also asking, in addition to that family benefit in my brother's family, is there any potential impact on the treatment selection for the bladder cancer? Any comment? Dr. Dubard-Gault: Yes, I do believe there is actually more today than ever before, especially with the new medications that have come around, right? So sometimes a genetic mutation will happen in the DNA or the code that is important for repairing the code of the DNA, or sometimes it will happen in an area that helps boost the immune system or the response to the cancer cells by the immune system. So in that case, if we find a genetic mutation, then we can use a chemotherapy that concentrates or targets that area that's not working well and fix it, right? So that's one really important area. And then another area, and Dr. Grivas, I know you've done a lot more clinical trials and studies that involve the DNA that makes new blood vessels for feeding the tumor. And in that case, you can use a chemotherapy that would block the body from making those new blood vessels and basically shut off the feeding system to the tumors. And so that way, the genetic testing can also help the patient find a therapy that would work better for them. Dr. Grivas: That's a great discussion. And we're doing many clinical trials to test this hypothesis. This assumption kind of practice, and we try to look at particular therapies that might be relevant in the context of a germline mutation. And those clinical trials are very promising. And I always encourage our patients to consider subsequent trials. And the other aspect of it, as you said very nicely, is that a patient who may have some changes in the code encoding some enzymes, some proteins that repair the DNA, this can cause some more mutations. And in this particular scenario, there may be a much higher response to immunotherapy. That immunotherapy may help shrink those tumors with what we call more unstable genomes. So that's very interesting to see that across tumor types, to your point. The other question is if someone is referred to genetic counseling, how can they be better prepared for their appointment? Dr. Dubard-Gault: I think the most important thing that I would say is to really embrace it and go. Because it's often something that makes people worried that they have a genetic predisposition in the family, and they may not necessarily be ready to hear it or want to have as much information, especially being diagnosed with a cancer at the time. And so really embrace it and go for the genetic visit because it is something that could be very useful and bring information not only to you as a person for your own treatment, and/or then for your siblings or relatives for them to have access to interventions they would not have otherwise. Dr. Grivas: What question do you think people should ask their providers? How can they better prepare for the visit with the provider overall regarding the topic we are discussing today? Dr. Dubard-Gault: That's also very important because as much information as you can gather is really important. So, if possible, gathering as much information about your family history as you can, as Dr. Grivas mentioned. And sometimes you can't have all the information, some grandparents died, they did not share the information about their cancer diagnosis because they didn't want to upset the family. Sometimes you have no information on one side of the family because you don't know who your father's parents are, for example, or a certain relative may be OK now and they have cancer later on, and you will probably not have that information, right? We can still do the genetic test knowing that some of this information is missing. So keeping in mind that as much information as you can get is good. And if we have a lot, that's helpful, and if we don't, we will kind of factor that in our conversation. And a few other tips I would keep in mind is the timing of the testing matters. Sometimes doing the testing earlier in the process is a good thing because it takes a little while for the results to come back. That's a sophisticated test that takes usually 3 to 4 weeks. There are many different types of genetic testing; that's also very important. You may very well have more than 1 genetic test, as Dr. Grivas mentioned. The test on the tumor, the test on your genetic makeup from a blood sample or a saliva sample. I mean, keeping in mind-- I think the third one that's really important is keeping in mind that when we do the genetic test, the results may implicate other people in the family straight away. And I'll share an example of this because this comes up in my clinic very often. So I met a brother not so long ago who had bladder cancer. No exposures, no smoking, nothing to point to a risk of bladder cancer for him, but his sister had uterine cancer earlier on before the age of 40, and then had colon cancer as a second primary cancer. And the test came back with the genetic predisposition we talked about, Lynch syndrome. And this diagnosis basically explained his cancer diagnosis on why he had an unstable genome in his tumor. And his sisters, both of his sister's cancer. So by proxy by testing him, we tested not only him, but his sister as well, even if we'll do the sisters confirmation tests, we know the sister is likely positive for this. Dr. Grivas: Thank you so much, Marianne. The very useful information. Again, the positive impact and benefit for the broader family. What happens during and after the initial meeting with the genetic counselor or the geneticist? Dr. Dubard-Gault: Well, I love genetic counselors, I think they're very helpful. And I work with them on a day-to-day basis. So, what they'll do is they'll sit down with you either in person or telemedicine or telehealth from the comfort of your own home or on the phone. I don't like the phone as much as I like the interpersonal connection with a person. But they'll help you draw out your family tree, put all the people in the family on the page together to kind of see and share a pattern. They'll talk a little bit more about the different types of genetic testing one person could have. And then they'll facilitate getting the genetic test that is best for you and your family. And so that really is the most important piece because they'll work with your oncology doctors and other doctors to come up with the best option. And the one that matches the family story. And then if you're in person, you could even provide a sample, either a blood sample or a saliva sample, right there. And then the authorization and all goes through, and then the results usually will come back a few weeks later. And then the genetic counselor or myself as a genetics doctor will sit down with you when the results come back to review what they mean, not only what the actual test says, but what they mean specifically for your treatment, and/or for yourself or your screening and interventions later on, and/or your family members, if they need to be tested themselves or what needs to happen for them. And then you can obviously be referred to a specialist like Dr. Grivas or others for a colonoscopy or for thyroid ultrasound or some other tests that may be needed for these screening interventions in the future. Dr. Grivas: Great points. And as you mentioned before, it's important for the patients who see the provider to discuss their family history-- close and distant family history as much as they can, and they can even ask whether they need to see genetic counselors. Sometimes the patients can remind a busy provider how important that is and ask for a referral, it's definitely important to ask the provider.  Very quickly, Marianne, you mentioned before the value of testing for both the patient and the broader family in terms of what we call cascade testing and cancer prevention. You mentioned the example in your patient, can you very briefly comment on that and what is the value here again for the patient and the family? Dr. Dubard-Gault: Absolutely. And sometimes someone with a genetic predisposition, so someone born with a genetic predisposition to cancer, can be at risk of more than 1 cancer in their lifetime. So sometimes, when they're diagnosed with the cancer, we find this genetic predisposition to said cancer, but it may come with other cancers as well, just like the bladder cancer and uterine cancer and colon cancer. And this may not be something a person would want to hear when they're diagnosed with cancer, but it is good information that will stay there for the future as they go through the treatment for having interventions done, right? So it's good information to talk about with their doctors so their doctors can order the colonoscopy or different screening protocol. We'll recognize a certain intervention like removing the uterus of someone in the family so they would reduce their risk of uterine cancer. And obviously, genetic mutations tend to be shared in the family. It's most likely something was inherited in the family rather than new in a person. So each person who's positive for a genetic predisposition, we think about their siblings, their children, their nieces and nephews, and those people may have exactly the same genetic predisposition or mutation, and they may be at risk of the same kinds of cancers. And that's the reason why they would get this information to be eligible for other screenings as well. And interventions. Dr. Grivas: Very important, and very useful for the patient. Before we wrap up, Marianne, can you comment a little bit on barriers to testing, out-of-pocket costs, culture, trust, literacy, busy practice, competing priorities? Dr. Dubard-Gault: Yes, absolutely. I think the main ones are awareness that bladder cancer can be a genetic cancer. It's really rare, but it can be. And so keeping that in mind, because then if you're not even referred or that doesn't come to mind, it may not get us to doing this genetic testing. The diagnosis of cancer is a lot to take in, right? So it may not be the right time to do it right away, but keeping that in mind for the future is also important. The cost. Sometimes the generic testing isn't covered by Medicare, unless there are specific criteria that we talked about, a family history of specific type or early diagnosis and all these things. And the genetic counselor will really help push to find as much information as possible to get the test covered. And there are lower-cost options out there. And I think the last 2 are really the privacy of the results. People worry that this information will be shared outside of health care, and/or sharing themselves this information with their family members when they're probably or maybe not ready to disclose their cancer diagnosis. So I find that that's maybe less or lower on the list, but in order to keep in mind as well. Dr. Grivas: Thank you, Marianne. Maybe the last 2 very quick questions for you. Germline testing and options and value of counseling. I know you have touched upon that already. But did you have any departing thoughts on that part on the value on the patient and the family and any other considerations, for example, DNA biobank, etc.? Dr. Dubard-Gault: Absolutely. So, I find that meeting with the genetic counselor, even after you've had genetic testing and the results are back, is a valuable thing to do. And not necessarily right away, but later on down the road, right? So because this field, the genetics field, advances rapidly, it's possible someone will be testing again or there are more genes or more mutations out there we weren't testing for a few years ago that we would test again. So keeping in mind, we can test again. And that meeting with the genetic counselor is always useful even if you have heard a little bit about it already. And then the DNA biobanking piece, if that's a service that's available to you, keeping your DNA for the future, when the technology is not advanced yet, is very important because we know for sure the knowledge will change and will bring new treatments and new options for screening and interventions, so keeping the DNA for the future is very useful. Dr. Grivas: That's a great point. And because technology is evolving very fast, the methodologies are changing, many times we have the information and genetics team, and counselors and geneticists try to keep track and follow those people who are tested to see if any of the information may potentially make a mutation that was of a certain significance-- something that may be significant down the road as more information are coming in. And because of this rapidly evolving nature of information, it is good for people with cancer and also any affected family members to stay in touch periodically and follow up with the genetics team. Maybe the last question for you, Marianne, is if you have any take-home message for our people, our audience today so they can remember going forward. Dr. Dubard-Gault: Information is power. It really is. And having this information helps your doctors bring the best treatment to the tumor that you have and not somebody else's, right? And for the family, that may bring an answer that was longed for really generations before you, and that would help not only have this information, but take it forward and say, "You know what? I'm going to do something about it because we can." So to me, that's the reason I transitioned careers, and that's the message that I want to keep sharing. Dr. Grivas: What a great message by Dr. Dubard-Gault. And now we're trying hard to involve and engage genetic counselors and geneticists to our multidisciplinary clinics. And bladder cancer is a great model for multidisciplinary approach, and we try to engage them earlier. So we need more of you, Dr. Dubard-Gault. We need more geneticists and genetic counselors. And with your background in oncology, it's fantastic to work with you. Thanks again for a great discussion. Thanks again to Cancer.Net for all they do for the mission of patient education and of course ASCO. And thanks to the audience for your attention today. Thank you. Dr. Dubard-Gault: Thank you for inviting me. ASCO: Thank you, Dr. Grivas and Dr. Dubard-Gault. Learn more about genetic testing and cancer at www.cancer.net/genetics.  Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

On this episode of the Psychedelic Therapy Frontiers podcast, Dr. Joe Flanders interviews Dr. Anthony Back, M.D. Dr. Back is a co-founder of VitalTalk, a national nonprofit that provides innovative, interactive clinician and faculty development courses to improve communication skills on an individual and institutional level. Dr. Back is a professor of medicine at the University of Washington in Seattle, and the Fred Hutchinson Cancer Research Center. Dr. Back earned his MD at Harvard University. He is triple-board certified in hospice and palliative medicine, medical oncology, and general internal medicine. In his role as a medical communication educator and a VitalTalk co-founder, Dr. Back was the principal investigator for Oncotalk, co-wrote Mastering Communication with Seriously Ill Patients, released the first iPhone app for clinician communication skills, and authored the online communication skills curriculum offered by the Center to Advance Palliative Care.(3:00) Dr. Back introduces himself(6:55) What is palliative care?(9:06) Improving quality of life and having a good death(15:30) The applications of psychedelics for end-of-life care(17:35) Dr. Back's article, "What psilocybin taught me about dying"(21:00) Materialist vs spiritualist views of life and death(29:14) Roland Griffiths' cancer diagnosis (34:07) Gratitude for cancer(38:22) How psychedelics might help people at end-of-life(55:23) Randomized trial of psilocybin for health care practitioners with depression(01:01:07) How do you train a health care practitioner in good palliative care?(01:07:51) How do we scale psychedelic-assisted therapy?Learn more about our podcast at https://numinus.com/podcast/Learn more about Numinus at https://numinus.com/Follow us on Instagram: https://www.instagram.com/drstevethayer/https://www.instagram.com/innerspacedoctor/https://www.instagram.com/joeflanders/https://www.instagram.com/numinushealth/Disclaimer: The content of this podcast does not constitute medical advice or mental health treatment. Consult with a medical/mental health professional if you believe you are in need of mental health treatment.

A new research paper was published in Aging (listed as “Aging (Albany NY)” by MEDLINE/PubMed and “Aging-US” by Web of Science) Volume 14, Issue 23, entitled, “DNA methylation GrimAge version 2.” Researchers Ake T. Lu, Alexandra M. Binder, Joshua Zhang, Qi Yan, Alex P. Reiner, Simon R. Cox, Janie Corley, Sarah E. Harris, Pei-Lun Kuo, Ann Z. Moore, Stefania Bandinelli, James D. Stewart, Cuicui Wang, Elissa J. Hamlat, Elissa S. Epel, Joel D. Schwartz, Eric A. Whitsel, Adolfo Correa, Luigi Ferrucci, Riccardo E. Marioni, and Steve Horvath from the University of California Los Angeles, Altos Labs, University of Hawaii at Manoa, Fred Hutchinson Cancer Research Center, University of Edinburgh, National Institute on Aging, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Harvard T.H. Chan School of Public Health, University of California – San Francisco, and the University of Mississippi Medical Center previously described a DNA methylation (DNAm) based biomarker of human mortality risk DNAm GrimAge. In their current study, the researchers describe version 2 of GrimAge (trained on individuals aged between 40 and 92) which leverages two new DNAm based estimators of (log transformed) plasma proteins: high sensitivity C-reactive protein (logCRP) and hemoglobin A1C (logA1C). “To arrive at version 2 of GrimAge, we developed two additional DNAm based surrogates for plasma proteins that are widely used in the clinic (DNAm logCRP and DNAm logA1C).” The team evaluated GrimAge2 in 13,399 blood samples across nine study cohorts. After adjustment for age and sex, GrimAge2 outperforms GrimAge in predicting mortality across multiple racial/ethnic groups (meta P=3.6×10-167 versus P=2.6×10-144) and in terms of associations with age related conditions such as coronary heart disease, lung function measurement FEV1 (correlation= -0.31, P=1.1×10-136), computed tomography based measurements of fatty liver disease. The researchers presented evidence that GrimAge version 2 also applies to younger individuals and to saliva samples where it tracks markers of metabolic syndrome. DNAm logCRP is positively correlated with morbidity count (P=1.3×10-54). DNAm logA1C is highly associated with type 2 diabetes (P=5.8×10-155). DNAm PAI-1 outperforms the other age-adjusted DNAm biomarkers including GrimAge2 in correlating with triglyceride (cor=0.34, P=9.6×10-267) and visceral fat (cor=0.41, P=4.7×10-41). Overall, the team demonstrated that GrimAge version 2 is an attractive epigenetic biomarker of human mortality and morbidity risk. “GrimAge2 will not replace existing clinical biomarkers. Rather, GrimAge2 complements existing clinical biomarkers when evaluating an individual's aging rate.” DOI: https://doi.org/10.18632/aging.204434 Corresponding Author: Steve Horvath - shorvath@mednet.ucla.edu About Aging-US: Launched in 2009, Aging (Aging-US) publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at www.Aging-US.com​​ and connect with us: SoundCloud – https://soundcloud.com/Aging-Us Facebook – https://www.facebook.com/AgingUS/ Twitter – https://twitter.com/AgingJrnl Instagram – https://www.instagram.com/agingjrnl/ YouTube – https://www.youtube.com/agingus​ LinkedIn – https://www.linkedin.com/company/aging/ Reddit – https://www.reddit.com/user/AgingUS Pinterest – https://www.pinterest.com/AgingUS/ For media inquiries, please contact media@impactjournals.com.

Carla is the Managing Director of THAXA, Inc. THAXA works with clients who are pursuing ambitious goals in the business and non-profit sectors achieve greater success through brutal focus. Bringing the best research from performance science to her work with clients, she helps them identify the most critical factors to reaching their goals to maximize their impact.Prior to founding THAXA, Carla attended Brown University, where she graduated magna cum laude with a BA in Human Biology. She then completed her MD PhD at the University of Washington, researching cancer immunology at Fred Hutchinson Cancer Research Center. Continually passionate about high performance environments, she chose to complete her intern year in the field of general surgery at Stanford University. Following this, Carla returned to Seattle to found THAXA and apply her science background to conversations about performance to benefit clients.Outside of work, Carla enjoys running, hiking, and skiing the many trails and mountains of the Pacific Northwest. Her community involvement includes being a partner at Social Venture Partners where she has helped launch and moderate a new Jeffersonian dinner series around big ideas and challenges in philanthropyCarla is a member of the Washington Women's Foundation and Seattle Rotary and chairs the Board of Trustees for Bloodworks Northwest.

30. Can Estrogen Cause Breast Cancer?    I loved this interview with my naturopathic oncologist, Dr. Laura James. She is a wealth of information and was a great support to me during my breast cancer battle.   We discussed estrogen's role in breast cancer and how too much can be problematic. According to Dr. James, excess estrogen (we pick up a lot of additional estrogen from using plastic and cosmetics) may encourage cancer growth. However, she states that the "jury is still out" on whether estrogen causes cancer.   We also talk about consuming soy products (spoiler alert, I eat soy!) and if some soy products are better than others.   We also discussed a few products I use and that Dr. James recommends for those gosh-darn hot flashes!     Her website is a powerful resource for anyone fighting breast cancer or trying to avoid it! Visit LauraJamesND.com.   For the Hot Flash supplement created by Dr. James, visit her website above or click here!  

We have two special announcements!Next episode we will be celebrating a decade of DNA Today! That's right, we released our first episode on September 1st, 2012. It also coincides with our 200th episode. We want to mark these milestones with you on the show. So send in your favorite episode. You can write it, or better yet, record a voice memo sharing your favorite episode and why you enjoy listening to the show. After all, our podcast would not be possible without you loyal listeners. That's why we want to celebrate together! Send in your voice memo or written message about your fav episode of DNA Today to info@dnapodcast.com. Deadline is August 27th.Thank you to all you listeners for nominating us in the Podcast Awards, you did it! We have officially been nominated. It's year number 6 being nominated and it might be our third time winning the Best Science and Medicine Podcast Award. BUT that's only going to happen if you check your email inbox for an email from The Podcast Awards with the subject line, “Podcast Awards Final Slate Voting”'. If you got this email you are one of the few that were selected to be a voter. It's imperative that you vote! There is a hyperlink to click to get to the voting page. You do have to quickly log back in. Once you do, select DNA Today in the “Science and Medicine category”, select your other fav podcasts and then Hit the “Save Nominations” button. It's that easy. You have until September 10th to do this, but please do it now if you got the email so you don't forget! In this episode we are educating you about prostate cancer as we are on the cusp of prostate cancer awareness month starting next week. Joining us for this discussion is Dr. Heather Cheng, Director of the Prostate Cancer Genetics Clinic at the Seattle Cancer Care Alliance, Assistant Professor in the Division of Medical Oncology at the University of Washington School of Medicine, and Associate Professor in the Clinical Research Division at the Fred Hutchinson Cancer Research Center. She focuses on improving the care of patients with prostate and bladder cancers. An expert in prostate cancer genetics, she is studying ways to use genetics to guide the care of prostate cancer patients and their family members who may also be at high risk for the disease.On This Episode We Discuss:The prevalence of prostate cancerSigns of hereditary prostate cancer in family historyProstate Cancer Registry of Outcomes and Germline Mutations (PROMISE)The goals of PROMISEWho is eligible to enroll in PROMISE and what is requiredThe most common genes that are identified as having a pathogenic variantCurrent treatments available for people with prostate cancerThe lifetime risk of prostate cancerTo learn more about the PROMISE study, visit the study website and check out thisarticle!You can keep up with our guest, Heather Cheng on Twitter, and LinkedIn, and stay up to date with the latest developments in prostate cancer research by following the Prostate Cancer Foundation on Twitter and ​​LinkedIn, and Instagram.Next episode of DNA Today on September 2nd, 2022, we are celebrating 200 episodes and 10 years of the show! New episodes are released on Fridays. In the meantime, you can binge all our other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. Episodes since 2021 are also recorded with video which you can watch on our YouTube channel. DNA Today is hosted and produced by Kira Dineen. Our social media lead is Corinne Merlino. Our video lead is Amanda Andreoli. See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, DNApodcast.com. Questions/inquiries can be sent to info@DNApodcast.com. PerkinElmer Genomics is a global leader in genetic testing focusing on rare diseases, inherited disorders, newborn screening, and hereditary cancer. Testing services support the full continuum of care from preconception and prenatal to neonatal, pediatric, and adult. Testing options include sequencing for targeted genes, multiple genes, the whole exome or genome, and copy number variations. Using a simple saliva or blood sample, PerkinElmer Genomics answers complex genetic questions that can proactively inform patient care and end the diagnostic odyssey for families. Learn more at PerkinElmerGenomics.com. (SPONSORED)

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, our guests will discuss new research in head and neck cancer, brain tumors, and health equity that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois. First, Dr. Cristina Rodriguez will discuss 2 studies on new treatment options for locally advanced head and neck cancer. Dr. Rodriguez is a medical oncologist at Seattle Cancer Care Alliance, an Associate Professor in the Division of Medical Oncology at the University of Washington, and an Associate Member for solid tumor clinical research at the Fred Hutchinson Cancer Research Center. She is also the Cancer.Net Associate Editor for Head and Neck Cancers. You can view Dr. Rodriguez's disclosures at Cancer.Net. Dr. Rodriguez: Hello. My name is Christina Rodriguez. I'm a medical oncologist with a clinical and research focus on head and neck cancer. And today I'm going to discuss research on head and neck cancer that was presented at the most recent 2022 ASCO Annual Meeting. I don't have any relationship to disclose that pertains to the research that I will talk about today. I'd like to discuss 2 abstracts that I thought were practice changing or practice affirming that really addresses some of the key questions that patients and doctors like me have about the treatment of patients with head and neck cancer. So, as you know, most patients with head and neck cancer present with typically locally advanced disease, and most head and neck cancer patients are treated with the intent of curing them most of the time with the use of radiation either as the main treatment or after surgery. And many clinical trials have shown that when we add a chemotherapy called cisplatin to radiation, we improve curative outcomes for patients. But the first abstract that I will talk about, abstract 6003, asks the question "What do we do for patients who are not candidates for cisplatin chemotherapy?" And we know that a significant proportion of our patients will have other medical problems that could make it difficult for us to give chemotherapy and often will result in complications or more toxicity or in side effects for patients. This clinical trial was carried out in India, and it compared radiation alone for patients with head and neck cancer versus radiation given with a non-cisplatin chemotherapy called docetaxel. What's unique about this clinical trial is that it's specifically focused on patients who were not candidates for cisplatin chemotherapy, something that really hasn't been done for this population. Interestingly enough, they found that when we give docetaxel with radiation in these patients, we find that they do better, they live longer, and they feel better based on quality-of-life questionnaires. So I will say that this study, abstract 6003, tells us that even in patients who are not candidates for cisplatin to be given with radiation, there is an alternative treatment that we can use, such as docetaxel given with radiation, that might still improve patient's cure rates for their head and neck cancer. The second study that I think was another interesting study was a clinical trial that asked the question, "Can we give cisplatin in an alternative manner for patients who are undergoing definitive radiation treatment as their main treatment for head and neck cancer?" Like I mentioned, the clinical trials that led to the use of chemoradiation as a standard use cisplatin given in larger doses every 3 weeks, but there's been concern about how well that approach is tolerated by patients. So this particular clinical trial compared patients receiving radiation as curative intense therapy for head and neck cancer with either the cisplatin given every  3 weeks or the cisplatin given at a lower dose once a week. It's important to know that this trial was done in India, where the population is pretty different from what we see in the United States. These are mostly patients who have HPV-negative cancers, mostly cancers acquired through exposures like tobacco and alcohol. And what they found was that these 2 groups of patients had very similar outcomes. In other words, there didn't seem to be a reduction in the rates of cure when we give chemotherapy every week versus every 3 weeks. And interestingly enough, it looked like from a toxicity or side effect standpoint, the every week seems to be a little bit better tolerated. Patients who got the treatment every 3 weeks also had less need for hospitalization or IV fluids and less utilization of health care resources. I think this is a very interesting finding because it really provides us with what we call high-level data that the weekly administration can work. I think it's important to recognize that the population that it studied for this particular clinical trial really was more an HPV-negative population. That's important to know because the standards for HPV-positive head and neck cancer are generated from larger trials that use cisplatin every 3 weeks. But we are continuing to study this question, and there's actually a large NRG study, HN009, that is asking that question both for the HPV- positive and HPV- negative population. So we are, I think, making strides in terms of asking the questions that allow our patients not only to receive treatment that is highly efficacious but also that limits side effects and toxicity. I will also mention that these trials were completed during the COVID-19 pandemic, which tells you that the dedication of these researchers to complete something like this in such a challenging time is to be commended. That's all I have to say, and thank you for listening to this brief summary of new research in head and neck cancer from the ASCO 2022 Annual Meeting. ASCO: Thank you, Dr. Rodriguez. Next, Dr. Glenn Lesser will discuss 3 studies that looked at new treatments for different types of brain tumors. Dr. Lesser is the inaugural Louise McMichael Miracle Professor and Associate Chief in the section on Hematology and Oncology in the Department of Internal Medicine at Wake Forest Health. He is also the Cancer.Net Associate Editor for Central Nervous System Tumors. You can view Dr. Lesser's disclosures at Cancer.Net.   Dr. Lesser: Hello. My name is Glenn Lesser, and I'm a professor of medical oncology and the director of medical neuro-oncology at the Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem, North Carolina. I'm also the editor of the brain tumor section for ASCO's Cancer.Net. And today, I would like to briefly discuss several clinically relevant research studies involving patients with brain tumors that were presented at this year's ASCO Scientific Program. Of note, I have no disclosures or relationships relevant to the abstracts I'll be discussing today. The first presentation to talk about is a late-breaking abstract presented by Dr. Eric Bouffet, who described the results of a phase II trial of 2 targeted anticancer agents, dabrafenib and trametinib, in pediatric patients with a kind of brain tumor called a low-grade glioma, which harbored something called a BRAF V600E mutation in their tumor DNA. By way of background, gliomas account for about 45% of all pediatric brain tumors, and the majority of these gliomas are low-grade, which include World Health Organization grade 1 and 2 tumors. Common types of pediatric low-grade gliomas include pilocytic astrocytomas, gangliogliomas, and low-grade gliomas that are not otherwise specified. Now, mutations in the BRAF gene are common in certain kinds of cancers, particularly melanoma, and novel oral targeted therapies have been developed to effectively treat these tumors by targeting this mutant BRAF gene. A particular mutation in this gene called a V600E mutation occurs in about 15% to 20% of pediatric low-grade gliomas. The presence of this mutation is thought to lead to an increased risk of progression to a higher grade or a more malignant glioma in these patients, and these mutations in their tumors also predict a less favorable response to chemotherapy. In adults, recent studies in patients with malignant gliomas, papillary craniopharyngiomas, and melanomas containing V600E mutations have shown excellent results, with 1one of several similar 2-drug combinations that target both the V600E mutation and a second pathway that cells use to escape from this BRAF blockade. Now, early pediatric data suggested that one of these pairs of drugs, the combination of dabrafenib and trametinib, was safe and tolerable and had the ability to effectively treat patients whose tumors had the V600E mutation. So with that as background, this study was started and enrolled patients from 12 months to 18 years of age who had a low-grade glioma that contained a BRAF V600E mutation. And it randomized them to receive either the combination of dabrafenib and trametinib, or an older, standard cytotoxic chemotherapy regimen consisting of carboplatin and vincristine. Importantly, these patients were newly diagnosed, and this was the first systemic treatment they got, following their surgery or biopsy. 110 patients were enrolled, with 73 given the new targeted therapy combination and 37 receiving the standard combination. The most common types of tumors that the patients enrolled on this study had included pilocytic astrocytoma, ganglioglioma, and low-grade glioma. The results of this trial were that the patients who received the newer combination, targeted treatment of dabrafenib and trametinib, did substantially better than those who received standard, older cytotoxic chemotherapy. Their overall response rate - that's defined as a complete or partial disappearance of the tumor on MRI scan - was 47% versus 11% in the control arm. When patients who had stable disease by MRI were included, 86% of those on the new combination versus 46% of those patients treated with the older chemotherapy had the so-called best clinical response. Now, a large number of patients responding to dabrafenib and trametinib, remain on treatment and are receiving these drugs with an ongoing imaging and clinical response at the time of this report. Patients receiving the new combination had a median or average progression-free survival of 20 months versus about 7.4 months with the older, standard chemotherapy. The investigators conducting this study also had patients fill out a variety of questionnaires to assess their quality of life while on treatment. Once again, the patients who received dabrafenib and trametinib, on average, experienced an improved quality of life in contrast to those on standard chemo who, on average, had a worse quality of life. The new treatment was also well-tolerated with fewer serious adverse events or side effects when compared with standard chemotherapy. And these side effects were no different than what has been seen in patients without brain tumors who have been treated with this combination, including fevers, headaches, fatigue, skin changes, and lower blood counts. The authors appropriately suggested that these findings demonstrate the importance of molecular testing of these pediatric low-grade glioma tumors at the time of diagnosis and that this combination of dabrafenib and trametinib is a new potential standard of care in those patients who have the BRAF V600E mutant, low-grade tumors. Of note, liquid formulations of these drugs have been developed for those pediatric patients who are unable to swallow capsules or tablets. The second presentation at ASCO highlighted the continued importance of prospective randomized clinical trials in patients with malignant brain tumors. Dr. Jann Sarkaria from the Mayo Clinic presented the long-awaited results of the Alliance for Clinical Trials in Oncology cooperative group phase II/III study of a PARP inhibitor or placebo added to standard temozolomide and radiation in adult patients with newly- diagnosed glioblastoma, and in addition, glioblastomas that had specific molecular finding called MGMT promoter methylation. This change to the DNA of the tumors prevents the MGMT DNA repair enzyme from being made in the tumors and leads to a better outcome with temozolomide treatment. Some very elegant laboratory science had suggested that adding a type of drug called a PARP inhibitor, which also causes defects in DNA repair, could lead to improved killing of glioblastoma tumor cells. So patients with newly- diagnosed glioblastomas, which had MGMT promoter methylation on genomic analysis, were enrolled on this study between December of 2014 and October of 2018. The study was conducted in 2 phases separated by a pre-planned pause after the first group of patients were enrolled, which was the phase II part of the study. This was done in order to allow a preliminary analysis of the outcomes of the treatment arms to make sure that there was a signal of activity that justified moving on to test this treatment in a larger number of patients, the so-called phase III part of the trial. This trial design hopes to minimize the number of patients treated with an inactive drug and save years of drug development time by avoiding large trials that go on for a long time with what turns out to be ineffective drugs. For this trial, 447 patients were eventually treated on this trial. Despite the convincing laboratory evidence and early, promising clinical results that led to the trial moving to the second or phase III portion, the final results showed no statistically significant difference in progression-free or overall survival between the 2 arms, that is, those treated with a PARP inhibitor, and those treated with placebo. I personally was very excited about this study and had hoped that the long wait to hear the results indicated that something good was happening. In addition, several of my patients who were treated on the study did exceedingly well, so I, incorrectly, it turns out, expected positive results from the trial. These negative results are a stark reminder of why we spend lots of time and money and energy performing well-designed clinical trials to determine appropriate treatment strategies for our patients, rather than relying on expert opinion or 1 institution's published experience. This approach turns out to be the best way to fairly test treatment strategies and establish new therapeutic approaches which are truly effective. A final, interesting abstract that was presented at a poster discussion session at ASCO was from the group with the University of Pennsylvania in Philadelphia, and it dealt with the risk of bleeding in patients with brain tumors who had blood clots and were then treated with a newer class of blood thinners or anticoagulants called direct oral anticoagulants, or DOACs for short. It's been known for over 100 years that a variety of types of cancer cause patients to be hypercoagulable, that is, to be predisposed to developing blood clots throughout the venous system. Patients with malignant brain tumors have the highest incidence of all tumors of developing blood clots, which typically occur in the legs, called deep venous thrombosis or DVTs, or in the lungs, called pulmonary emboli or PEs. These clots can lead to a variety of severe and debilitating symptoms, including leg pain, swelling, shortness of breath, heart strain, and even death. For the past 2 to 3 decades, affected patients have typically been treated with a class of medications called low-molecular-weight heparins, which need to be injected under the skin once or twice daily. Over the past decade, a new class of oral anticoagulants called DOACs have generally replaced low-molecular-weight heparins as the primary method of treatment for patients with and without cancer who develop venous blood clots because of their safety, ease of administration, and a lack of requirement for regular blood tests or monitoring. However, little, if any, data has been available to determine the safety of these agents in patients with brain tumors and blood clots, a situation where bleeding into the brain or the brain tumor as a side effect of the anticoagulant could be catastrophic. In fact, this potential risk led to the exclusion of patients with brain tumors from several of the large trials which established the safety of the DOACs. Despite the absence of evidence, the DOACs are now pretty broadly used in brain tumor patients for the reasons described above. So this abstract described a cohort of patients with glioblastoma who developed venous blood clots between 2014 and 2021 while under treatment at Penn. The authors reviewed the medical record to determine the relative efficacy or effectiveness and the toxicity or side effects experienced by patients treated with the low-molecular-weight heparins and with the DOACs, including the rates of bleeding into the brain or the brain tumor. 121 patients were identified who fit these criteria, and the cumulative incidence of clinically significant intracranial hemorrhage, that is, bleeding into the brain or the brain tumor, by 30 days after starting the drugs, was minimal and similar in the 2 groups. When measured at 6 months, 24% of the patients in the low-molecular-weight heparin group had developed intracranial bleeding, and 4 of those patients had died from this bleeding, while none of the 32 patients in the DOAC group experienced this complication. Thus, these investigators felt that their data suggested that there was a lower incidence of clinically important intracranial hemorrhage or bleeding in patients with glioblastoma and venous blood clots who were treated with DOACs as compared to low-molecular-weight heparin. They went on to suggest that the use of DOACs was a safe alternative in patients with glioblastoma. Now clearly, either a prospective trial, a larger trial, or additional retrospective evaluations with a larger number of patients are needed to prove the safety of this approach. But this data is pretty comforting, as the use of these agents is now widespread in patients with high-grade gliomas. The ease of administration of a pill once or twice a day, as compared with potentially lifelong injections once or twice a day, is a major quality of life advantage for our patients. Thank you for listening to this brief summary of new research in neuro-oncology from the 2022 ASCO Annual Meeting. ASCO: Thank you, Dr. Lesser. Finally, Dr. Manali Patel discusses new research focused on reducing disparities in cancer care. Dr. Patel is a medical oncologist and Assistant Professor of Medicine at Stanford University. She is also the Cancer.Net Associate Editor for Health Equity. You can view Dr. Patel's disclosures at Cancer.Net. Dr. Patel: Today I have the privilege of discussing several really exciting research abstracts that were presented at the 2022 ASCO Annual Meeting. My name is Manali Patel. I'm a thoracic oncologist, meaning I take care of patients and try to provide good care delivery for patients with lung cancer. And I also am a researcher focused on health equity. I have no relevant disclosures for any of the studies that I will be presenting today with the exception of one that I was leading. And there were several wonderful abstracts that were presented on describing disparities and the ongoing state of disparities continuing within cancer care delivery. What I was particularly struck by were many of the abstracts that I'm presenting this morning and this podcast that really focus on what we can do as a nation and what we can do individually in our clinics to try to move towards action to overcoming these inequities. The first abstract I want to present was looking at how the Affordable Care Act and changes in the Affordable Care Act led to differences in mortality or deaths by race and ethnicity following the enactment in California. And this particular study looked at greater than 150,000 people who were diagnosed with breast cancer, colorectal cancer, and cervical cancer. And they evaluated death rates from these cancers both before and after the implementation of the Affordable Care Act. And what they found was that the cancer death rates for everyone was much lower after the Affordable Care Act was passed, but specifically for individuals who had self-identified as Hispanic ethnicity, who also identified as Black and who identified as White. And so what this abstract showed me was that at a larger level and a macro level, our policies that are enforced at the national level really do play a role in terms of how we can overcome disparities in cancer. Our group, as I mentioned before, has worked on really trying to integrate community health workers into care. So this abstract paired with local union organizations in Chicago and in Atlantic City to try to help individuals who self-identified as having been from families that were from low-income households and racial and ethnic minorities to communicate their goals and their preferences for care and to also better their relationships with their clinicians as well as to describe their symptoms. And what we found in this randomized trial was that for individuals who received this community health advocate who helped them to better engage with their clinician and who also helped them to describe the symptoms that they were experiencing as well as receive community resources such as food boxes if they were food insecure or be connected to household agencies if they were having difficulties with housing, we found a significant improvement in quality of life, but we also found reductions in the use of the hospital unnecessarily. We also found that this translated into reductions in total cost of care, thereby reducing the amount of out-of-pocket costs these individuals were spending on their cancer care. One of the other abstracts that I thought really was reflective of the many different ways that we can move towards action was an abstract which looked at during the pandemic, trying to reduce the number of times people need to come in for mammograms, their biopsies, and then any further testing that they needed after their biopsy. And this particular study evaluated what was called a same-day biopsy service, which layered on a same-day mammogram reading program. So at this particular institution, they had already implemented when you came in to get your mammogram as a woman or a man, you would have a read on the same day. So you did not have to wait to find out what your results were. And what they did further to push better care was that they layered on on that same day you could get your biopsy. So almost a one-stop shop. And what they found was that for everyone, regardless of race and ethnicity, the time to biopsies decreased by almost half. And the median days, for example, from an abnormal mammogram to obtaining a biopsy, meaning a sample of that tissue, that it decreased from 10 days median to 5 days. And particular patient populations did much better. And so they were able to show that when you do interventions that move the care to provide better care for everyone, everyone benefits, but particularly our patient populations who identify as racial and ethnic minorities who were more likely to experience delays in care, they also received some benefit from this intervention. The last study I want to highlight is work which looked at how to improve specialized services for people who would otherwise not receive those. And this particular study looked at stem cell transplantation for people with blood cancers. And what they found was that these services are often only offered in very tertiary centers, so places that may not be as accessible, large institutions that a lot of people may not have access to receiving care. So what they did was they partnered with this large academic institution so that they could build a pathway for individuals who would otherwise not get stem cell transplantation so that they could have access to those services. And it was really a multipronged approach where they not only educated the clinicians in the community practice about the effort, but they also educated the institution-level clinicians about the effort. They also provided shared medical records, which oftentimes in practice, we don't share our medical records with other clinics. And what they were able to do was to convince these clinics and the institution, let's share the medical records so that then you can have access to seeing what's happening for patients that are diagnosed in the community. And then that way we can both document, we can both have access in the community as well as in the institution where they're receiving the specialized service so that there's better communication. They also provided a navigator for each patient that would help each patient to identify any sort of barriers that they may experience to receiving stem cell transplantation. And then they offered telemedicine, which allowed for individuals to receive specialized services in the comforts of their own home without having to travel after the stem cell transplantation had occurred. And what they found was that usually in the institution, most individuals were more affluent. So they had higher levels of socioeconomic status. But after the intervention, individuals that were referred from this community clinic made it such that the affluence really decreased so that it was showing that people who wouldn't otherwise have access, who had identified as having low income, were now able to receive those services and had been receiving transplantation. I think that these studies really do move us towards a new paradigm of taking action on the many disparities that we know continue to happen. I really appreciate you all for listening to this brief summary of the new research on health equity from the 2022 ASCO Annual Meeting, and I hope to see you next year. ASCO: Thank you, Dr. Patel. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

We have two special announcements! Very soon we will be celebrating a decade of DNA Today! That's right, we released our first episode on September 1st, 2012. It also coincides with our 200th episode. We want to mark these milestones with you on the show. So send in your favorite episode. You can write it, or better yet, record a 30-60 second voice memo sharing your favorite episode and why you enjoy listening to the show. After all, our podcast would not be possible without you loyal listeners. That's why we want to celebrate together! Send in your voice memo or written message about your fav episode of DNA Today to info@dnapodcast.com. Deadline is August 27th.Thank you to all you listeners for nominating us in the Podcast Awards, you did it! We have officially been nominated. It's year number 6 being nominated and it might be our third time winning the Best Science and Medicine Podcast Award. BUT that's only going to happen if you check your email inbox for an email from The Podcast Awards with the subject line, “Podcast Awards Final Slate Voting”'. If you got this email you are one of the few that were selected to be a voter. It's imperative that you vote! There is a hyperlink to click to get to the voting page. You do have to quickly log back in. Once you do, select DNA Today in the “Science and Medicine category”, select your other fav podcasts and then Hit the “Save Nominations” button. It's that easy. You have until September 10th to do this, but please do it now if you got the email so you don't forget! Our guest this week is Dr. Sam Sternberg, who is a protein-RNA biochemist and CRISPR expert. He runs a research laboratory at Columbia University, where he is an assistant professor in the Department of Biochemistry and Molecular Biophysics. Sam's lab explores the biology of CRISPR-Cas systems and transposable elements, and develops these systems for genome engineering. In addition to publishing his research in leading journals and speaking internationally, Sam remains actively involved in public outreach and ongoing discussions on the ethical issues surrounding genome editing. Together with Nobel Prize winner Jennifer Doudna, he co-authored a popular science book about the discovery, development, and applications of CRISPR technology. Titled A Crack in Creation: Gene Editing and the Unthinkable Power to Control Evolution, which chronicles the development of CRISPR and explores bioethical aspects of the technology. Their book was a finalist for the Los Angeles Times Book Prize, and The New York Review of Books called it “required reading for every concerned citizen.”Sam received his B.A. in Biochemistry from Columbia University in 2007 and his Ph.D. in Chemistry from the University of California, Berkeley in 2014. He earned graduate student fellowships from the National Science Foundation and the Department of Defense, and was awarded the Scaringe Award from the RNA Society and the Harold Weintraub Graduate Student Award from the Fred Hutchinson Cancer Research Center. Sam worked as a Scientist and Group Leader at Caribou Biosciences before beginning his independent position at Columbia in 2018, and he is the recipient of the NIH Director's New Innovator Award, and is a Sloan Fellow, Pew Biomedical Scholar, and Schaefer Research Scholar.On This Episode We Discuss:Safety, ethical, regulatory considerations for using CRISPR technology Off target effects Working directly with Nobel Prize Winner Dr. Jennifer DoudnaThe 3 major areas of CRISPR applicationsFertility research Animal studies Human genetics Enter our giveaway for your own copy of A Crack In Creation through our social media! For updates on the Sternberg lab, visit their website or follow Sam on Twitter and LinkedIn! You can also read one of his most recent papers on the profiling of CRISPR RNA-guided transposition products here. Stay tuned for the next new episode of DNA Today on August 26th, 2022! New episodes are released on Fridays. In the meantime, you can binge over 195 other episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “DNA Today”. Episodes since 2021 are also recorded with video which you can watch on our YouTube channel. DNA Today is hosted and produced by Kira Dineen. Our social media lead is Corinne Merlino. Our video lead is Amanda Andreoli. See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, DNApodcast.com. Questions/inquiries can be sent to info@DNApodcast.com. PerkinElmer Genomics is a global leader in genetic testing focusing on rare diseases, inherited disorders, newborn screening, and hereditary cancer. Testing services support the full continuum of care from preconception and prenatal to neonatal, pediatric, and adult. Testing options include sequencing for targeted genes, multiple genes, the whole exome or genome, and copy number variations. Using a simple saliva or blood sample, PerkinElmer Genomics answers complex genetic questions that can proactively inform patient care and end the diagnostic odyssey for families. Learn more at PerkinElmerGenomics.com. (SPONSORED)

Jordan Mulligan from the inspirational Mulligan Brother Podcast talks to the amazing Jonathan Bricker about his work as a psychologist. Bricker is an internationally recognised leader in ACT, acceptance and commitment therapy. A therapy that focuses on self-control, primarily for smokers and other addictions. His programs have made a massive difference and have been tested on multiple platforms. His approach to addiction is not to ignore cravings, but instead to become aware of triggers and make the choice not to act on them. He is a professor at the Fred Hutchinson Cancer Research Center and the University of Washington. His team works to test the effectiveness of acceptance and commitment therapy, Bricker hopes to expand the ACT approach to help treat obesity and alcohol addiction. Aspiring to make a real difference and change people's lives He talks to us about his incredible work and career, as well as tips on self-control to help people move forward with self-improvement.   

Are you confused by all the claims about the “best” diets, what foods to avoid, and the never-ending list of nutritional fads highlighted in books and headlines? We are too. And in today's episode, we're going to do something about it, including a discussion about the nuances surrounding the recent intermittent fasting study that haven't come out in the latest headlines.Welcome to the Catalyst Health, Wellness & Performance Coaching Podcast. Today's guest is Dr. Mario Kratz, the founder and director of Nourished by Science, an evidence-based resource I have a feeling everyone is going to be tapping into after hearing this episode. Dr. Kratz has been on the faculty in the Departments of Epidemiology and Medicine as well as the Nutritional Sciences Program at the University of Washington and intimately involved at the Fred Hutchinson Cancer Research Center in Seattle, Washington. He now focuses his time providing trustworthy, rigorous, and evidence-based information about nutrition, health, and chronic disease for those – like us - who share his passion for science and a healthy lifestyle at https://nourishedbyscience.com/.Looking for weekly tips, tricks and turbo boosts to enhance your life? Sign up for the CATALYST 5 here, a brief weekly bullet point list of 5 ideas, concepts or boosts Dr. Cooper has discovered to improve your personal and professional life!For more information about the Catalyst Community, earning your health & wellness coaching certification, the annual Rocky Mountain Coaching Retreat & Symposium and much more, please see https://www.catalystcoachinginstitute.com/ or reach out to us Results@CatalystCoachingInstitute.com If you'd like to share the Be A Catalyst! message in your world with a cool hoodie, t-shirt, water bottle stickers and more (100% of ALL profits go to charity), please visit https://teespring.com/stores/be-a-catalyst If you are a current or future health & wellness coach, please check out our Health & Wellness Coaching Forum Group on Facebook: https://www.facebook.com/groups/278207545599218.  This is an awesome group if you are looking for encouragement, ideas, resources and more. Finally, if you enjoy the Catalyst Podcast, you might also enjoy the YouTube Coaching Channel, which provides a full library of freely available videos covering health, wellness & performance: https://www.youtube.com/c/CoachingChannel

We talk with Dr. Tamanash Battacharya, a postdoctoral fellow in the Malik lab at the Fred Hutchinson Cancer Research Center, who studies the viral evolution of arboviruses.

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, 4 Cancer.Net Specialty Editors discuss new research in prostate, bladder, kidney, and testicular cancers presented at the 2022 Genitourinary Cancers Symposium and 2022 ASCO Annual Meeting. This episode has been adapted from the recording of a live Cancer.Net webinar held June 15th, 2022, led by Dr. Neeraj Agarwal, Dr. Timothy Gilligan, Dr. Petros Grivas, and Dr. Tian Zhang. Dr. Agarwal directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah. Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig (TOSS-ig) Cancer Center. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine. He is also an associate member of the clinical research division at the Fred Hutchinson Cancer Research Center. Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center. Full disclosures for Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang are available at Cancer.Net. Greg Guthrie: Good afternoon, everyone. I'm Greg Guthrie, and I'm a member of the Cancer.Net content team. I'll be your host for today's Research Round Up webinar focusing on cancers of the genitourinary tract. Cancer.Net is the patient information website of the American Society of Clinical Oncology, known as ASCO. So today, we'll be addressing research from 2 2022 scientific meetings, the ASCO Annual Meeting held in Chicago in June and the Genitourinary Cancers Symposium held in San Francisco in February. Our participants today are all Specialty Editors of the Cancer.Net Editorial Board, and they are Dr. Neeraj Agarwal of the Huntsman Cancer Institute in University of Utah, Dr. Timothy Gilligan of the Cleveland Clinic Taussig Cancer Center, Dr. Petros Grivas of the Fred Hutchinson Cancer Research Center and University of Washington, and Dr. Tian Zhang of the University of Texas Southwestern Medical Center. Thank you, everyone, for joining us today. So starting us off today is Dr. Agarwal who will be talking about research in prostate cancer. Go ahead, Dr. Agarwal. Dr. Agarwal: Hi. Thank you, Greg. So I'd like to start with 2 studies. They both are in prostate cancer which will be followed by my colleagues presenting studies in other cancers in bladder cancer and kidney cancer. So I'll start with this abstract, which was highly discussed by the doctors at the ASCO Annual Meeting a few weeks ago, and it has a lot of relevance in our practice. So this is abstract #5000 presented by Dr. Michael Hofman, and this was the update on a clinical trial which compared lutetium PSMA-617, or lutetium PSMA, to put it simply, with cabazitaxel in patients with metastatic castration-resistant prostate cancer who had disease progression after receiving docetaxel chemotherapy. So, who were the patients who were enrolled on the study? These patients had, as I said, metastatic castration-resistant prostate cancer, who had disease progression after docetaxel chemotherapy, and who had to have high PSMA-expressing prostate cancer. And the way they assessed the presence of high PSMA expression was by using a specialized kind of PET scan known as Gallium 68 PSMA-11 PET scan. In addition, they made sure that these patients do not have another type of prostate cancer, also call it dedifferentiated prostate cancer, by making sure that those patients did not have a traditional PET scan-positive disease. So this was a highly selected patient population who were expressing PSMA on their prostate cancer. Prior to this presentation, the earlier presentation had shown that lutetium PSMA was superior to cabazitaxel as far as progression-free survival is concerned and also was associated with lower incidence of grade 3 or 4 side effects. In this update, after a longer follow-up of 3 years, Dr. Hofman and Dr. Davis, who is a senior author, they presented the data on overall survival, which was a secondary analysis, and overall survival was similar with cabazitaxel as well as lutetium PSMA in the range of 19 months. We did not see any new safety signal. So, what does it mean for us? What does this mean for our patients? My key takeaway message here is, lutetium PSMA is a suitable option for men with metastatic castrate-resistant prostate cancer who are expressing high PSMA on their prostate cancer after they had sustained disease progression after docetaxel. However, cabazitaxel is also a valid option in this setting. I would like to add my own view in addition to this because lutetium PSMA was better tolerated and was also associated with better progression-free survival. In my patients who are progressing on docetaxel chemotherapy, I would like to use lutetium PSMA first followed by cabazitaxel chemotherapy. So that would be my key takeaway from this abstract. Now we can move to the next abstract. This was also an update, a much longer update, on ENZAMET trial. If you recall, ENZAMET trial was one of those trials which established that deeper androgen blockade, or deeper androgen signaling inhibitors such as enzalutamide, apalutamide, or abiraterone, these trials were conducted in 2015 onwards, and all these trials showed that upfront using deeper androgen signaling inhibitors at the time of metastatic hormone-sensitive prostate cancer onset improved survival. So ENZAMET trial used enzalutamide, and it showed in the first analysis, which was presented by Dr. Davis and Dr. Sweeney in the 2019 ASCO Meeting Plenary session, that adding enzalutamide to androgen-deprivation therapy in patients with metastatic hormone-sensitive prostate cancer significantly improved survival. In this longer follow-up of 68 months, so we are talking about almost 6 years of follow-up, now, these investigators from ENZAMET trial, as presented by Dr. Davis, showed that the combination of enzalutamide with androgen deprivation therapy or testosterone suppression therapy continues to significantly improve survival in patients with newly diagnosed hormone-sensitive prostate cancer or metastatic prostate cancer. One interesting part of this unique aspect of this trial was that patients were allowed to receive docetaxel chemotherapy concurrently to the protocol treatment. And in this trial, 45% patients actually receive docetaxel chemotherapy. So 503 patients exactly out of 1,000-plus patients. So if you look at the subgroup analysis of those patients who received docetaxel chemotherapy, enzalutamide does not seem to benefit those patients from the overall survival perspective. So on the face of it, it looks like enzalutamide is not helping those patients who are receiving docetaxel concurrently. But there are some caveats with that kind of subgroup analysis. The first one is this is not a randomized assignment of docetaxel chemotherapy. Patients were determined to have docetaxel chemotherapy after discussion with their respective oncologist. This was not a prespecified analysis that so many patients with docetaxel will receive enzalutamide. Also, this was not a randomized assignment of docetaxel. And third, that I don't think this trial had enough power to look for that subgroup analysis. So my take on this trial is that updated results from this trial, almost 6 years of follow-up now show that enzalutamide continues to improve overall survival with a 30% reduction in risk of death in patients with metastatic castration-sensitive or hormone-sensitive prostate cancer. Furthermore, the effect of enzalutamide, in my view, on overall survival is independent of the receipt of docetaxel. If you look at the whole trial population for which the trial was covered for, enzalutamide improved survival for all patients. And based on these results, I feel more confident in saying that upfront intensification of treatment with deeper androgen inhibition remains a standard of care for our patients with metastatic hormone-sensitive prostate cancer and should be offered to all eligible patients with this condition. With that, I would like to wrap up the prostate cancer abstracts. Thank you very much. Greg Guthrie: And thank you, Dr. Agarwal. Next up, we will have Dr. Gilligan, who is going to be discussing testicular cancer. Dr. Gilligan: Thank you very much. So I have 2 studies I want to talk about and then just give a headline of some interesting things that I think are kind of coming down the road. Both of these abstracts have to do with improvement over time in specific patient populations we used to worry about. I'm not saying we don't worry about them anymore, but things are looking better now than they had 1 or 2 decades ago. So the first topic addresses late relapses in testicular cancer. And historically, we have been concerned that these patients did worse and had worse outcomes. And late relapse could variously be described as after 2 years or after 5 years. In the current study, they defined late relapse as being after 2 years and very late relapse as being after 5 years. And what was special about the study was that it captured the entire population of patients with testis cancer in Norway and Sweden so that it wasn't based on a center of excellence that gets selective referrals. It was actually a population-based study. And the key conclusion of the study was one I found, once again, that late relapses are rare. So for stage I patients, 2% of patients will relapse after 2 years, 1% after 5 years, and 0.5%, so 5 out of 1,000 patients, after 10 years. So if you're 2 years out, the likelihood of a relapse is quite low. And if you're 5 years out, it's half of that. In patients with metastatic disease, similarly, 3.6% relapse after 2 years, 1.6% after 5, and 0.8% after 10 years. And what was interesting to me was that if you looked at the more recent patients who were diagnosed after 1995 - I know that doesn't sound very recent, but they had even earlier patients also in the study - the very late relapse rate almost resolved and went away. It went from 2.2% all the way down to 0.8%. So I think with modern imaging, modern care patterns, we're seeing less of this than we used to. But overall, patients were doing better even if they do relapse late. One thing that was interesting in the study to me also was for stage I disease, we typically recommend surveillance rather than active treatment. So active treatment with non-seminomas would be a retroperitoneal lymph node dissection or more surgery or chemotherapy. With seminoma, it would usually be chemotherapy or radiation, although surgery is being investigated there now. And they did find that in men who chose surveillance, which we still recommend, the late relapse rate was a little bit higher, but it was still affecting a small percent of patients. So the relapse rate beyond 2 years was 4% rather than 1%, but out of 4,000 patients, there were only 3 deaths from late relapse. So this isn't changing the recommendation for surveillance, but it is an alert that patients who are on surveillance for stage I disease have a slightly higher risk of late relapse and that may affect how we follow them and specifically how long we follow them. One of the things that was interesting in the study is in the United States, we often stop scans at 5 years, but in the SWENOTECA countries, they continue scans all the way out to 10 years. I don't know that U.S. guidelines are going to change, but it was a provocative finding. The key thing, as I alluded to at the beginning, was that 61% of patients with late relapse were alive 10 years later, and while we would like that number to be higher, it used to be around 50% in older studies. So it's a significant improvement from where we were before. A particularly interesting thing to me was that patients relapsing 2 to 5 years out actually had the best prognosis. Patients who relapsed in years 1 to 2 had a worse prognosis and patients relapsing after 5 years had a worse prognosis, whereas the patients relapsing 2 to 5 years had a better prognosis. In the end, I think what this means for us is that patients are doing better. It's not going to really change our treatment patterns, but it's reassuring that we shouldn't be pessimistic about late relapses, and we still have a solid chance of curing them. So again, bottom line, most men with late relapse is cured and late relapse is less common now than it was earlier, particularly in non-seminomas. Let's go to the next study. So this is a different group of patients who had a particularly ominous prognosis historically and still we have a lot of room for improvement. These are patients with non-seminomas that start in the mediastinum. So in the chest, under the breastbone, under the sternum typically. And patients are treated aggressively upfront, they are considered poor risk at the initial time of diagnosis, and they're treated aggressively at the time with 4 cycles of BEP or 4 cycles of VIP chemotherapy. And then they go for surgery to remove any residual disease. And the hope is they're cured at that point because historically, if there was a relapse after chemotherapy and surgery, it was almost impossible to cure them. Indiana University published their results using high-dose chemotherapy in this population, and they reported that 30% of men who were treated with high-dose chemotherapy had no evidence of cancer after 2 years, and 35% were still alive. Obviously, we need longer follow-up, but most of the relapses you're going to see are going to be in the first 2 years. So while again, there is significant room for improvement here, this indicates that high-dose chemotherapy is a good option, and that has been a question. So this is reassuring in that regard. But it is a good option for men with relapsed mediastinal non-seminomas of the germ cell tumors. So there's hope there where in the past, this has felt a little bit helpless. The thing I wanted to also highlight was that there are 3 things I think are going to be interesting to keep an eye on over the next year. One is the use of surgery for early-stage seminomas. There are a number of papers out about that. I still think this is an investigational approach, and so I didn't want to go into great detail about it, but it is looking like that RPLND, or retroperitoneal lymph node dissection, will likely or may be an option for stage I and stage II seminoma in the future. We are getting more evidence for that. It's not quite as promising as we had hoped until there's more data that's needed, but it's looking like that will become an option. So for men with early-stage seminoma, at least raising the question whether surgery is an alternative to chemotherapy or radiation, is an important discussion to have with your oncologist. Secondly, MRI rather than CT scans for surveillance. So to keep an eye on men who have been treated or men who are just stage I and are being followed and typically come in routinely for CT scans, which expose people to ionizing radiation, which theoretically has a risk of causing cancer, there's more and more data that MRI is just as good as CT, and MRI does not use ionizing radiation. So there's probably going to be an expanding role for MRI as an alternative to CT scans. And lastly, the use of microRNA rather than just depending on serum tumor markers. So right now, we use the blood tests alpha-fetoprotein, beta hCG, extensively to monitor for relapse, and there's more and more evidence for using what we call microRNAs instead. It may be more accurate in multiple different settings. So it'll be interesting to see how that evolves and that's what I wanted to cover today. Thank you very much. Greg Guthrie: Thank you, Dr. Gilligan. And now we have Dr. Grivas, who's going to discuss some research in bladder cancer. Dr. Grivas: Thank you so much, Greg, and thanks Cancer.Net for the great opportunity to discuss this for our patients. We're very excited about the data from the ASCO Annual Meeting, and I would encourage the audience to review as possible other presentations as well. I'm going to cover 3 highlights. I'm going to start with the QUILT-3.032 study. This trial reported the final results of a clinical trial that took place in different centers and involved patients with what we used to call “superficial bladder cancer.” And the modern term is “non-muscle-invasive bladder cancer.” Bladder cancer that does not involve the muscle layers, not that deep in the bladder wall. Non-muscle-invasive bladder cancer is usually treated by our colleagues in urology with installation inside the bladder with an older form of immunotherapy which is BCG. And that's the most common way we treat this disease. And proportion of patients may have tumors that may not respond to BCG that may come back or persist despite the installation of the BCG in the bladder. And these patients usually have a standard of care of getting what we call radical cystectomy, meaning, removal of the bladder and the lymph nodes around the bladder, radical cystectomy and lymph node dissection. However, many patients may not have, I would say, the opportunity to get the surgery because the body may not be that strong to undergo that significant procedure. Very few patients may have that challenge because of other medical conditions or what we call poor performance status. Or some patients for quality-of-life reasons may try to keep their bladder as long as possible. And for some of those patients, that might be an option. And we have been looking for those options in the last few years. Intravesical, inside the bladder, installations of chemotherapy have been used with some positive results in some other studies. So that's an opportunity. We call this intravesical, inside the bladder, installations of chemotherapy, and the other option is an FDA-approved agent given intravenously inside the vein called pembrolizumab, which is in the form of immunotherapy. Of course, research continues. And this study I'm showing here from Dr. Chamie and colleagues, looked at this combination of BCG plus this molecule called N-803. This is another form of immunotherapy, and this was tested in patients who have this BCG-unresponsive, as we called it, non-muscle-invasive bladder cancer. The results were very promising. I would say impressive that it was a high response rate if we focus our attention on patients who had the superficial form carcinoma in situ, about 70% had no evidence of cancer upon further evaluation of the bladder. And in many of those patients that this response lasted for more than 2 years. 96% of patients avoided to have worsening of the bladder cancer in 2 years for those who had a response, and about 9 out of 10 avoided cystectomy again from those patients who had received the response. So it was 70% of all the population. And as you see, all patients, 100% were alive without dying from bladder cancer after 2 years, which again is a very promising finding. This combination, to conclude, this inside the bladder installations of BCG plus the N-803, looks very promising. For those patients with BCG-unresponsive non-muscle-invasive bladder cancer, that might be an option down the road, we have to see. Now I'm going to shift my attention to patients with metastatic or spread urothelial cancer. I want to point out that I'm a co-author in this abstract and I participated in that survey I will show you the results from. This is a population of patients who have spread cancer from the urinary tract, either the bladder was the most common origin or other parts of the urinary tract, for example, what we call kidney, pelvis and ureter, or rarely the urethra. The urothelial cancer that starts from those areas, again more commonly bladder, if it spreads, if it goes outside the urinary tract system, usually those patients get chemotherapy, what we call with an agent called cisplatin if they can tolerate that chemotherapy drug or carboplatin if they cannot tolerate the cisplatin drug. And usually either of these, cisplatin or carboplatin, is combined with a drug called gemcitabine. That's the most common chemotherapy used as initial therapy for patients with spread metastatic urothelial cancer. In this abstract, Dr. Gupta and colleagues tried to survey 60 medical oncologists, including myself, who treat urothelial cancer that considered experts in this disease type, to see if there are any features that could deter us from using chemotherapy in those patients. In other words, are there any features that may make us think that chemotherapy may be too risky for our patients and we should not do it? We should give immunotherapy instead. This is probably a small proportion of our patients, maybe 10 to 20% in our practice, may not be able tolerate that chemotherapy. And which are those features? Poor performance status, meaning the body is very tired and the patient is not moving too much, is confined in the chair or the bed most of the day, and rely on others on daily activities. This is what defines the performance status of ECOG 3. Peripheral neuropathy, meaning that there is numbness or tingling or weakness in the hands or the feet that impact the quality of life. And patients may have trouble buttoning buttons or tying laces, so impacting the quality of life. That's grade 2 neuropathy. Symptomatic severe heart failure, there is a grading system, like New York Heart Association Class III or IV that is significant, notable heart failure symptoms. And also, patients with kidney failure with what we call creatinine clearance below 30 cc per minute. That's a marker how we measure kidney function and the creatinine clearance more than 60 is usually close to normal. As the creatinine clearance drops and goes below 30, chemotherapy with these platinum agents may become a challenge by itself or if it's combined with the ECOG performance status of 2, which means more patients are not moving most of the day. So those features again have to do with the functionality of the day-to-day life. The presence of significant neuropathy, heart failure, and poor kidney function may potentially make the oncologist recommend immunotherapy versus the standard of care, which is chemotherapy, in those patients. And I would say if someone gets chemotherapy, which is the majority of patients, usually they may get immunotherapy later. So pretty much I would say discuss with the medical oncologist what is the right treatment for you. Most patients get chemotherapy up front, followed by immunotherapy. Some others may need to get immunotherapy, and those criteria help us make that patient selection for the right treatment at the right time. So I just alluded to you that most patients with spread or metastatic urothelial cancer, most of them receive chemotherapy. We discussed some criteria in the previous studies that we may use immunotherapy upfront instead of chemo, but for the vast majority of patients, chemotherapy is used upfront and that was based on the results of phase 3 clinical trial called JAVELIN Bladder 100. This was presented at the ASCO Annual Meeting in 2020 about 2 years ago, and it was published in a big journal. And that study showed that if you give chemotherapy upfront, those patients who can tolerate the chemotherapy, of course, who do not have the previously listed criteria, those patients benefit and live longer, so longer overall survival, meaning they live longer, and they have longer progression-free survival, meaning they live longer without worsening of the cancer if they get immunotherapy with, immunotherapy drug is given through the vein, called avelumab. If that is given after the end of chemotherapy for patients who have a response or stable disease, meaning no progression on chemotherapy. So if you get a complete response, meaning that the CAT scans look normal after chemotherapy as at least we can tell visually. Partial response, meaning that the CAT scans look better, but still we can see some cancer spots. Stable disease, meaning that the scans look stable compared to the beginning before we start chemotherapy. If someone has worsening of the cancer in chemotherapy, then the concept of maintenance therapy doesn't apply. So it's only for patients with complete response, partial response, or stable disease, SD. And the poster we had, and I can tell you - I was a co-author in the abstract and co-investigator in the trial, as a disclosure - was sort of the benefit of the patient with avelumab as maintenance therapy after chemotherapy was notable in patients with complete response, partial response, and stable disease. So in any of these 3 categories, avelumab immunotherapy should be offered as level 1 evidence and benefit patients in terms of overall survival and progression-free survival as long as there's no progression to the upfront initial chemotherapy of the patient with metastatic urothelial cancer received. Many other abstracts on these cancers were presented, and I would encourage you to look at them. Thank you so much for the opportunity today. Greg Guthrie: And thank you, Dr. Grivas. Next, we have Dr. Zhang who will discuss some research in kidney cancer. Dr. Zhang: Hi everyone, glad to be here today. I'll be discussing 2 highlights from ASCO 2022 in kidney cancer. The first one we wanted to highlight was a trial called EVEREST: everolimus for renal cancer ensuing surgical therapy, a phase 3 study. And in context, this study is a trial of evaluating everolimus, an mTOR inhibitor, in the post-surgical context. And we do have in the landscape 2 approved therapies, sunitinib and pembrolizumab. And as we have seen, some effective therapies in the refractory setting, many of these therapies are being tested in this postoperative space. So this particular study of EVEREST looked at patients with renal cell carcinoma who underwent resection for their primary nephrectomy and looking to evaluate postsurgical treatment. So everolimus has been approved as a treatment on its own in the refractory setting as well as in combination with lenvatinib. And so this question of whether everolimus alone could delay or prevent disease recurrence in the postoperative setting was tested in this EVEREST trial. The study ultimately enrolled more than 1,500 patients and assigned them to receiving either everolimus or placebo in the postoperative setting. Of these patients, 83% had clear cell kidney cancer and the remaining had non-clear cell kidney cancer. And the follow-up was quite long, over 5 years, and actually over 6 years, and the researchers looked at time until disease recurrence. And risk of recurrence was actually decreased by 15% in patients who were treated with everolimus compared to placebo. But the prespecified cut-off for a statistical significance was not quite reached, and the researchers took a specific look at a group of very high-risk patients defined by larger tumors, invasion of the perinephric fat in renal veins or invasion of nearby organs or known positive disease. And those patients with very high-risk disease had more benefit from everolimus compared to placebo. Of note, 37% of patients who were treated with everolimus had to stop treatment due to their side effects, and the most common severe side effects included mouth ulcers, high triglyceride levels, and high blood sugars. So ultimately this particular study did not show sufficient benefit of everolimus given the toxicity and lack of statistical significance. And so this is a balance between potential benefit in delaying recurrence versus treatment toxicities that we must have in this adjuvant setting. So what does this particular study mean for patients? Well, it was certainly a large phase 3 trial performed in the cooperative group setting and through the generosity of 1,500 patients and the principal investigators on the study, we learned this answer for a very important question of whether everolimus makes a difference in this postoperative setting. I think we're not using this in clinical context currently, but in this postoperative setting, we are always balancing this risk of toxicity with the potential for benefit and discussing the potential treatment options. I do not think this particular trial changes the standard of care in this adjuvant setting. And then I think finally for today's prepared talks, this abstract on depth of response and association with clinical outcomes with CheckMate 9ER patients treated with cabozantinib and nivolumab. So this was a post-trial analysis of patients who had kidney cancer with disease spread and treated with cabozantinib and nivolumab compared with sunitinib in the CheckMate 9ER study. And the context, this was the phase 3 trial in which the benefit of cabozantinib and nivolumab was established in the first-line setting and gained the registration and approval of this combination in the first-line treatment of metastatic kidney cancer. This particular analysis, presented at ASCO this year, was a post-trial prespecified analysis evaluating this depth of partial responses and associating those with clinical outcomes of time until disease progression as well as time until death. These depth of responses were defined as 80 to 100% for PR-1, 60 to 80% for PR-2, and then 30 to 60% as PR-3. And as we saw in this analysis, the deeper the responses on cabozantinib and nivolumab, the more correspondence with higher 12-month rates of disease-free progression compared with those same depths of responses from sunitinib. And there were similar 12-month overall survival rates for patients with similar depth of responses for either the cabozantinib and nivolumab combination compared with sunitinib. So I do think the degree of partial response in these settings is productive of time until progression and establishes further the efficacy and benefit of cabozantinib and nivolumab compared with sunitinib. And what does this trial mean for our patients? I think that early on, as we're looking for responses and radiographic changes for our patients on cabozantinib, nivolumab in the first-line setting, these deeper responses are associated with longer time until disease progression, and we can counsel patients, to discuss whether cabozantinib and nivolumab is working for them. This could be an early indicator for how patients will do overall on this combination. So with that I'd love to wrap up and turn it back over to you, Greg. Greg Guthrie: Thanks so much Dr. Zhang. And now it's time to move on into our Q&A session. This is for you, Dr. Agarwal. So the question is utility of triple therapy, ADT plus docetaxel plus ASI and metastatic hormone-sensitive prostate cancer given ENZAMET was inconsistent with PEACE-1 and ARASENS. Would you give ASI concurrent or sequential after chemotherapy for tolerability? I'm assuming ASI here is androgen suppression, correct? Dr. Agarwal: Yes. Great question. There are 2 questions here. Number 1, if I would use triplet therapy given the negative subgroup analysis of the ENZAMET trial, and number 2, what is the role of triplet therapy in general? The answer to the first question is ENZAMET trial, subgroup analysis is very different from preplanned, prespecified, well-powered analysis from PEACE-1 and the ARASENS trial. So yes, we saw discrepant results, but my impression from ENZAMET trial is enzalutamide is an effective option for all patients regardless of the receipt of docetaxel chemotherapy because that was a subgroup analysis. So I don't think it really affects negatively the results of the ARASENS and the PEACE-1 trial. But a bigger question here is triplet therapy versus doublet therapy? Is triplet therapy for all or doublet therapy for all? Answer is no. Triplet therapy trials only showed that adding a novel hormonal therapy or deeper androgen blockade to the backbone of ADT plus docetaxel improves survival. These trials did not answer the question, if adding docetaxel chemotherapy to ADT plus, for example, enzalutamide or darolutamide or apalutamide, will improve survival. We do not have that question answered by any of the trials and unlikely any other trial will answer that question. So my take ADT plus docetaxel is replaced by ADT plus docetaxel plus these deeper androgen blocker therapy. So wherever I was going to use docetaxel chemotherapy, so those are the patients with visceral metastases or in my practice, when I do comprehensive genomic profiling, I see those molecular aberrations which predict lack of response to deeper androgen blockade such as baseline AR variants. Or if I see 2 out of 3 mutations of p53, RB loss, p10 loss, if I see 2 out of these 3, I tend to think about docetaxel chemotherapy. So in those patients where I'm using ADT plus docetaxel, I would add another androgen receptor blocker such as abiraterone and darolutamide. But when I'm using enzalutamide or apalutamide which I use for majority of those patients, my patients with metastatic hormone-sensitive prostate cancer, I do not think about triplet therapy. Greg Guthrie: Thanks, Dr. Agarwal. We actually have a follow-up question, and this is, what is the role of oncology in low-stage early prostate cancer? Can neoadjuvant chemotherapy reduce the number of people who end up with metastatic prostate cancer? Dr. Agarwal: This answer is very simple. There is no role of neoadjuvant chemotherapy in high-risk localized prostate cancer or any localized prostate cancer setting. Greg Guthrie: Great. Thank you. Next question. I believe that this is for everybody. How long will it be until the information from the trials discussed will be used in the community clinics? What can patients do to bring this information to their less experienced doctors? Dr. Grivas: So, Greg, just to clarify the question, is it about the translation of the results of the clinic from ASCO to clinical practice, generically speaking, or any particular tumor type or any particular data results? Greg Guthrie: The way I read this question, it's more just kind of a broader scope question about just like, how long does the results of clinical trials make it to community practice, and what role can patients have in perhaps fostering this transmission of information? Dr. Grivas: Of course, I can start briefly, and then my colleagues can add. I would say the world we live in right now, the information travels very quickly. It's much faster compared to the past. And I think there is much more alignment, in my opinion, in terms of information access between academic oncologists and community oncologists. If, for example, a trial result comes at ASCO being presented, and then there's a follow-up approval authority from a regulatory agency, this agent may be accessible to both community and academic practices. Of course, there are always opportunities for education, and Dr. Agarwal is the director of the ASCO Daily News, and he knows that well to disseminate the information well, broadly, in an equitable manner across academic oncologist providers and community providers. And I think CME, continued medical education practices, can help in that regard. And obviously, the other aspect of that is the ongoing clinical trials and how we can do a better job disseminating the opportunity for equitable participation in clinical trials across racial groups, ethnicity groups, minority groups, to give them the chance to participate in ongoing clinical trials that may change the practice down the road, which are just early thoughts. But other colleagues can comment. Dr. Zhang: Yeah, if I could chime in. I think these continuing medical education programs, particularly in the context after large symposia like the ASCO Annual Meeting we just had, are particularly important. And the Best of ASCO series, as well as ASCO Direct Highlight series - I believe Dr. Grivas and I are hosting 2 of these - are very helpful, I think, to bring the latest findings from the ASCO Annual Meeting to our community colleagues. And they really are our colleagues. We work together with our oncologists within the community to take care of our patients, oftentimes for standard of care treatments. Patients can access them more in their backyards. And I think from a patient standpoint on the second part of the question, they're able to hear these from patient-friendly platforms and to bring that to the attention of their oncologist, wherever that may be. It all helps in the grand context of clinical care. So I hope that these trial results and the latest findings from ASCO can get inseminated very quickly.   Dr. Grivas: And to also add very briefly, the role of patient advocacy groups, and in the bladder cancer work, there are many, for example, the Bladder Cancer Advocacy Network, World Bladder Cancer Coalition, and many others can help also in that regard and teaming up with all of us to disseminate information and also clinical trial access. Greg Guthrie: Great. Thank you, everyone. We have a question for Dr. Grivas. After the survey results in the study you described, is there any plan to make a guideline or tool to make sure we standardize the definition of cisplatin/platinum ineligibility? Dr. Grivas: Great question. Just 1 more thing on my prior answer, kudos to Cancer.Net for serving that mission, Greg and Claire in that-- or the previous question to have a complete answer. Answering this new question here, which is very important. I think the next step is to try to publish the results of the survey. The survey like the previous one done by Dr. Galski about 10 years ago-- it's a survey on expert oncologists, and it's a consensus-based definition. It's criteria that we came up with together. And I think the next step here is to publish this in a peer-review process. And our hope is by publishing these results, we can have a more formal definition to help guide our practices in academia, but also in the community oncology practices and make sure that we have a standardized way that we approach this therapy selection and of course, to help design clinical trials that for this particular patient population in order to improve outcomes in this setting. So hopefully publication will come soon. Greg Guthrie: Thanks, Dr. Grivas. I'll just drop a really quick pitch there. Here at Cancer.Net, we do have a very broad array of information on clinical trials. And patients can come visit us at Cancer.Net and learn about clinical trials, what they mean, and how they help advance cancer research. We now have a question for Dr. Zhang. Based on the results of EVEREST and other trials approved systemic therapies in the adjuvant setting like sunitinib and pembrolizumab, are there ongoing other trials in this setting and is risk stratification used? Dr. Zhang: The short answer is yes. There are ongoing adjuvant trials that build on pembrolizumab in the adjuvant setting. There's one that is looking at the addition of belzutifan with pembrolizumab in the adjuvant setting. So that trial is a global trial which is about to get started, if not enrolling already. And in the context of adding on in the adjuvant setting, I do think we really need to discuss with our patients how much of a benefit the treatment will have versus the real toxicity in the postoperative setting, many patients will not have symptoms from their cancer, so they may have some pain or healing side effects from surgery, but they won't have symptoms from cancer. So any toxicities from medications can be further amplified, so are we truly giving a lot of benefit in that context or not. So that's an individualized decision, and I do think conversations must be had to make that decision together. Greg Guthrie: Thanks, Dr. Zhang. I want to ask a question myself of Dr. Gilligan. You had mentioned that microRNA is an emerging field of study, and I've heard about this in other types of cancer as well. I wonder if you could discuss that a little bit more. Dr. Gilligan: Yeah, microRNA, the promise that holds is being a more accurate detector, specifically of testicular cancer. So the problem we have with alpha fetoprotein and beta HCG is half of the testicular cancers may not make 1 or both of those markers. So people can relapse without the markers going up, even though markers are most commonly what we see, there are a couple of different scenarios. Someone has stage I testicular cancer, which means their testicles removed and all their scans show no evidence of cancer. We know that 25% or so of non-seminomas and 20% or so of seminomas will relapse, even though we can't see what the cancer is, and the markers are negative in that situation. MicroRNA may be able to detect those people who still have cancer much, much earlier. So we know that they're, in fact, not stage I and that they need active treatment right away. So that's one place. Another place that we're seeing evidence is that men who've had metastatic testicular cancer. They go through chemotherapy, and they have residual masses. And we're wondering if there's cancer in those masses or is it all dead scar tissue or is it teratoma? MicroRNAs may be able to allow us to determine who needs additional treatment, who needs surgery without having it. Right now, we typically go in and operate just to figure that out. So there are a number of situations in which we could more accurately stage patients and figure out who's cured and who's not cured much earlier in the course of disease. And for a patient, this would be fantastic, because right now, if you've got stage I disease with non-seminomas and you go on surveillance and somebody says you have a 25% risk the cancer is going to come back, that's a 1 in 4 chance that at some point in the next 2 years, most likely, or longer, you're going to have to suddenly drop everything and go through months of chemotherapy. If we knew on day 1, it looks like you're cured, but in fact, there's cancer hiding there somewhere, and we need to treat you now, that would be helpful to know so they can get it over with. And the other men, we could say we're really extremely confident that there's not a 25% risk, it's a 5% risk or something much lower. So there are a number of ways, if this really gets proven and there's emerging data that's promising, I think we could reassure men, treat them more appropriately, spare them unnecessary treatment, and give them more peace of mind. Greg Guthrie: Great. Thanks, Dr. Gilligan. I think we have a question from Dr. Grivas now. Dr. Grivas: Thank you, Greg. This is a great panel. I like to learn from my colleagues here. One question for Dr. Zhang, you have done so much work in the field, leading the field there, Dr. Zhang. Any comments about the ideal end points in the adjuvant setting in kidney cancer, urothelial cancer, disease-free survival or overall survival? Would you comment about how we design trials, and what will be an acceptable benchmark? And what is meaningful for patients, too, in the adjuvant treatment after radical surgery for kidney cancer and urothelial cancer? Dr. Zhang: Oh, that's a great question, Petros. Thank you so much for asking. We have discussed this many times together because you and bladder cancer and myself and kidney cancer, we're thinking a lot along the same lines right as new immunotherapies get approved in the postoperative setting, so disease-free survival as an endpoint and recurrence-free survival as an endpoint is a valid endpoint. It's a direct result of the randomized treatment on the trial, so I do think that is the valid endpoint, and it's an endpoint that the FDA has approved the sunitinib and pembrolizumab indications in kidney cancer, nivolumab and bladder cancer. So I think it's certainly a valid endpoint to delay disease recurrence. How much of that is meaningful degree of improvement for an individual patient? Their own measure of recurrence is either yes or no. It's much more binary than population effects. So how much does that translate into benefits for the patient? I think that warrants deeper individualized discussion. But these disease-free survival endpoints in all of these studies is a valid endpoint to see whether the treatment is worthy in delaying disease recurrence in each of these disease types. Greg Guthrie: Thanks, Dr. Zhang. We have one last question here, and I believe this is a follow-up for Dr. Gilligan. And what is the time frame for the rollout of microRNA 371 to the community? Dr. Gilligan: I don't know the answer to that. I'm not sure that we have enough data right now that it's going to get approved. I think we're headed in the right direction, but it's very hard to know what the timing of that is. There are trials going on, so I don't know at the moment of exactly what the scenarios are in which people are going to be, which patient populations are going to be eligible, but there are trials going on. I think I'm hoping within the next 2 years or so, but I really don't know what the time frame is, unfortunately. Dr. Grivas: And if I may add a more generic comment to Dr. Gilligan's wonderful answer is that when we have what we call biomarkers that are like metrics that can give us information about how the patient does over time, it's important to tease out what we call prognostic, meaning how can this biomarker give us a sense of the chance of recurrence, as Dr. Gilligan said, or death from the cancer. But also, the bigger question is, is it going to give us information to predict benefit from an individual therapy? And that's a bigger question in oncology that is a harder one. This predictive question and try to identify biomarkers and validate them to make sure they have, they're clinically useful. They can help us make treatment decisions in the clinic. And I'm very excited about what Dr. Gilligan discussed about the promise in the future. But more trials are needed for many biomarkers. Dr. Gilligan: I think when we do this update next year, we'll have significantly more data then, I'm hopeful. Greg Guthrie: Thank you to you all. Thank you, Dr. Agarwal. Thank you, Dr. Grivas. Thank you, Dr. Gilligan. Thank you, Dr. Zhang, for sharing this great research with us, as well as your expertise. It's been a real pleasure this afternoon. And to all of our viewers, thank you for joining us. You can find more coverage of the research from ASCO Annual Meeting and other scientific meetings at the Cancer.Net blog, which is at www.cancer.net/blog. And if you're interested in more Cancer.Net content, please sign up for a monthly Inside Cancer.Net newsletter or follow us on social media. We're on Facebook, Twitter, and YouTube where our handle is always @CancerDotNet, with dot spelled out. Thank you all, and be well. Thanks. ASCO: Thank you, Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

The Fred Hutch scientist was one of the first people to explain COVID-19 to the public. Thousands of Twitter followers and a MacArthur grant later, he reflects on what he learned. In many ways, the world is swimming in information about the pandemic. Two-plus years after the virus was first detected in the United States, the COVID-19 dashboard has become, and remains, a fixture in many Americans' lives. There is still room for more information that would help the public in its battle against the virus, but the need is nothing compared with the early days of the pandemic.  Those early days are where Trevor Bedford found a new role for himself as a science communicator. A professor in the vaccine and infectious disease division of the Fred Hutchinson Cancer Research Center in Seattle, Bedford was busy at the start of the pandemic. In addition to his day job, he used Twitter to deliver a steady stream of information on the new threat to a public desperate for it. Bedford continues to inform the public, now with more than 400,000 Twitter followers and a MacArthur “genius” grant to his name.  For this episode of the Crosscut Talks podcast, reporter Hannah Weinberger speaks with Bedford about how his particular experience with this difficult period has impacted the way he thinks about his work, communication and the pandemic. --- Credits Host: Mark Baumgarten Producer: Sara Bernard Event producers: Jake Newman, Andrea O'Meara Engineers: Resti Bagcal, Viktoria Ralph

An interview with Dr. Sharon Giordano from the University of Texas MD Anderson Cancer Center in Houston, TX, and Dr. Nancy Davidson from Fred Hutchinson Cancer Research Center and the University of Washington in Seattle, WA, co-chairs on "Systemic Therapy for Advanced HER2-Positive Breast Cancer: ASCO Guideline Update." This guideline updates recommendations on systemic therapies for advanced HER2-positive breast cancer, focusing on second-line, third-line, and greater treatment. Read the full guideline.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey and today I'm interviewing Dr. Sharon Giordano from the University of Texas MD Anderson Cancer Center in Houston, Texas, and Dr. Nancy Davidson from Fred Hutchinson Cancer Research Center and the University of Washington in Seattle, Washington, co-chairs on 'Systemic Therapy for Advanced Human Epidermal Growth Factor Receptor 2 Positive Breast Cancer: ASCO Guideline Update'. Thank you for being here. Dr. Giordano and Dr. Davidson. Dr. Sharon Giordano: Thank you. Dr. Nancy Davidson: Thank you for having us. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Giordano, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Sharon Giordano: No, I do not. Brittany Harvey: Thank you. And Dr. Davidson, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Nancy Davidson: No, I do not. Brittany Harvey: Thank you. Let's talk about the content of this guideline update. So first, Dr. Giordano, what prompted an update to this guideline on the systemic therapy for advanced HER2-positive breast cancer, and what is the focus of this update? Dr. Sharon Giordano: So, we were prompted to update the guidelines for HER2-positive metastatic breast cancer because several new studies have been presented and published, which are really changing our standard of care approaches. We have new therapies and new combinations that have resulted in improvements in progression-free survival and in overall survival for this patient population. Given the clinical importance of these new studies, we felt that an update of the treatment guidelines was clearly needed. Overall, the focus of our update is really in the title, so, it's systemic therapies for advanced HER2-positive breast cancer. And specifically, what we're focusing on is updating the recommendation for second-line therapy, and then adding multiple new options for systemic therapies for third-line and greater treatment. Brittany Harvey: Great. Thank you for that overview. So, then I'd like to review the updated recommendations of this guideline for our listeners. Starting with, Dr. Davidson, what is recommended for first-line therapy for patients with advanced HER2-positive breast cancer? Dr. Nancy Davidson: So, that was the part of this guideline that really did not change. In the previous iteration and in the current iteration, we felt that the evidence suggested that a combination of trastuzumab and a taxane should be the first-line treatment for individuals with metastatic HER2-positive breast cancer unless they have some sort of contraindication to the taxanes. Now, the evidence supporting that is very strong. The trial that supported this continues to be updated and continues to show benefit. So, that's a very high level of evidence and our recommendation on this was extremely strong. Brittany Harvey: Great. And then following those first-line recommendations, Dr. Giordano, what is recommended for second-line treatment for these patients? Dr. Sharon Giordano: So, we did change our recommendation for second-line treatment for HER2-positive patients. The current new recommendation is, and I quote from our guideline, “If a patient's HER2-positive, advanced breast cancer has progressed during or after first-line HER2 targeted therapy, and the patient has not received trastuzumab deruxtecan, clinicians should recommend trastuzumab deruxtecan as a second-line treatment.” So, as I said before, this recommendation is a change from our prior second-line recommendation. Previously, we had recommended T-DM1. So, this change was really, I think, one of the most important changes to the guidelines with this update. We made the recommendation based on the initial presentation of the results of the Destiny-Breast03 trial, really given the magnitude of the benefit that was seen in the study. And the manuscript I would note was published this month in the New England Journal of Medicine. Overall, the study showed statistically significant and highly clinically meaningful reduction in progression-free survival. So, just to give you some of these numbers, to kind of give you a sense of how big the impact was, so 76% of patients who were treated with trastuzumab deruxtecan versus 34% of patients treated with trastuzumab emtansine were alive and without disease progression at a year, with a hazard ratio of 0.28. The response rates are also quite impressive with 80% versus 34% response rates. And the overall survival data are still immature but do favor treatment with trastuzumab deruxtecan and that hazard was 0.55. So, I will note though, that toxicity was a bit higher with the new drug, with trastuzumab deruxtecan. So, any grade adverse events were 98% versus 87%. And then if you look at grade three and four drug-related adverse events, it was 45% versus 40%. I think of note, rather than just kind of the overall numbers, though, one thing that clinicians need to be aware of is the risk of interstitial lung disease with this new drug. And this occurred in about 10% of treated patients in this study, although only 1%, or I think it was two patients, who had grade three or higher pulmonary toxicity. So, this is a toxicity that is specific to this drug that clinicians do need to be aware of. Dr. Nancy Davidson: I think the other thing on that, Sharon, is that the incidence was lower in the Destiny Breast03 trial than it had been in some of the really early studies of this agent, so, that should be reassuring to us. Although, of course, it doesn't mean that the side effect doesn't happen, you have to take note of it. Dr. Sharon Giordano: That's a great point. It definitely was lower than we'd seen before. So, a little bit of a relief, but still there. Brittany Harvey: Great, thank you both for reviewing that data. I appreciate the overview. So then, following those recommendations for second-line treatment, Dr. Davidson, what are the recommended options for third-line therapy for patients with HER2-positive advanced breast cancer that has progressed on second-line or greater HER2 targeted therapy? Dr. Nancy Davidson: Well, of course, this is the area where there has been considerable change as well. And that's because of the wealth of new anti-HER2 agents that Dr. Giordano talked about earlier. So, we had a variety of recommendations for clinicians and patients to make decisions about how to proceed. I think certainly one of them, is that if the patient did not receive trastuzumab emtansine (T-DM1) in the second line, as we just talked about, our new recommendation would be that they would not, that they would receive trastuzumab deruxtecan, so you put off for T-DM1 in that [third-line] setting. And that's a new recommendation for us. And the strength of the recommendation is quite high. Another agent that's come along that's very exciting is tucatinib, one of the small molecule inhibitors. And we think that that is also an alternative, that tucatinib in combination with trastuzumab and capecitabine, again, nice activity and pretty strong recommendation based on analyzed critical trials. And then finally, if for some reason the patient didn't receive the trastuzumab deruxtecan in a second-line setting and you're now in the third-line setting, that would be a very reasonable agent for them as well. Those are all pretty strong recommendations. And I think the choice of which to proceed will depend a little bit on the decision making between the patient and the doctor about the mode of administration, your side effect profile, what seems the most appropriate, and it might be more one of the order of the recommendation. As opposed to saying, 'This one, but not that one', it might be, 'Pick this one next and know that you will be able to return to some of these in the future.' Now, there are a lot of other possibilities here. We already had available to us neratinib and capecitabine, that continues to be part of the portfolio. And we also had lapatinib and capecitabine, also part of the portfolio. Other combinations of chemotherapy, trastuzumab could be considered, a new agent called margetuximab with chemotherapy, which has also come on to the market. And of course, there's the possibility of thinking about the anti-HER2 agents in the context of endocrine therapy for those patients who have estrogen receptor-positive breast cancer as well. And new information suggesting that you might, in some cases, even think about one with CDK 4/6 inhibitors in the context of trastuzumab and fulvestrant. So, lots of possibilities here that patients and doctors can weigh, and again think about order of administration as opposed to selecting for or against the other. I do think that the leading contenders at the beginning are going to be T-DM1 or trastuzumab deruxtecan, if that hasn't been used, or tucatinib in combination, those would be my personal preferences. Brittany Harvey: Great. Thank you for reviewing those options and describing where a patient might receive these during their treatment. Dr. Nancy Davidson: I'd like to hear Dr. Giordano's thoughts on that, how would you stack those up? Dr. Sharon Giordano: Yeah, well, as you said, I think it does depend on what the patient's been treated with previously. I mean, certainly, T-DM1 or trastuzumab deruxtecan, if they haven't had those agents. Otherwise, I think the data from the tucatinib trastuzumab capecitabine regimen is pretty impressive as it did show an overall survival benefit. And as you know, I think that regimen is also really interesting, because it does seem to have some efficacy for patients with brain metastases. That actually has a very nice advantage. Then the other ones, I think it just sort of depends on what they've seen previously, what side effects they may be experiencing, and kind of other quality of life issues. I don't see that there's a clear way to sequence the other ones since most of them haven't really been directly compared head-to-head against each other. Brittany Harvey: It seems like it may be an individual discussion between clinicians and patients at that level. So, then, Dr. Giordano following that, how will this guideline impact clinicians and what should they know as they implement these updated recommendations? Dr. Sharon Giordano: I think the bottom line is really the clinicians are now going to have more options for the treatment of HER2-positive advanced breast cancer which is fantastic news to have all these different choices and options for our patients. To me, I think probably the most important changes and recommendations, again, are the addition of trastuzumab deruxtecan in the second-line setting just given the very impressive clinical benefit that's seen with that drug, or, as Nancy mentioned in the third-line setting if patients, for some reason haven't received it previously. And then I also think, as we talked about, the tucatinib combination is really an exciting new combination that does seem to have significant clinical benefit. I think the clinicians will need to be aware that that might be an option for patients with CNS metastases that are progressing. And also, just to be aware, as we mentioned before, about the risk of the interstitial lung disease with trastuzumab deruxtecan but it's really encouraging to me to have such a long list of drugs and combinations that we can use to treat our patients. Brittany Harvey: Excellent. Those are great points. So, then finally, to wrap us up, Dr. Davidson, in your view, how will these guideline recommendations impact patients with advanced HER2-positive breast cancer? Dr. Nancy Davidson: Well, Brittany, I think one thing we hope, of course, is that those patients will cumulatively have a longer survival, and a better survival as a consequence of all of these new insights that we've been able to make. I can imagine it would be maybe a little confusing to patients that there are so many things that they might potentially be able to choose from, but this is one where I think that the larger the panel of agents that you have available to you, the happier it is. So, I hope that patients are going to look at this as an opportunity for partnership with their oncologists to try to figure out of all these possibilities, what's the best one for me now, and they're going to have the comfort of knowing that there'll be other things that they can fall back on in the future, and that, hopefully, these things will improve outcomes. And again, without excessive toxicity. This last thing I'm going to hope that clinicians and physicians will remember is that we've made a lot of headway here, but that our results are not perfect. And so, right now, we're able to change guidelines, these guidelines today because of clinical trials that have been put together in the last several years and successfully implemented. And I hope that we're going to continue to do that because until we get to a point where survival from HER2-positive breast cancer is 100%, we've got work to do. So, they're going to be other new clinical research strategies, and I hope that doctors and patients will take advantage of those whenever possible. Brittany Harvey: Absolutely, both hoping for longer survival and better quality of life and looking forward to more clinical trials to give clearer answers. I want to thank you both so much for your time today and for all of your work on updating these guideline recommendations, Dr. Davidson and Dr. Giordano. Dr. Nancy Davidson: Thanks, Brittany. Dr. Sharon Giordano: Thank you so much. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guideline Podcast Series. To read the full guideline go to www.asco.org/breast-cancer-guidelines. There's a companion guideline update on the management of advanced HER2-positive breast cancer and brain metastases also just published in the Journal of Clinical Oncology and on asco.org. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines App available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.     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 expressed their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Dr Bill Nelson speaks with Dr Channing Paller from the Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital in Washington DC and Dr Heather Cheng from the Fred Hutchinson Cancer Research Center about the PROMISE prostate cancer registry. The PROMISE registry is studying the role of genetics in determining health outcomes for patients with prostate cancer. Learn more about PROMISE at prostatecancerpromise.org/

Dr. Jones is an assistant professor in the Cancer Prevention Program, Public Health Sciences at Fred Hutchinson Cancer Research Center. She has a Doctor of Philosophy degree in psychology from the Ohio State University and completed post-doctoral training in aging and women's health research at Group Health Research Institute (now Kaiser Permanente Washington Health Research Institute). Dr. Jones is a clinical psychologist and psychometrician who studies financial hardship, financial anxiety and health. She is also working on creating patient-centered methods of determining meaningful change on patient-reported outcomes and developing measures to improve implementation of evidence-based practice. Her previous studies have investigated fear of cancer recurrence/progression and the relationship between physiological markers of health and distress.

Michele Andrasik, a clinical health psychologist at the Fred Hutchinson Cancer Research Center, on improving community outreach and diversity in clinical trials.

In this episode, I have the privilege of hosting the amazing Dr. Kristin G. Anderson, a Research Associate at the Fred Hutchinson Cancer Research Center in Seattle, Washington. Kristin talks about her research in ovarian cancer, in the defensive strategies of the tumors and engineering it into the therapies. She shares the improvements happening in the research, ways to improve survival, key learning in her studies, how she is helping mentor the next generation of scientists, and more. This is a great interview, and there are fascinating things to learn about T cells and research, so please tune in! Click this link to the show notes, transcript, and resources: outcomesrocket.health

Bladder cancer affects more males than females by 3:1. In this episode, two experts demystify this common cancer, in a detailed and accessible discussion. They cover risk factors, cancer types, symptoms, diagnostic tests, treatments & reconstructive options. Useful information for anyone with bladder cancer or at risk for it   Guests:  Max Kates, M.D. Urologist at Johns Hopkins Hospital, Baltimore Maryland; Associate Professor and Director of the Bladder Cancer Program at Johns Hopkins' Hospital Brady Urologic Institute. Jonathan Wright, M.D. Urologist at The University of Washington, Seattle Washington; Professor of Urology, and Medical Director of the UWMC Urology Clinic at the University of Washington School of Medicine; Associate Professor at the Fred Hutchinson Cancer Research Center.    Resources: bcan.org Bladder Cancer Advocacy Network; founded by spouses of bladder cancer patients, comprehensive resource for patient support, information, advocacy, and research. Make connections to local support groups and other patients.    Social Media Facebook Page: https://www.facebook.com/theoriginalguidetomenshealth/ Twitter: https://twitter.com/guide2menshlth LinkedIn: https://www.linkedin.com/company/the-original-guide-to-mens-health

Dr Evan Yu from the Fred Hutchinson Cancer Research Center in Seattle, Washington, discusses recent therapeutic advances in metastatic castration-resistant prostate cancer CME information and select publications here (http://www.researchtopractice.com/OncologyTodaymCRPC21/Issue2).

Muscle endurance can be improved, in older adults, without physical exercise, according to the results of a new clinical trial.  Scientists in the US and Switzerland say their research suggests supplementation with a gut metabolite, known as urolithin A, may counteract age-associated muscle decline.  This is significant as a potential intervention that could slow the onset of frailty in older people, and prolong healthspan.   The study, sponsored by the Swiss life science company, Amazentis  (also sponsors of this podcast), was conduced at the University of Washington Medical Center and the Fred Hutchinson Cancer Research Center in Seattle.  It was designed to test the hypothesis that long-term supplementation with Mitopure, a highly pure, synthetic form of urolithin A, would improve mitochondrial function and muscle performance in older adults.   In this LLAMA podcast interview, the study's principal investigator, Prof. David Marcinek, explains the findings and why he believes they could be especially beneficial for older people who are unable to exercise.  We also delve into the importance of mitochondrial health and why the so-called powerhouses of our cells play such a pivotal role in our ability to thrive and enjoy a long life. Interview recorded: January 12, 2022 | Read a transcript and show notes at the LLAMA website.This episode is brought to you in association with Amazentis. A Swiss lifescience company that's pioneering, cutting edge, clinically validated cellular nutrition under its timeline brand.Affiliation disclosure: DoNotAge.org is offering listeners to LLAMA a 10% discount on its range of products, including NAD boosters. The podcast receives a small commission when you use the use code LLAMA for purchases at DoNotAge.org - it helps to cover production costs and ensures that our interviews remain free for all to listen. Health queries can be answered by emailing: hello@donotage.org

Can cocoa consumption help us age better? Medical College of Georgia, Sept. 14, 2021 Whether consuming cocoa, known to be packed with powerful antioxidants that protect our cells from damage, helps us age better, is a question scientists want to definitively answer. The COSMOS Trial (COcoa Supplement and Multivitamin Outcomes Study), led by investigators at Brigham and Women's Hospital and the Fred Hutchinson Cancer Research Center, gathered data from 21,444 men and women looking at the impact of a cocoa extract supplement and/or multivitamins on common health problems, most of which increase with age. Dong and his colleagues will be looking specifically at aging, including so called “inflammaging,” and epigenetic aging, both considered good indicators of our biological age. Rather than just looking at the year you were born, biological age also takes into account key factors that impact your function and health, like genetics and lifestyle. He also has more standard aging measures on these individuals, like blood pressure and cognitive function tests. (NEXT) Psychobiotics as a novel strategy for alleviating anxiety and depression Jiangnan University (China), September 10, 2021 As an important ‘microbial organ', the gut microbiota directly participates in nutrient metabolism and peripheral immune regulation and even distantly affects brain functions and behaviours. This review provides an overview of recent discoveries regarding how the gut microbiota influences anxiety and depression and aims to establish the key signalling pathways between the gut microbiota and the brain. Finally, the psychobiotic strategy for treating mood disorders is discussed, covering both pre-clinical and clinical studies. Psychobiotic treatment could provide a novel therapeutic approach to treat anxiety and depression. In recent years, the gut microbiota has been viewed as a physiological control centre that is linked to the host's immune system, hormonal system, nervous system, or other physiological pathways. Until now, many studies have revealed the inextricable relationship between the gut microbiome and the brain, especially its participation in the regulation of memory, mood, and behaviour (Cryan et al., 2019b). (NEXT) Further evidence that vitamin D might protect against severe COVID-19 disease and death Trinity College (Ireland) and University of Edinburgh, September 16, 2021 New research from Trinity College and University of Edinburgh has examined the association between vitamin D and COVID-19, and found that ambient ultraviolet B (UVB) radiation (which is key for vitamin D production in the skin) at an individual's place of residence in the weeks before COVID-19 infection, was strongly protective against severe disease and death. Researchers, for the first time, looked at both genetically-predicted and UVB-predicted vitamin D level. Almost half a million individuals in the UK took part in the study, and ambient UVB radiation before COVID-19 infection was individually assessed for each participant. When comparing the two variables, researchers found that correlation with measured vitamin D concentration in the circulation was three-fold stronger for UVB-predicted vitamin D level, compared to genetically-predicted. (NEXT) Study: Eating yogurt can help older adults with high blood pressure University of Maine, September 13, 2021 Yogurt consumption can help lower blood pressure in older adults with elevated levels, according to a new study led by an international team, including researchers at the University of Maine. The MSLS team examined the relationship between yogurt consumption and bloodpressure among older adults with and without high blood pressure. Statistical analyses revealed modest but statistically significant reductions in systolic blood pressure among those with high blood pressure who consumed yogurt. (NEXT) Comprehensive review of antioxidants and common arterial condition University of Connecticut, September 13, 2021 Nutritional science graduate student Chelsea Garcia and associate professor Christopher Blesso recently published an article in Free Radical Biology and Medicine outlining the research to date on a type of antioxidant called anthocyanins and its impact on atherosclerosis. Atherosclerosis occurs when fats and cholesterol build up along the artery walls. This can restrict blood flow and cause blood clots. This condition is associated with oxidative stress, a process our bodies undergo throughout our lifetime as they encounter free radicals. These oxygen-containing molecules are highly reactive and unstable. They occur when a molecule gains or loses an electron. The unpaired electron on the free radical can react with other molecules and cause age-related harms in the body. (NEXT) Blueberry and soluble fiber improve serum antioxidant and adipokine biomarkers and lipid peroxidation in pregnant women with obesity University of Nevada, September 10, 2021 According to news originating from the University of Nevada research stated, “Pregnancies affected by obesity are at high risk for developing metabolic complications with oxidative stress and adipocyte dysfunction contributing to the underlying pathologies.” We conducted an 18 gestation-week randomized controlled trial to examine the effects of a dietary intervention comprising of whole blueberries and soluble fiber vs. control (standard prenatal care) on biomarkers of oxidative stress/antioxidant status and adipocyte and hormonal functions in pregnant women with obesity (* * n* * = 34). Serum samples were collected at baseline (

Andy begins with his guide to navigating the holidays now that Omicron is in our lives. Then he explores the cutting-edge science of this new variant with computational biologist and MacArthur "Genius Grant" winner Trevor Bedford. Andy and Trevor cover Omicron's possible origins, the latest on how our current vaccines are holding up to it, and when he expects an Omicron wave to hit the United States. We're learning more about Omicron every single day, and no one's better at explaining what we know and what it means than Trevor.   Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.    Follow Trevor @trvrb on Twitter.   Joining Lemonada Premium is a great way to support our show and get bonus content. Subscribe today at bit.ly/lemonadapremium.    Support the show by checking out our sponsors!   Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: https://lemonadamedia.com/sponsors/  Throughout the pandemic, CVS Health has been there, bringing quality, affordable health care closer to home—so it's never out of reach for anyone. 

Learn more at cvshealth.com.   Check out these resources from today's episode:    Read more about how the Pfizer vaccine is holding up to Omicron: https://www.bbc.com/news/world-59582006 Check out more about the decision to expand booster access to 16- and 17-year-olds: https://www.washingtonpost.com/health/2021/12/09/covid-vaccine-boosters-16-17-year-old/ Keep up to date on Omicron with The New York Times's live blog: https://www.nytimes.com/live/2021/12/10/world/covid-omicron-vaccines Check out The Bedford Lab at the Fred Hutchinson Cancer Research Center: https://bedford.io/ Find a COVID-19 vaccine site near you: https://www.vaccines.gov/  Order Andy's book, Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response: https://us.macmillan.com/books/9781250770165    Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.    For additional resources, information, and a transcript of the episode, visit lemonadamedia.com/show/inthebubble. See omnystudio.com/listener for privacy information.

This week Matthew is joined by Harmit Malik, the co-associate director of Basic Sciences at the Fred Hutchinson Cancer Research Center to talk all things heroes, villains, and genomes. Tune in as Harmit walks us through his exploration of genetic conflict and explains its implications for the study of genetic viruses and their hosts. His journey reminds us to stay motivated and trust our instincts when it comes to experimentation.

One of the most unnerving things about this pandemic is that the virus keeps changing. And yet, viruses we're familiar with don't spawn vastly more dangerous variants every year. Even flu, while it changes enough to require a new shot, doesn't usually turn the world upside down. Will SARS-CoV-2 reach some limit on the new variants it can produce? Biologist Jesse Bloom of the Fred Hutchinson Cancer Research Center had studied influenza evolution for years before turning his attention to how SARS-CoV-2 is evolving. We talk about where things might be going, and where the virus might have come from. “Follow the Science" is produced, written, and hosted by Faye Flam, with funding by the Society for Professional Journalists. Today's episode was edited by Seth Gliksman with music by Kyle Imperatore. If you'd like to hear more "Follow the Science," please like, follow, and subscribe!

Join us for episode 57 of 17 Minutes of Science as we talk with Dr. Pamela Padilla about how scientific societies can build intentional partnerships to reach true diversity, equity, and inclusion. Dr. Pamela Padilla is the current President of SACNAS (Society for Advancement of Chicanos/Hispanics and Native Americans in Science) in addition to being the Vice President of Research and Innovation (interim), Associate Dean of Research and Graduate Studies, and Professor of Biological Sciences at University of North Texas. Dr. Padilla received her Ph.D. from the University of New Mexico and conducted her post-doctoral research at the Fred Hutchinson Cancer Research Center in Seattle WA. She has an interest in how environmental stress affects living organisms at the cellular, genetic and molecular level. She has experience studying stress with various genetic model systems including C. elegans, yeast, zebrafish, killifish, and mammalian cell culture. SACNAS is the largest STEM diversity organization in the United States and is dedicated to fostering the success of Chicano/Hispanic and Native American scientists – from college students to professionals – to attain advanced degrees, careers and positions of leadership in the science, technology, engineering and math fields. Founded more than 40 years ago, the society serves nearly 20,000 members with more than 100 chapters at colleges and universities throughout the U.S. and Puerto Rico. Join us to learn more from Dr. Padilla about SACNAS, intentional partnerships, and how scientific societies can reach true DEI.

How could genetic testing results impact your metastatic breast cancer treatment options? In this podcast, Dr. Julie Gralow will discuss essential testing, the latest targeted therapies and emerging breast cancer research.About the Guest:Dr. Julie Gralow is the Jill Bennett Endowed Professor of Breast Medical Oncology at the University of Washington, Fred Hutchinson Cancer Research Center, and the Seattle Cancer Care Alliance. More about this expert: https://www.seattlecca.org/providers/julie-r-gralow.

Scientists have been working non-stop to rid the world of Covid19. Amazingly, they achieved safe and effective vaccines in a mere 11 months. In this episode learn how and why the vaccines work to 1) protect us from infection, 2) reduce the threat of variants, and 3) wipe out highly infectious disease. Guest is Dr. L. Corey, a leader in the global strategic response to Covid. [312 char]   Guest:   Lawrence Corey, MD, Professor of Medicine and Laboratory Medicine, University of Washington;  member of Vaccine and Infectious Disease Division of Fred Hutch Cancer Research Center; past president and director of Fred Hutchinson Cancer Research Center, Seattle, Washington

In March, Gastro Broadcast will feature a series of conversations for Colorectal Cancer (CRC) Awareness Month. Our first guest in the series is Dr. Rachel Issaka of the Fred Hutchinson Cancer Research Center in Seattle, Washington. Dr. Lisa Mathews explores how Dr. Issaka became interested in a career in academia and her research on disparities in CRC screening. Join Dr. Mathew and Dr. Issaka as they discuss some of the factors that influence disparities in CRC screening and the role that private GI practices play in increasing screening rates in their communities. Produced by Andrew Sousa and Hayden Margolis for Steadfast Collaborative, LLC Original score by Hayden Margolis Gastro Broadcast, Episode 12

This C-Session's guests are Pat Garcia-Gonzalez, CEO of The Max Foundation (Max). In addition, Jerry Radich, MD, of Fred Hutchinson Cancer Research Center. Both share the amazing story of Max, and how it's reaching and treating cancer patients on a global scale. Max is a nonprofit global health organization that provides cancer patients in low and middle-income countries with access to lifesaving treatment and care. Today, Max provide services to over 30,000 patients in more than 70 countries, including access to over 8 million daily doses of medicine yearly. Max's patient services include efforts to expand access to molecular diagnostics, educational workshops, and one-on-one care. The Max Foundation supports physicians in diagnosing and monitoring patients in areas where patients have no access or cannot afford diagnostic testing. Max's leading access to treatment model harnesses the power of effective partnerships with local hospitals, cancer centers, NGOs and Ministries of Health, as well as global drug manufacturers, diagnostic companies, and international distributors to ensure that every patient receives the right treatment at the right time. --- Support this podcast: https://anchor.fm/randall-broad/support

Dr. Jennie Crews & Andy Peet of SCCA In this edition of C-Sessions, your host, Randall Broad interviews Andy Peet, Telehealth Program Manager along with Dr. Jennie Crews, M.D., Medical Director, with SCCA. Telehealth has accelerated heavily since the COVID 19 Pandemic. SCCA has expanded Telehealth services significantly in the past year. Please join in and learn about the latest breakthrough and benefits of communication via phone and Zoom with treatment providers. Dr. Crews is Medical Director for the SCCA Network, Administrative / Medical Director for Community Sites and a Clinical Professor of Medicine at the University of Washington. Her clinical focus is Survivorship. She received her B.S. in Biology with highest honors from UNC- Chapel Hill and completed her MD and oncology fellowship at Duke University. Andy Peet is excited to be working at the intersection of technology and healthcare as the Telehealth Program Manager at SCCA. Prior to joining the Telehealth team, he was Manager of Medical Staff Services and Access in the Medical Director's Office of SCCA. A seasoned healthcare operations, project, and people manager, Mr. Peet has served in various operational and technical roles at SightLife, the largest global health NGO focused on eliminating corneal blindness. He also served as Project Manager in the Vaccine and Infectious Disease Division of Fred Hutchinson Cancer Research Center. --- Support this podcast: https://anchor.fm/randall-broad/support

In this weeks C-Sessions, we're pleased to have Dr. Jerry Radich of Fred Hutchinson Cancer Research Center. Please join in to hear Jerry's cancer research world, his theory of the Darwinian nature of cancer evolution, and its implications for genetic therapy. --- Support this podcast: https://anchor.fm/randall-broad/support

What's your cancer risk?  Trained in oncology, epidemiology, and genetics, Melanie R. Palomares, M.D., M.S., affectionately known as “Dr. Mel”, practices preventive oncology: the care of healthy patients at increased risk for cancer and cancer survivors at risk for new cancers.    After nearly 20 years in academia, first at the Fred Hutchinson Cancer Research Center in Seattle, and then at the City of Hope in Los Angeles, and after experiencing cancer personally, Dr. Mel founded the Cancer Prevention Movement.  This Cancer Prevention Movement, whose vision is a Cancer-Free World, empowers individuals to outsmart cancer through personalized prevention.  Learn about what your risk factors are at Dr. Mel's website:  https://cancerriskprevention.com/  or find her in the Facebook Group “Dr. Mel Talks Health,” and Instagram @drmelpal.

Earn CME credit for listening to this episode of Prioritizing Equity. This June 18, 2020 installment of Prioritizing Equity focused on how COVID-19 may uniquely impact LGBTQ individuals and communities. Hear from LGBTQ physician leaders on topics such as the pandemic's impact on testing, trends and equity concerns in health care and beyond. Panel: Oni Blackstock, MD—Assistant commissioner for the New York City Department of Health and Mental Hygiene, Bureau of HIV Jesse Ehrenfeld, MD, MPH, FASA, FAMIA—Senior associate dean and director, Advancing a Healthier Wisconsin Endowment David J. Malebranche, MD, MPH—Associate professor of medicine, director, Student Employee Health Services at Morehouse School of Medicine Shilpen Patel, MD, FACRO, FASTRO—Radiation oncologist, associate professor in the UW Department of Global Health and affiliate appointment in the Division of Public Health at the Fred Hutchinson Cancer Research Center. Asa Radix, MD, PhD, MPH, FACP—Senior director of research and education at Callen-Lorde Community Health Center. Moderator: Aletha Maybank, MD, MPH—Chief health equity officer, group vice president, Center for Health Equity, American Medical Association Originally aired: June 18th, 2020 The AMA's Digital Code of Conduct: https://www.ama-assn.org/code-conduct

Photo credit Eric Crawford Dev's been playing drums since 1993, in symphonic band, marching band, jazz band, and various musicals. He stopped playing for a few years in his 20's, a silly decision he hopes you won't repeat.Since 2014 Dev has been a musician and organizer in https://vamola.org/, the Seattle drum and dance bloco. He also plays for dance classes around the city.For the last two years he's been visiting groups all over the US and Canada. He's hoping to visit and play with every samba group in North America. You'll probably recognize him as that guy who shows up for a rehearsal in your town and then disappears for a year.When he's not playing music, Dev is a data scientist at the Fred Hutchinson Cancer Research Center.Yep, he's a giant nerd. For example, this episode isn't really about music, it's about paperwork.Links: Dev's how to start a non-profit document: https://docs.google.com/document/d/1w34DRKd2SwsfdP83wR9R1nrk7WRWfjrz9qpKvR2sHRg/edit?usp=sharinghttps://www.facebook.com/dev.nambi https://devnambi.com https://vamola.orghttps://blocopacifico.com/ me@devnambi.com This podcast sponsored by Go Samba! All your samba drums and gear can be found here! Click to shop!