Podcasts about medical oncologist

In this episode, Dr. Paul Wheatley-Price talks to Dr. Sara Moore about her work and experience in caring for Inuit populations in Nunavut affected by lung cancer. What is the scope of the populations she treats, the unique access barriers for diagnostics and treatment, and how their lung cancer experiences may differ than those living in Southern Canada. Dr. Moore is an Assistant Professor at University of Ottawa, Medical Oncologist and Lung Disease Site Lead at The Ottawa Hospital.

Macca, Kenny and  Fiona are joined up first this week by Dr. Cameron McLaren, as they discuss evidence based Voluntary Assisted Dying (VAD) in Australia, Dr. Cameron McLaren is a Victorian-based medical oncologist and a leading advocate for, and practitioner of, Voluntary Assisted Dying (VAD) in Australia. He works at Casey Surgical Group (Berwick) and Monash Health, specialising in gastrointestinal, genitourinary, lung, and breast cancers, while supporting patients with end-of-life care options The post Sat, 9th, 2026: Dr. Cameron McLaren, Medical Oncologist, Voluntary Assisted Dying appeared first on Saturday Magazine.

Three years after her small cell lung cancer diagnosis, patient advocate Wendy Brooks sits down with Dr. Ashish Saxena, medical oncologist at Weill Cornell Medicine, to talk about the rapid changes transforming SCLC care. From immunotherapy and bispecific T-cell engagers to emerging targeted therapies, this episode unpacks what every patient should know about today's treatment landscape. You'll learn why clinical trials are NOT a last resort, why you should ask about them at your very first appointment, and how to advocate for yourself through side effects and treatment decisions. Dr. Saxena also explains the evolving role of biomarker testing in small cell lung cancer and shares why he's more hopeful than ever about patient outcomes. Whether you're newly diagnosed, a long-term survivor, or a caregiver, this conversation delivers honest answers and real hope. Guests: Dr. Ashish Saxena, Medical Oncologist, Weill Cornell Medicine Wendy Brooks, Patient Co-Host, Living with Small Cell Lung Cancer Show Notes: https://lcfamerica.org/wp-content/uploads/2026/05/LCFA-SCLC-Clinical-Trials-Long-Term-Outlook-Show-Notes.pdf  Transcript: https://lcfamerica.org/wp-content/uploads/2026/05/LCFA-HWA-SCLC-Clinical-Trials-Transcript.pdf  Video: https://youtu.be/RCwJvdcOS-4  For more information, visit lcfamerica.org.

This episode features Marwan G. Fakih, MD - Medical Oncologist, Professor, Department of Medical Oncology & Therapeutics Research, Deputy Director, City of Hope Comprehensive Cancer Center, Division Chief, GI Medical Oncology, Co-director, Gastrointestinal Cancer Program at City of Hope. Here he shares his thoughts around potentially screening younger patients, due higher rates of colon cancer. He also discusses the importance of educating patients to not overlook potential symptoms, clinical trials, and more.

This episode features Marwan G. Fakih, MD - Medical Oncologist, Professor, Department of Medical Oncology & Therapeutics Research, Deputy Director, City of Hope Comprehensive Cancer Center, Division Chief, GI Medical Oncology, Co-director, Gastrointestinal Cancer Program at City of Hope. Here he shares his thoughts around potentially screening younger patients, due higher rates of colon cancer. He also discusses the importance of educating patients to not overlook potential symptoms, clinical trials, and more.

In today's episode, Dr. Paul Wheatley-Price chats with Dr. Natasha Leighl, Medical Oncologist and Lung Site Lead at the Princess Margaret Cancer Center in Toronto, all about liquid biopsies. What is a biopsy, the difference between a tissue vs liquid biopsy, how does it work, when it can be done, and where is it available in Canada? Dr. Leighl gets into all the details with her renowned expertise in this topic!

Welcome to the Oncology Brothers podcast! In this episode, we dived into the evolving treatment algorithms for bladder cancer following the latest data presented at GU ASCO 2026. Listen us on: Spotify: https://open.spotify.com/show/31BXhY9FM4gPWG10WgE11o Apple Podcast: https://podcasts.apple.com/us/podcast/oncology-brothers-practice-changing-cancer-discussions/id1653340966 Follow us on social media: X/Twitter: https://twitter.com/oncbrothers ⁠Instagram: https://www.instagram.com/oncbrothers Website: https://oncbrothers.com/ Join us as we explore: The role of immunotherapy in non-muscle invasive bladder cancer, highlighting the recent positive trials: CREST with Sasanlimab and POTOMAC with Durvalumab. Insights on the current standard of care and the implications of combining BCG with immunotherapy. The shift in treatment strategies for muscle-invasive bladder cancer, including the new standard of care with the EV-Pembro combination and its impact on pathologic complete response rates. The challenges and considerations in managing side effects associated with new therapies, as well as the importance of patient selection and coordination between urologists and medical oncologists. The emerging role of ctDNA in guiding treatment decisions and the ongoing discussions around the sequencing of therapies in refractory settings. Hope you enjoy this informative discussion that aims to keep you up to date in the world of cancer treatment, here focusing on bladder cancer. Subscribe to our channel for more episodes and discussions on the latest in oncology! #BladderCancer, #NMIBC, #MIBC, #Immunotherapy, #GU26, #OncologyBrothers

We've known for decades that breastfeeding is associated with a reduced risk of breast cancer. What we've never fully understood is why.That question is what makes this research so significant.In this episode of The Science of Motherhood, Dr Renee White sits down with Professor Sherene Loi, Medical Oncologist and Group Leader at the Peter MacCallum Cancer Centre in Melbourne, to discuss a landmark paper published in Nature that identifies the immune mechanism behind that long-observed link. Together they explore how pregnancy and breastfeeding appear to reprogram the breast's immune environment in ways that can persist for years, and what that could mean for the future of breast cancer prevention.It turns out the body's been doing something extraordinary all along. Science is only now catching up to explain it.You'll hear about:Why breastfeeding appears to reprogram a mother's immune systemHow T cells in breast tissue connect to long-term cancer protectionWhat "anything is better than nothing" actually means for breastfeeding durationWhy women's reproductive history has been missing from major cancer datasetsHow this research could shape future prevention strategies for all womenThis research doesn't add pressure to the breastfeeding conversation. It adds meaning to it.If this episode resonated, share it with someone who'd want to understand the science behind their own body. And subscribe so you never miss an episode of The Science of Motherhood.Resources & Links

In this episode, Dr. Paul Wheatley-Price chats with Dr. Ines Menjak, Medical Oncologist at Sunnybrook Health Sciences Centre in Toronto, about the 2026 landscape of immunotherapy treatment for lung cancer. What exactly is immunotherapy, how does it work, when is it used, common side effects to expect, what are the latest drugs, and what's coming down the pipeline.

New treatment options for melanoma are being described as the global gold standard. Pharmac's proposing to increase access to nivolumab and ipilimumab for treating stage 3b and 4 melanoma, from May. Pre-surgery use of the immunotherapy drugs can lower the chance of cancer returning. Medical oncologist Dr Gareth Rivalland told Ryan Bridge it's state of the art treatment. He says it's the best combination and will kill off the cancer in 60% of people. LISTEN ABOVE See omnystudio.com/listener for privacy information.

While testicular cancer is rare, it is the most common cancer in young men aged between 15 and 39 years. Like with every cancer, early detection is the key. Self-examination is important along with seeking medical attention if there are any concerns. Fortunately, overall survival is around 95%. This is the story of testicular cancer. Our special guests: Dr Nari Ahmadi who is a Urologist and coordinator of the Urological Oncology Cancer research at Chris O’Brien Lifehouse. Professor Peter Grimison who is a Medical Oncologist at the Chris O’Brien Lifehouse, VMO at the Royal Prince Alfred Hospital, and Clinical Professor at the University of Sydney. Professor Fiona Maclean who an Anatomical Pathologist, Clinical Professor at Macquarie University, and previous President of the Australasian Division of the International Academy of Pathology (IAP). Listen: This Medical Life podcast is available on all podcasting services and Spotify. Help support us on our donation page.See omnystudio.com/listener for privacy information.

Topic: Why More Cancer Is Being Diagnosed in Younger AdultsIntro: We're seeing more cancers diagnosed in adults under 50—why is this happening?Dr. Brittany Case, medical oncologist at Southern Cancer Center, is here to discuss what we know, what we don't know, and how care is changing.

In our second episode of the "Perspectives" series, Dr. Paul Wheatley-Price chats with two guests, both with a depth of experience in ROS1+ lung cancer, a rare subtype of non-small cell lung cancer (NSCLC) which represents only about 1-2% of all lung cancer cases in Canada. Rev. Richard Reimer from Edmonton shares his story being diagnosed in 2009 with stage 4 lung cancer that was later identified as ROS1, and how he's been navigating life ever since. Dr. Geoffrey Liu is a Medical Oncologist at the Princess Margaret Cancer Center in Toronto and provides his clinical expertise on what is ROS1, how common is it, how does it get tested, and what the current treatment options are for those diagnosed with this rare subtype of lung cancer. This episode is dedicated to Richard's late beloved wife, Dana Rayment ❤️

This episode reviews the IASLC 2025 Hot Topic in Basic and Translational Science Conference, which focused on unraveling precancer and early-stage lung cancer, a theme that really captures where the field is heading. Instead of reacting to advanced disease. Guests: Dr. Triparna Sen, a professor of Internal Medicine at The Ohio State University and the director of the Lung Cancer Preclinical Therapeutics Platform at the OSUCCC – James. She also serves as the associate director of research for the Division of Medical Oncology. Her research focuses on understanding and therapeutically targeting mechanisms of therapy resistance and lineage plasticity in lung cancer, with a primary emphasis on small cell lung cancer (SCLC) and biologically aggressive subsets of non-small cell lung cancer. Dr. Aaron Tan is a physician-scientist whose work bridges early detection, translational biology, and clinical relevance in lung cancer. Dr. Tan is a Medical Oncologist at the National Cancer Centre Singapore (NCCS), where he is involved in early drug development, genomics with a focus on EGFR mutated lung cancer, and clinical implementation of liquid biopsy including for advanced lung cancer and MRD in early-stage lung cancer.

There are concerns our health system isn't keeping pace with our accelerating cancer rates. The Cancer Control Agency's latest State of Cancer Report has found more New Zealanders are being diagnosed with cancer, but they're surviving cancer for longer. It's projecting diagnoses will increase by 50% over the next two decades. Otago University Medical Oncologist Dr Chris Jackson told Heather du Plessis-Allan this means fewer people getting scans, surgeries, and procedures. He says funding is increasing, but outcomes aren't improving at the same rate. LISTEN ABOVE See omnystudio.com/listener for privacy information.

Advances in molecular diagnostics are reshaping how cancer is detected, monitored, and treated, and liquid biopsy is becoming central to that progress. This simple blood draw can reveal key tumor biology at diagnosis and over time, providing timely insight and guiding more precise decisions throughout a patient's journey. Clinicians now face an important challenge: knowing what is actionable today and what is coming next so more patients can benefit from the promise of these advances.As we kick off Season 7, host and patient advocate Karan Cushman expands this season's focus on Bringing Precision Medicine to Everyone with a deeper look inside the science of liquid biopsy. The conversation features two leaders shaping the field: Dr. Christian Rolfo, Division Director of Medical Oncology at The James Comprehensive Cancer Center at Ohio State University, and Dr. Roberto Borea, Medical Oncologist and emerging investigator from the Rolfo Lab.Together, they break down the scientific momentum driving liquid biopsy forward, including tumor fraction, MRD-guided treatment strategies, resistance monitoring, fragmentomics, and the expanding frontier of early detection. They also discuss the barriers that continue to slow broader adoption, such as assay variability, limited standardization, reimbursement gaps, and operational challenges in community settings.In this episode, we cover:• How tumor fraction is emerging as a meaningful real-time biomarker• Where MRD-driven escalation and de-escalation strategies are heading• The current promise and limitations of early detection and MCED testing• What is required to standardize liquid biopsy across reporting, workflows, and clinical trialsEpisode 70 offers a clear look at the advances researchers are helping drive right now and what these developments could mean for clinicians, laboratories, and patients in the near future.This conversation builds on episode 69 with Dr. Kashyap Patel, who introduced the foundations of liquid biopsy and its role in accelerating treatment decisions. Combined, these two episodes offer clinicians and patients an overview of where the science and real-world applications stand now and where the field is headed next.

On this episode, Dr. Debra A. Wong, Medical Oncologist at City of Hope and Medical Director at AccessHope, joins the podcast to discuss better supporting frontline oncologists in resource-limited settings, improving cancer care access, and the importance of not losing sight of the human element in care.

On this episode, Dr. Debra A. Wong, Medical Oncologist at City of Hope and Medical Director at AccessHope, joins the podcast to discuss better supporting frontline oncologists in resource-limited settings, improving cancer care access, and the importance of not losing sight of the human element in care.

On this episode, Dr. Debra A. Wong, Medical Oncologist at City of Hope and Medical Director at AccessHope, joins the podcast to discuss better supporting frontline oncologists in resource-limited settings, improving cancer care access, and the importance of not losing sight of the human element in care.

In this episode, Dr. Paul Wheatley-Price is back for our annual recap of the IASLC 2025 World Conference on Lung Cancer (WCLC), which took place in Barcelona, Spain in early September. He is joined by two special guests, Dr. Barbara Melosky, Professor of Medicine at UBC and Medical Oncologist at BC Cancer, and Dr. Peter Ellis, Professor of Oncology at McMaster University and Medical Oncologist at Juravinski Cancer Center. They chat about all the updates for treatments like osimertinib for EGFR+ lung cancer, immunotherapy for small-cell lung cancer, and promising new treatments like for HER2 and ADCs coming down the pipeline.

GDP Script/ Top Stories for November 20th Publish Date: November 20th PRE-ROLL: SUGAR HILL ICE SKATING From the BG AD Group Studio Welcome to the Gwinnett Daily Post Podcast. Today is Thursday, November 20th and Happy birthday to Bobby Kennedy I’m Peyton Spurlock and here are your top stories presented by KIA Mall of Georgia. Lawmakers consider paring tax credits and exemptions to offset income tax cuts Piedmont Eastside and Piedmont Oncology welcome medical oncologist Sami Ali Gwinnett commissioners to issue bonds for Gas South Arena renovations Plus, Leah McGrath from Ingles Markets on rice All of this and more is coming up on the Gwinnett Daily Post podcast, and if you are looking for community news, we encourage you to listen daily and subscribe! Break 1: STRAND THEATRE STORY 1: Lawmakers consider paring tax credits and exemptions to offset income tax cuts  Georgia lawmakers are seriously considering wiping out the state income tax—$16 billion in revenue—and replacing it by slashing $30 billion in tax credits and exemptions. “It’s not if, it’s when,” said Sen. Blake Tillery, who’s leading the charge. He called it a move for “competitiveness.” Supporters like economist Arthur Laffer praised states like Tennessee for thriving without income taxes, calling it “really cool” not to file returns. But critics, like Sen. Nan Orrock, warned it could hit low-income families and retirees hardest, especially if sales taxes rise. The debate? Far from settled. STORY 2: Piedmont Eastside and Piedmont Oncology welcome medical oncologist Sami Ali  Piedmont Eastside Medical Center and Piedmont Oncology are thrilled to welcome Dr. Sami Ali to their team. Dr. Ali, a board-certified hematologist and oncologist, brings years of experience treating patients with lung cancer, colorectal cancer, blood disorders, and more. Before joining Piedmont, Dr. Ali spent eight years at The Oncology Institute in Los Angeles, where he provided personalized care, led treatment plans, and contributed to clinical research. “We’re excited to have him,” said Larry Ebert, Piedmont Eastside’s CEO. “His expertise will help us expand cancer care in Gwinnett County.” Dr. Ali is now accepting new patients. For appointments, visit Piedmont.org or call 678-639-3950. STORY 3: Gwinnett commissioners to issue bonds for Gas South Arena renovations   Gwinnett County commissioners took a big step Tuesday toward funding a major facelift for the 23-year-old Gas South Arena. The plan? Revenue bonds—up to $172 million worth—to cover renovations like new seating, upgraded security, better concessions, and even a shiny new parking deck. The total cost? Somewhere between $170 and $176 million. The county might chip in $40 million to ease the debt load, according to Financial Services Director Russell Royal. What’s changing? Think premium seating, revamped suites, modernized restrooms, grab-and-go food, and a high-tech security plaza. Oh, and the roof, HVAC, and electrical systems? All getting replaced. We have opportunities for sponsors to get great engagement on these shows. Call 770.874.3200 for more info. We’ll be right back Break 2: 07.14.22 KIA MOG STORY 4: Georgia Gwinnett College celebrates International Education Week   Georgia Gwinnett College turned International Education Week into a colorful, culture-packed celebration that brought the world to campus. From Nov. 10, students and staff dove into 14 events—everything from global traditions to study-abroad opportunities. The highlight? A visit from Lithuania’s Consul General, DOH-vee-dahs Dovydas shpo-KOW-skas Špokauskas, who spoke on diplomacy and security, thanks to professor DOH-vee-leh Dovilė boo-DREE-teh Budryte. Korean culture stole the show at Seoul Connections, with K-Pop, snacks, and games filling the room. And the International Thanksgiving? A feast of global flavors, live music, and a cultural fashion show. The week wrapped with poetry, music, and a reminder: the world’s waiting—go explore it. STORY 5: Gwinnett waiving tax penalties for residents impacted by government shutdown Gwinnett County is throwing a lifeline to residents hit hard by the recent federal shutdown. On Tuesday, commissioners gave Tax Commissioner Denise Mitchell the green light to waive penalties and interest on late ad valorem taxes for those furloughed or who lost SNAP benefits during the chaos. “Georgia law lets me waive penalties for reasonable cause,” Mitchell explained. “And over the past few weeks, I’ve heard from residents struggling to pay their bills because of the shutdown.” This doesn’t erase the taxes—just the late fees. To qualify, folks need proof of furlough or lost benefits, and the waiver only covers bills due during or shortly after the shutdown. We’ll be right back. Break 3: THE SUGAR HILL HOLIDAY And now here is Leah McGrath from Ingles Markets on rice Break 4: BUFORD HOLIDAY FESTIVAL We’ll have closing comments after this Break 5: Ingles Markets 8 Signoff – Thanks again for hanging out with us on today’s Gwinnett Daily Post Podcast. If you enjoy these shows, we encourage you to check out our other offerings, like the Cherokee Tribune Ledger Podcast, the Marietta Daily Journal, or the Community Podcast for Rockdale Newton and Morgan Counties. Read more about all our stories and get other great content at www.gwinnettdailypost.com Did you know over 50% of Americans listen to podcasts weekly? Giving you important news about our community and telling great stories are what we do. Make sure you join us for our next episode and be sure to share this podcast on social media with your friends and family. Add us to your Alexa Flash Briefing or your Google Home Briefing and be sure to like, follow, and subscribe wherever you get your podcasts. Produced by the BG Podcast Network Show Sponsors: www.ingles-markets.com www.kiamallofga.com Strand Marietta – Earl and Rachel Smith Strand Theatre Ice Rink – Downtown Sugar Hill Holiday Celebration 2025 – City of Sugar Hill 2025 Buford Holiday Festival & Parade All-In-One Flyer News Podcast, Current Events, Top Headlines, Breaking News, Podcast News, Trending, Local News, Daily, News, Podcast, Interviews See omnystudio.com/listener for privacy information.

Guest Dr. Rusha Bhandari and host Dr. Davide Soldato discuss JCO article "Health Outcomes Beyond Age 50 Years in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study, " with a particular focus on mortality data, development of secondary malignancies and the importance of education for both patients and healthcare providers regarding long-term follow-up and care. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Davide Soldato: Hello, and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, Medical Oncologist at Ospedale Policlinico San Martino in Genoa, Italy. Today, we are joined by JCO author, Dr. Rusha Bhandari, a Pediatric Hematologist-Oncologist and Assistant Professor in the Department of Pediatrics and Population Science at City of Hope, California. Today, we will be discussing the article titled "Health Outcomes Beyond Age 50 Years in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study." So, thank you for speaking with us, Dr. Bhandari. Dr. Rusha Bhandari: Thanks so much for having me. Dr. Davide Soldato: So, I just want to go straight ahead in the paper and start from the title. So, we heard that you included in this study childhood survivors of pediatric cancer that were aged 50 years or higher. So, this is a very critical life stage when we know that there are a lot of aging-related comorbidities that can happen, also in the general population but potentially specifically in childhood cancer survivors. So, first of all, I wanted to ask you, why this specific study in this very specific population? Because I think that we had already some data in younger survivors, but now we are focusing specifically on patients aged 50 or more. Dr. Rusha Bhandari: Absolutely. So, to answer that question, I'll take a little bit of a step back in terms of where we are now and where we came from in terms of treatment for childhood cancers. So, thankfully, we now have great curative therapies and survival rates for many childhood cancers, including the most common ones. But this was not necessarily the case 50 or more years ago. So, we essentially are now seeing the first generation of older survivors who are 30, 40, or more years from completion of their cancer treatment. As you pointed out, we know from younger survivors that they have a markedly higher risk of malignancies and health conditions than the general population. You don't typically expect to see things like heart disease or diabetes, for example, in a young adult. But the question that remained was what the health status and risk of these conditions are in survivors who are entering this critical age, as you mentioned, 50 or older, when you do start to see these aging-related changes in the general population. And the question is whether we're still observing increased risks related to cancer treatment that was delivered 30 or more years ago in these survivors who are now entering ages 50 and beyond. Dr. Davide Soldato: Thanks so much. You used the data from a study that is called the Childhood Cancer Survivor Study. So, just a little bit of explanation for our listeners. How is the study conducted? What type of data are you collecting? And specifically for the interest of the study that was reported in this manuscript, which outcomes were really important for you and were so evaluated in the manuscript? Dr. Rusha Bhandari: Yes. So, the Childhood Cancer Survivor Study is a really excellent resource that combines information from children who were treated across North America at various different centers and sites. So it gives us a really good understanding of how different survivors are doing as they do progress through their survivorship journey. The Childhood Cancer Survivor Study includes a baseline questionnaire when participants are first eligible or first enter the study, and then includes a series of follow-up questionnaires to really understand how they're doing, like I mentioned, as they progress throughout their survivorship journey. And so for this study, we really wanted to take a global look at how these patients were doing as they entered that older age range. And so we wanted to look at outcomes ranging from mortality through the health conditions that we've seen from other survivorship studies, including subsequent malignant neoplasms, other health conditions, I mentioned earlier heart disease and other comorbidities we know survivors can be at increased risk for, and also things like frailty, which we know is, you know, the most widely recognized phenotype of aging. And we see that earlier on in our younger survivors. We want to see how this translated to these older survivors and then also other health outcomes like their health status. What is their self-report of their physical health, their mental health? Things like that. So we wanted a very comprehensive understanding of their health. Dr. Davide Soldato: This is a very comprehensive study. Right now it includes more than 30,000 patients that have been treated for childhood cancer, but specifically looking at the question of survivors aged 50 years or higher, you included more than 7,000 patients inside of this study. So, looking at the first outcome that you mentioned, which I think it's also one of the most important, you look specifically at mortality, and in this specific population, you saw a striking three-fold increase in mortality when comparing these survivors with the general population. I just wanted to dive in this result and ask you: What do you see as the main driver for this excess mortality in this population of survivors? And as you were mentioning, the study also collects information about the treatment received. So, was there any association with a specific kind of treatment that was received for curing these childhood cancers? Dr. Rusha Bhandari: I agree. I would say it's striking to see that mortality risk among the survivors relative to the general population. And we do know, again from prior studies, that survivors of childhood cancer do have an increased risk of mortality compared to the general population, but I think looking at those curves of the cumulative mortality risk was really quite striking as they diverge, and that's, you know, just so long past their initial diagnosis and treatment. We know that subsequent malignant neoplasms or secondary cancers are a really an important contributor to mortality among survivors. And I think it was important to note that even in these older survivors, it's still such an important contributor to mortality, and I think this really highlights the need for us to better understand what is driving specific secondary cancers and what are the differences in the biology and treatment approaches for some of these cancers? And how might that then be contributing to the mortality risk? Dr. Davide Soldato: Related to the treatment mortalities - because I think that one of the main forces of the study, as it is conducted, is that it contains a lot of information regarding radiotherapy, allogeneic transplant, surgery, type of chemotherapy received by these survivors - so, are we able right now with the data that we have to pinpoint which of these treatments can potentially lead to such increased risk of mortality? Dr. Rusha Bhandari: So, we weren't able to look at the comprehensive treatment exposures and mortality risk for this paper. So that might be one of the questions I would put on the side. We were able to look at that in relation to subsequent malignant neoplasms and health conditions though, as you mentioned. Dr. Davide Soldato: Another thing that I think is very important is that you were able to look at specific causes for mortality. So for example, you mentioned the increased rate of neoplasm in this population and specifically, more or less 7.6% of the patients that were included in the study developed another neoplasm after the ones they were cured for in the childhood period. So, you saw a wide range of cancer, for example, bone and soft tissue sarcomas, breast cancer, genitourinary cancer. And as you were mentioning, there were some associations for treatment modalities that were associated with a higher risk of developing this type of cancer. Can you expand a little bit on this? Dr. Rusha Bhandari: Absolutely. And so the key part here was that we really looked at any of these outcomes that occurred beyond age 50. What we found was there is still an increased risk of secondary cancers beyond that initial childhood cancer diagnosis, but when we really looked at that data, it was specifically among survivors who had a history of receiving radiation. And we did not necessarily see an association between different chemotherapy exposures and secondary cancers. And I think this speaks to what we're now learning in terms of the very long-term effects of radiation and how that impacts ongoing health risk even in patients who are 30 or more years out from their treatment. And I think it really highlights the importance of these- the efforts that have been made in the more recent decades to really try and reduce or eliminate radiation where possible, you know, as we've come to understand more about these long-term effects from it. Dr. Davide Soldato: A clear association with radiation therapy but no association when we look at specific types of chemotherapy that were used for curing this childhood cancer. Another thing that I think it's very interesting and you briefly mentioned before is that potentially when we look at these secondary malignant neoplasm that develop in this situation, we might also see some outcomes that are not comparable to the one of the general population, meaning that we managed to cure less this type of cancer when they develop in these childhood survivors. So, I just wanted to understand if you could provide us with a little bit of perspective also from a clinical standpoint being a pediatric hematologist-oncologist as to why this might be happening and how can we potentially increase the cure rate also in this population of childhood cancer survivors? Dr. Rusha Bhandari: Absolutely. While that was not the focus of this study, it was something that we were certainly interested in is understanding how even once a childhood cancer survivor, for example, develops a health condition or a secondary cancer further into survivorship, how does that outcome then differ from someone in the general population? And there's a lot of interest in ongoing studies actually evaluating that and understanding what are the differences from the initial presentation, biology, the characteristics of that cancer, through how they're treated. So I don't know if we have all of the answers for that quite yet, but you can imagine if someone hypothetically had a history of receiving a lot of anthracycline chemotherapy or already having received a lot of radiation, that might impact what treatment they might receive for that secondary cancer or if they already have other existing comorbidities that need to be taken into consideration. Dr. Davide Soldato: Speaking about comorbidities, you were mentioning in the beginning that one of the focuses of this scientific work was really to try and see whether also this type of adverse health outcomes that can be potentially related to treatments were more frequent among these childhood cancer survivors. So I think that it's very interesting that for this comparison, you were able to use the data from the siblings of the patients who were included inside of the study. So, just a little bit of a comment on why you decided to use this specific methodology, which I think has a very nice touch to it when we look at these outcomes like, for example, diabetes or cardiovascular disease, and in general, do we see an increased number of chronic health conditions among survivors who were treated for childhood cancers? Dr. Rusha Bhandari: Yes, so this is a really excellent strength of the Childhood Cancer Survivor Study is that they have information, longitudinal information, on survivors as well as their siblings. So, you know, when we were discussing the design of the study, I mentioned that we have initial baseline questionnaires as well as multiple follow-up questionnaires, and that is for both the survivors and the siblings. And so we're able to really understand their health course over time. We chose to evaluate sibling data because then you're really able to look at people who have similar characteristics, right? Similar environmental exposures in theory, potentially similar genetic predispositions and makeups and things like that. And so you can really try and have as good of a comparison as possible. Dr. Davide Soldato: Did we see any increase in chronic health condition when looking at survivors compared to the siblings? Dr. Rusha Bhandari: We did. And while that's been reported before, again, I think it's important to demonstrate that in this older population when you would expect that these siblings would now also be starting to develop different health conditions. Dr. Davide Soldato: One thing that was very interesting is that when we look at the coexistence of multiple comorbid conditions and chronic condition in this population, we also see that for some of these survivors, they basically have the same rates of comorbidities as compared to siblings who are potentially 20 years older than them. So I think that there is really that striking point, as you were mentioning before, of accumulation of changes, also physiological changes that can potentially drive a higher frailty index, which was also higher when looking at these survivors compared to their siblings. One outcome that was really not that worse when we look at survivors of childhood cancer was actually mental health. And as I read the paper, it was something that really surprised me a little bit because you would imagine that going through such a harsh diagnosis, such very complex treatment, very early in their life could potentially lead to some worse health outcomes also in terms of mental health over time. But this was not seen. And just a comment on this, because I think it's a very surprising data. Dr. Rusha Bhandari: Yes, I appreciate that question. So, as you mentioned, mental health is such an important issue for patients, both those undergoing treatment as well as those in long-term survivorship. And in our study, we found that survivors were not more likely, as you mentioned, to report poor mental health compared to their siblings. And I think there's a few possible reasons for this. You know, again, this is self-reported data amongst siblings and survivors who survived to at least 50 years of age and completed a questionnaire. And so that is the group of individuals that we were able to evaluate this in, so we have to keep that in mind. But I think our findings may also reflect the resilience of this particular cohort of aging survivors that we included. This finding has been reported in other studies of survivors as well, and so I think it very well may speak to the resilience of the cohort that we're looking at. Dr. Davide Soldato: Going back just a little bit, you mentioned that the majority potentially of these survivors who were included in the current analysis were treated between 1970s and 1980s. So, as you were mentioning before, radiotherapy was seen as a significant contributor to second neoplasm and also to the increase of this chronic health condition. So, do you believe that there is still a role for these survivorship studies as we are approaching treatment modalities where radiotherapy is administered less frequently or with lower doses or omitted at all in the treatment course of these survivors? Dr. Rusha Bhandari: Absolutely. I think you mentioned a very important point, which is these findings are most applicable to the patients who were included in this cohort or similar cohorts, those who were treated in the 1970s and 80s who now are 50 years or older at this point in time. And as you know, treatment modalities have really changed. You know, as you mentioned, we'll use less radiation in many cases whenever possible, but there are so many new modalities, so many different chemotherapeutic agents, immunotherapy. There's so much more we need to learn about the long-term effects of some of these newer treatment modalities. And also, we've been able to really intensify our treatment regimens with improvements in both treatment approaches and supportive care. And so I think we have a lot to learn about those late effects, and ongoing studies are certainly needed as we continue to have this growing population of older survivors. Dr. Davide Soldato: And now a more general question which builds on the results of the study but goes a little bit beyond what was the scope of the research. So we have just discussed that there is an excess mortality in general, there is a higher risk for secondary malignancies in this population, we see higher accumulation of chronic comorbid conditions that need to be treated. So building on these results, in your opinion, what would be the best framework to follow up these patients over time? Because I imagine that for some of these patients who have been treated 30, 40 years before the moment where we see this type of events, they can be potentially also discharged from more specialistic medical care. So what is the best course of action? Should we keep all of these patients under observation in a very specialistic environment under the care of the oncologist or the pediatric oncologist? Should we create a stronger bond with general practitioners so they know that there is this problem? Dr. Rusha Bhandari: Yes, I mean, I think you're reading my mind. We thankfully do have evidence-based guidelines. We utilize the Children's Oncology Group Long-Term Follow-Up Guidelines, which include screening recommendations for secondary cancers, chronic health conditions, everything based on the underlying diagnosis and treatment that these patients received. But we recognize that a large proportion of these survivors do not continue to have lifelong follow-up at a survivorship center, but really do need that specialized screening based on their treatment that they received. And I think for that reason, it's so important that we continue to build relationships with their primary care providers and really make sure that both patients and their providers have this information at hand regarding what their treatment is and what the screening is that they need and that we be able to have this community whereby we are able to help inform the screening in our own survivorship clinics, but also help guide some of the primary care providers who are going to be seeing these patients in the long run. Dr. Davide Soldato: Do we have any data showing what is the adherence rate of these patients to this type of continuous screening and monitoring over time? Because I imagine that that might also be a point for improvement in terms of quality of care. Can we retain as much childhood cancer survivors as we want as we are learning that there are all these potential negative health outcomes over time? Dr. Rusha Bhandari: We definitely within the survivorship community do want to help make sure as many survivors as possible are being engaged, again, whether it's at their specific cancer center or whether it's in the community, recognizing that for many reasons, it's not feasible to always return to that cancer center for your regular survivorship care. I think there's a lot we can do. Going a little bit outside the scope of your question, but I think there's a lot that we can do nowadays in terms of telehealth and being able to communicate with patients and their providers even if they're geographically not located right near us. But we do have data that shows that the further out many patients get from their initial diagnosis and treatment, the less often they might follow up with a survivorship provider. Some of this varies by different treatment. Dr. Davide Soldato: So, basically the final question is that we need more education and potentially more resources for survivorship clinics and in general to better inform patients and providers about these potential long-term outcomes. Dr. Rusha Bhandari: That's certainly a focus of our survivorship program, for example, is to make sure that we're able to educate patients, inform them of their risks, and why certain screening tests are recommended at certain times in their survivorship journey. And then I think again, thankfully nowadays with all of the electronic medical records and different methods for us to communicate, there's a lot of opportunity for us to continue building these relationships with those primary care providers and making sure they have the information at their fingertips as well as to be able to work in conjunction with these patients to continue to formulate their plans and carry out these screenings and then again, like I was saying, have an easy open line of communication with the oncology centers if they do have any questions. Dr. Davide Soldato: Thanks so much. This brings us to the end of this episode. I would like to thank again Dr. Bhandari for joining us today. Dr. Rusha Bhandari: Thank you so much. It's been a real pleasure speaking with you. Dr. Davide Soldato: And we appreciate you sharing more on your JCO article titled "Health Outcomes Beyond Age 50 Years in Survivors of Childhood Cancer: A Report From the Childhood Cancer Survivor Study." If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  

On this edition of The Mark White Show, we're shining a light on the often-overlooked heroes in prostate cancer care, the caregivers. A new national survey reveals that 85% of caregivers attend medical appointments with their loved one and are four times more likely to notice treatment side effects than the patients themselves. Joining me are Dr. Daniel George, Medical Oncologist and Professor at Duke University School of Medicine, and Gina Carithers, President of the Prostate Cancer Foundation. Together, we discuss what this survey uncovers about the day-to-day realities of caregiving, how families can better navigate this journey, and the vital importance of supporting those who give so much of themselves in the process.

Host: Jasmine T. Kency, M.D., Associate Professor of Internal Medicine and Pediatrics at the University of Mississippi Medical Center.Guest(s): Wade Christopher, M.D., Surgical Oncologist at the University of Mississippi Medical Center Barbara Craft, M.D., Medical Oncologist at the University of Mississippi Medical CenterTopic: Breast cancer. Medical and surgical treatments, clinical trials, and screenings.Email the show: remedy@mpbonline.org. If you enjoy listening to this podcast, please consider contributing to MPB. https://donate.mpbfoundation.org/mspb/podcast. Hosted on Acast. See acast.com/privacy for more information.

Never heard of Common Sense Oncology?? Well if you enjoy this podcast then we think you will might find the Common Sense Oncology (CSO) movement to be very interesting indeed! Declan Murphy caught up recently with Dr Bishal Gyawali, Medical Oncologist at Queen's University, Kingston, Ontario, to talk about CSO which he co-founded in 2023. They are on a mission to ensure that cancer care and innovation, should focus on results that are meaningful to patients (eg survival, quality of life, equity), rather than just regulatory approval, commercial success, or statistical endpoints. "Outcomes that matter", is their battle cry. They are also very focussed on communication, and are quick to call out when stakeholders make ridiculous claims for their product or innovation. And Bishal happens to be one of the very best communicators out there. Great to have him on GU Cast and we at GU Cast are 100% supportive of their mission. You can visit their website and join the movement for all the latest updates

In this episode, Dr. Paul Wheatley-Price chats with Dr. Arielle Elkrief, Medical Oncologist, Co-Director of the CHUM Microbiome Center, and Clinician-Scientist at the University of Montreal. They discuss everything about the microbiome and gut health - what is the microbiome, why it's important in cancer and treatments, tips for a healthy microbiome, antibiotics, and even "poop pills".

In this episode of, "Empowered Intimacy: Getting Your Sexy Back After Breast Cancer," we open up an important conversation about sexual health after a breast cancer diagnosis. Melissa is joined by her friend Deltra, a mom of five living with triple-negative metastatic breast cancer, and Dr. Laila Agrawal, a board-certified medical oncologist dedicated to putting sexual health at the forefront of cancer care. Many carry these concerns silently, but intimacy is an important part of quality-of-life care. Together, they share personal stories, explore why this topic is often overlooked, and offer practical tips for starting the conversation with your doctor, asking the right questions, and advocating for the support and resources that you deserve. Special thanks to Lilly, Merck, and Novartis for supporting the Cancer Fashionista Foundation and making this episode possible.

JCO PO author Dr. Asaf Maoz at Dana-Farber Cancer Institute shares insights into article, “Causes of Death Among Individuals with Lynch Syndrome in the Immunotherapy Era.” Host Dr. Rafeh Naqash and Dr. Maoz discuss the causes of death in individuals with LS and the evolving role of immunotherapy. TRANSCRIPT Dr. Rafeh Naqash: Hello, and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCOPO articles. I'm your host, Dr. Rafeh Naqash, podcast editor for JCO Precision Oncology and Associate Professor Medicine, at the OU Health Stephenson Cancer Center. Today, I'm super thrilled to be joined by Dr. Asaf Maoz, Medical Oncologist at Dana-Farber Cancer Institute, Brigham and Women's Hospital, and faculty at the Harvard Medical School, and also lead author on the JCO Precision Oncology article entitled "Causes of Death Among Individuals with Lynch Syndrome in the Immunotherapy Era." This publication will be a concurrent publication with an oral presentation at the annual CGA meeting. At the time of this recording, our guest's disclosures will be linked in the transcript. Asaf, I'm excited to welcome you on this podcast. Thank you for joining us today. Dr. Asaf Maoz: Thank you so much for highlighting our paper. Dr. Rafeh Naqash: Absolutely. And I was just talking to you that we met several years back when you were a trainee, and it looks like you've worked a lot in this field now, and it's very exciting to see that you consider JCOPO as a relevant home for some of your work. And the topic that you have published on is of significant interest to trainees from a precision medicine standpoint, to oncologists in general, covers a lot of aspects of immunotherapy. So, I'm really excited to talk to you about all of this. Dr. Asaf Maoz: Me too, me too. And yeah, I think JCOPO has great content in the area of cancer genetics and has done a lot to disseminate the knowledge in that area. Dr. Rafeh Naqash: Wonderful. So, let's get started and start off, given that we have hosts of different kinds of individuals who listen to this podcast, especially when driving from home to work or back, for the sake of making everything simple, can we start by asking you what is Lynch syndrome? How is it diagnosed? What are some of the main things to consider when you're trying to talk an individual where you suspect Lynch syndrome? Dr. Asaf Maoz: Lynch syndrome is an inherited predisposition to cancer, and it is common. So, we used to think that, or there's a general notion in the medical community that it is a rare condition, but we actually know now from multiple studies, including studies that look at the general population and do genetic testing regardless of any clinical phenotype, that Lynch syndrome is found in about 1 in 300 people in the general population. If you think about it in the United States, that means that there are over a million people living with Lynch syndrome in the United States. Unfortunately, most individuals with Lynch syndrome don't know they have Lynch syndrome at the current time, and that's where a lot of the efforts in the community are being made to help detect more individuals who have Lynch syndrome. Lynch syndrome is caused by pathogenic germline variants in mismatch repair genes, MLH1, MSH2, MSH6, or PMS2, or as a result of pathogenic variants in EPCAM that cause silencing of the MSH2 gene. Dr. Rafeh Naqash: Excellent. Thank you for that explanation. Now, one of the other things I also realized, similar to BRCA germline mutations, where you require a second hit for individuals with Lynch syndrome to have mismatch repair deficient cancers, you also require a second hit to have that second hit result in an MSI-high cancer. Could you help us understand the difference of these two concepts where generally Lynch syndrome is thought of to be cancers that are mismatch repair deficient, but that's not necessarily true for all cases as we see in your paper. Can you tease this out for us a little bit more? Dr. Asaf Maoz: Of course, of course. So, the germline defect is in one of the mismatch repair genes, and these genes are responsible for DNA mismatch repair, as their name implies. Now, in a normal cell, we think that one working copy is generally enough to maintain the mismatch repair machinery intact. What happens in tumors, as you alluded to, is that there is a second hit in the same mismatch repair gene that has the pathogenic germline variant, and that causes the mismatch repair machinery not to work anymore. And so what happens is that there is formation of mutations in the cancer cell that are not present in other cells in the body. And we know that there are specific types of mutations that are associated with defects in mismatch repair mechanisms, and those are associated a lot of times with frameshift mutations. And we have termed them ‘microsatellites'. So there are areas in the genome that have repeats, for example, you know, if you have AAAA or GAGA, and those areas are particularly susceptible to mutations when the mismatch repair machinery is not working. And so we can measure that with DNA microsatellite instability testing. But we can also get a sense of whether the mismatch repair machinery is functioning by looking at protein expression on the surface of cancer cells and by doing immunohistochemistry. More recently, we're also able to infer whether the mismatch repair machinery is working by doing next-generation sequencing and looking at many, many microsatellites and whether they have this DNA instability in the microsatellites. Dr. Rafeh Naqash: Excellent explanation. As a segue to what you just mentioned, and this reminds me of some work that one of my good friends, collaborators, Amin Nassar, whom you also know, I believe, had done a year and a half back, was published in Cancer Cell as a brief report, I believe, where the concept was that when you look at these mismatch repair deficient cancers, there is a difference between NGS testing, IHC testing, and maybe to some extent, PCR testing, where you can have discordances. Have you seen that in your clinical experience? What are some of your thoughts there? And if a trainee were to ask, what would be the gold standard to test individuals where you suspect mismatch repair deficient-related Lynch syndrome cancers? How would you test those individuals? Dr. Asaf Maoz: We do sometimes see discordance, you know, from large series, the concordance rate is very high, and in most series it's over 95%. And so from a practical perspective, if we're thinking about the recommendation to screen all colorectal cancer and all endometrial cancer for mismatch repair deficiency, I think either PCR-based testing or immunohistochemistry is acceptable because the concordance rate is very high. There are rare cases where it is not concordant, doing multiple of the tests makes sense at that time. If you think about the difference between the tests, the immunohistochemistry looks at protein expression, which is a surrogate for whether there is mismatch repair deficiency or not, right? Because ultimately, the mismatch repair deficiency is manifested in the mutations. So if the PCR does not show microsatellite instability and now NGS does not show microsatellite instability, the IHC may be a false positive. At the end of the day, the functional analysis of whether there are actually unstable microsatellites either by PCR or by NGS is what I would consider more informative. But IHC again is an excellent test and concordant with those results in over 95% of cases. Now there is also an issue of sampling. It's possible that there's heterogeneity within the tumor. We published a case in JCOPO about heterogeneity of the mismatch repair status, and that was both by immunohistochemistry, but also by PCR. So there are some caveats and interpreting these tests does require some expertise, and I'm always happy to chat with trainees or whoever has an interesting or challenging case. Dr. Rafeh Naqash: Thanks again for that very easy to understand explanation. Now going to management strategies, could you elaborate a little bit upon the neo-adjuvant data currently, or the metastatic data which I think more people are familiar with for immunotherapy in individuals with MSI-high cancers? Dr. Asaf Maoz: Yeah, that's an excellent question and obviously a very broad topic. Individuals with Lynch syndrome typically develop tumors that are mismatch repair deficient or microsatellite unstable. And we have seen over the last 15 years or so that these tumors, because they have a lot of mutations and because these mutations are very immunogenic, we have seen that they respond very well to immunotherapy. And this has been shown across disease sites and has been shown across disease settings. And for that reason, immunotherapy was approved for MSI-high or mismatch repair deficient cancer regardless of the anatomic site. It was the first tissue-agnostic approval by the FDA in 2017. And so there are exciting studies both in the metastatic setting where we see individuals who respond to immunotherapy for many years, and one could wonder whether their cancer is going to come back or not. And also in the earlier setting, for example, the Cercek et al. study in the New England Journal from Sloan Kettering, where they showed that neoadjuvant immunotherapy can cause durable responses for rectal cancer that is mismatch repair deficient. And in that series, the patients did not require surgery or radiation, which is standard of care for rectal cancer otherwise. And there's also exciting data in the adjuvant space, as was presented in ASCO by Dr. Sinicrope, the ATOMIC study, and many more efforts to bring immunotherapy into the treatment landscape for individuals with MSI-high cancer, including individuals with Lynch syndrome. Dr. Rafeh Naqash: A lot of activity, especially in the neo-adjuvant and adjuvant space over the last two years or so. Now going to the actual reason why we are here is your study. Could you tell us why you looked at this idea of patients who had Lynch syndrome and died, and the reasons for their death? What was the thought that triggered this project? Dr. Asaf Maoz: As we were talking about, we now know that immunotherapy really has changed the treatment landscape for individuals with Lynch syndrome, and that most cancers that individuals with Lynch syndrome do have this mismatch repair deficiency. But we also know that individuals with Lynch syndrome can develop tumors that do not have mismatch repair deficiency, and we call them mismatch repair proficient or microsatellite stable. And there was a series from Memorial Sloan Kettering showing that in colorectal cancer, about 10% of the tumors that individuals with Lynch syndrome developed did not have mismatch repair deficiency. In addition to that, we anecdotally saw that some of our patients with Lynch syndrome died of causes that were not mismatch repair deficient tumors. We wanted to see how that has changed since immunotherapy was approved in a tissue-agnostic manner, meaning that we could look at this regardless of where the cancer started, because we would anticipate that if the tumor was mismatch repair deficient, the patient would be able to access immunotherapy as standard of care. Dr. Rafeh Naqash: Thank you. And then you looked at different aspects of correlations with regards to individuals that had an MSI-high cancer with Lynch syndrome or an MSS cancer with Lynch syndrome. Could you elaborate on some of the important findings that you identified as well as some of the unusual findings that perhaps we did not know about, even though the sample size is limited, but what were some of the unique things that you did identify through this project? Dr. Asaf Maoz: The first question was what cause is leading to death in individuals with Lynch syndrome? And we had 54 patients that we identified that had died since the approval of immunotherapy in 2017, 44 of which died of cancer-related causes. And when we looked at cancer-related causes of death, we wanted to know how many of those were due to mismatch repair deficient tumors versus mismatch repair proficient tumors or MS-stable tumors. And we found, somewhat surprisingly, that 43% of patients in our cohort actually died of tumors that were microsatellite stable or mismatch repair proficient, meaning of tumors that are not typically associated with Lynch syndrome. This is not entirely surprising as a cause of death because we know that immunotherapy does not typically work for tumors that are microsatellite stable. And so in the metastatic setting, there are much less cases of durable remissions with treatment. But it was helpful to have that figure as an important benchmark. There are previous studies about causes of death in Lynch syndrome, and particularly from the Prospective Lynch Syndrome Database in Europe. Those have provided really important information about cause of death by cancer site, but they typically don't have mismatch repair status and are more difficult to interpret in that regard. They also don't include a large number of individuals who have PMS2 Lynch syndrome, which is the most common, but least penetrant form of Lynch syndrome. Dr. Rafeh Naqash: As far as the subtype of pathogenic germline variants is concerned, did you notice anything unusual? And I've always had this question, and you may know more about this data, is: In the bigger context of immunotherapy, does the type of the pathogenic germline variant for Lynch syndrome associated MSI-high cancers, does that impact or have an association with the kind of outcomes, how soon a cancer progresses or how many exceptional responders perhaps with MSI-high cancers actually have a certain specific pathogenic germline variant? Dr. Asaf Maoz: That's an excellent question, and certainly we need more data in that space. We know that the type of germline mutation, or the gene in which there is a germline pathogenic variant, determines to a large degree the cancer risk, right? So we know that individuals who have germline pathogenic variants in MLH1 or MSH2 have a much higher colorectal cancer risk than, for example, PMS2. We know that for PMS2, the risks are more limited to colorectal and endometrial, and may be lower risk of other cancers. We also know that, you know, the spectrum of disease may change based on the pathogenic germline variants. For example, individuals who have MSH2 associated Lynch syndrome have more risk of additional cancers in other organs like the urinary tract and other less common Lynch-associated tumors. The question about response to therapy is one where we have much less information. There are studies that are trying to assess this, but I don't think the answer is there yet. Some of the non-clinical data looks at how many mutations there are based on the pathogenic variant and what the nature of those mutations are, whether they're more frameshift or others. But I think we still need more clinical data to understand whether the response to immunotherapy differs. It's also complicated by the fact that the immunotherapy landscape is changing, especially in the metastatic setting, now with the approval of combination ipilimumab and nivolumab for first-line treatment of colorectal cancer that is microsatellite unstable. But in our study, we did find that, as you would expect, there is an enrichment in MS-stable cancers among those with PMS2 Lynch syndrome. Again, our denominator is those who died, right? So this is not the best way to look at the question whether this is overall true, that is more addressed by the study that Sloan Kettering published. But we do see, as we would anticipate, that there are more microsatellite stable cancers among those with PMS2 Lynch syndrome that died. Dr. Rafeh Naqash: A lot to uncover there for sure. This study and perhaps some of the other work that you're doing is slowly advancing our understanding of some of these concepts. So I'd like to shift gears to a couple of provocative questions that I generally like to ask. The first is, in your opinion, and you may or may not have data to back this up, which is okay, and that's why we're having a conversation about it. In your opinion, do you think the type or the quality of the neoantigen is different based on the pathogenic germline variant and a Lynch syndrome associated MSI-high cancer? Dr. Asaf Maoz: I think there are some data out there that, you know, I can't cite off the top of my mind, but there are some data out there that suggest that that may be the case. I think the key question is the quality, right? I think that whether these differences that are found on a molecular level also translate to a clinical difference in response is something that is unknown at this moment. Some people hypothesize that if the tumor has less neoantigens, there's less of a response to immunotherapy. But I think we really need to be careful before making those assertions on a clinical level. I do think it's a really important question that needs to be answered, among others because, you know, in the colorectal space, for example, where we have both the option of doing ipilimumab with nivolumab and the option of doing pembrolizumab, we don't really know which patients need the CTLA-4 blockade versus which patients can receive PD-1 blockade alone and avoid the potential excess toxicity of the CTLA-4 blockade. There are a lot of interesting questions there that still need to be answered. And of course, individuals with Lynch syndrome are just a fraction of those individuals who have MSI-high cancer. So there's also the question about whether non-Lynch syndrome associated MSI-high cancer responds differently to immunotherapy than Lynch syndrome associated MSI-high cancer. A lot of very interesting questions in the field for sure. Dr. Rafeh Naqash: Absolutely. My second question is more about trying to understand the role of ctDNA, MRD monitoring in individuals with Lynch syndrome. If somebody has a germline, you know, Lynch syndrome MSI-high cancer, when you do a tumor-informed ctDNA assessment, what do you capture generally there? Because, and this question stems from a discussion I've had with somebody regarding EGFR lung cancer, since I treat individuals with lung cancer, and the concept generally is that even if the tissue showed EGFR, but for MRD monitoring, when you do a barcoded sequence of different tumor specific mutations, it's not actually the EGFR that they track in the blood when they do ctDNA assessment. But from a Lynch syndrome standpoint, if you have a germline, right, which is the first hit, and then you have the somatic in the tumor, which is the second hit, are you aware or have you tried to look into this where what is exactly being followed if one had to follow MRD in a Lynch syndrome MSI-high colorectal cancer? Dr. Asaf Maoz: I think a lot of the MRD assays are proprietary, and so we don't receive information about what the mutations that are being tracked are. In general, the idea is to track mutations that we would not expect to disappear as part of resistant mechanisms. We want these to be truncal mutations. We want these to be mutations in which resistance is not expected to result in reversion mutations. But what specifically is being tracked is something that I don't know because these assays, the tumor-informed ones, are proprietary, and we don't get the results regarding specific mutations. When it's circulating tumor DNA that is not necessarily tumor-informed, we do get those results, but that is less so about the specific selection of mutations. Dr. Rafeh Naqash: Thank you for clarifying that question to some extent, of course, as you said, we don't know a lot, and we don't know what we don't know. That's the most important thing that I've learned in the process of understanding precision medicine and genomics, and it's a very fast-paced evolving field. Last question related to your project, what is the next step? Are you planning any next steps as a bigger multicenter study or validation of some sort? Dr. Asaf Maoz: There are two big questions that this study raises. One, is this true across multiple other sites, right? Because this is a single center study, and we really need additional centers to look at their data and validate whether they are also seeing that a substantial portion of deaths in individuals with Lynch syndrome are attributable to mismatch repair proficient cancer. The other question is whether we can look at specifically MSI-high cancer versus MS-stable cancer and understand what the mortality rate for each of those are. From a clinical perspective, it's important to counsel individuals with Lynch syndrome about general cancer screening outside of mismatch repair deficient tumors and to understand that there is also a risk of mismatch repair proficient tumors and that treatment for those tumors would be different. There's a lot of work to be done in the future. Another major area of need is to see whether tumors that are microsatellite stable can be sensitized to immunotherapy, and that is beyond the Lynch syndrome field, but that is something that certainly would benefit these individuals with Lynch syndrome who develop mismatch repair proficient cancer. Dr. Rafeh Naqash: That's very interesting to hear, and we'll look forward to seeing some of those developments shape in the next few years. Now, I'd like to spend a minute, minute and a half on you specifically as a researcher, clinician, scientist. Could you briefly highlight - because I remember meeting you several years back as a trainee, with your interest in genomics, computational research - could you briefly tell us what led you to hereditary cancer syndromes based on your research and work? What are some of the things that you learned along the way that other early career investigators can perhaps take lessons from? Dr. Asaf Maoz: Big questions there, thanks for asking. I got interested in the field of hereditary cancer syndromes when I came to the United States and started doing lab research in Stephen Gruber's lab at the time at USC. He's now at City of Hope. And my interest was originally looking at immunotherapy and immunology, but I went to the case conferences where we were learning about individuals with hereditary cancer, and those were kind of earlier days where we were still trying to figure out how to test and what the implications for these individuals would be. And through fellowship, I was also very interested in that, and I did my senior fellowship years with Dr. Yurgelun here at Dana-Farber, who is the director of the Lynch Syndrome Center. And I I think it's the combination between being able to treat individuals based on precision medicine and what the germline mutation is, but also the ability to prevent cancer and to develop strategies to intercept cancer early that is really appealing to me in this field. It's also a great field to be in because it's a small field. If you come to the CGA-IGC meeting, you'll be able to interact with everyone. Everyone is super collaborative, super nice, and I really recommend it to trainees. The CGA-IGC annual meeting is really a great opportunity to learn more and experience some of the advancement specifically in the GI hereditary space. Lessons for trainees. I think there are a lot of lessons that I could think about, but I think finding strong and supportive mentors is one of the things that has helped me most. I think that just having close relationship with your mentor, having frequent discussions and honest discussions about what is feasible, what is going to make a difference for your patients and your research and what you want to focus on is really important. And so I think if I had to choose one thing, I would say choose a mentor that you trust, that you feel you have a good relationship with, and that has the availability to support you. Dr. Rafeh Naqash: Thank you so much for those insightful comments, and thank you for sharing with us your journey, your project, and some of your interesting thoughts on this concept of hereditary cancers. Hopefully, we'll see more of this work being published in JCOPO through your lab or work from others. Dr. Asaf Maoz: Thank you so much. I appreciate the opportunity to be here. Dr. Rafeh Naqash: Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all ASCO shows at ASCO.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

In this episode, Dr. Paul Wheatley-Price sits down with Dr. Andrew Robinson and Dr. Nathalie Daaboul on all the highlights coming out of this year's 2025 ASCO Conference, held in Chicago back in June. They discuss major developments in treatment for small cell lung cancer (SCLC), updates in immunotherapy, and a couple of unique drugs coming down the pipeline. Dr. Robinson is a Medical Oncologist and Associate Professor at Queen's University in Kingston, ON. Dr. Daaboul is a Medical Oncologist at L'Hôpital Charles Lemoyne in Montreal, Associate Professor at the University of Sherbrooke, and also the host of the Lung Cancer Voices podcast series in French!

Send us a textWelcome to the latest Series of Supportive Care Matters, a podcast hosted by Medical Oncologist and International Cancer Survivorship Expert, Professor Bogda Koczwara AM."If it were a pill, we would all want it." This powerful opening statement captures the essence of ground-breaking research that's transforming our understanding of cancer survivorship care. The CHALLENGE Study has delivered what many considered impossible: definitive evidence that structured exercise significantly extends the lives of colorectal cancer survivors.The results are nothing short of remarkable. Colorectal cancer patients who participated in a structured exercise program for three years after completing surgery and chemotherapy showed an 80% disease-free survival rate at five years, compared to 74% in those who received only health education materials. The results showed that structured exercise provides a significantly longer disease-free survival. Even more impressive, overall survival improved from 83% to 90% - a 37% decrease in risk. To put this in perspective, for every 14 patients who followed the exercise program, one additional life was saved.What makes this intervention unique is its sophisticated approach to behaviour change. Participants received individualised exercise prescriptions targeting 150 minutes of moderate aerobic activity weekly, combined with regular supervision and motivational support. Exercise physiologists conducted environmental scans to identify accessible opportunities, established accountability through regular check-ins and helped participants overcome barriers to physical activity. This wasn't simply about telling people to exercise - it was about teaching them how to make sustainable lifestyle changes.The implications for clinical practice are profound. To discuss this ground-breaking paper in detail, Professor Bogda Koczwara is joined by the Australian Principal Investigators - Professor Haryana Dhillon and Professor Janette Vardy.Visit www.oncologynews.com.au for show notes and more information about Supportive Care Matters.This conversation is proudly produced by the Podcast Team at The Oncology Podcast, part of the Oncology Media Group Australia.

Doctor Eleonora Teplinsky is a board-certified medical oncologist who focuses on breast and gynecologic cancers. She is the head of breast and gynecologic medical oncology at Valley Mount Sinai Comprehensive Cancer Care in Paramus, NJ and is a Clinical Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai.Doctor Teplinsky is passionate about working with young women facing breast cancer, especially when exploring things like survivorship, exercise, and how social media can play a role in cancer care. In this raw, refreshing, and beautifully honest episode, @wren_morr the founder of the Living Our Breast Lives Podcast is joined by the vibrant Dr. Teplinsky as she breaks down: 

In this episode, we visit KU Leuven in Belgium to explore GLIOMATCH, a groundbreaking European research initiative working to improve outcomes for adults and children with glioblastoma through collaboration across neurosurgery, oncology, immunology, and spatial omics. We speak with the experts leading this innovative work. Frederik De Smet, Professor and GLIOMATCH Project Coordinator at KU Leuven, outlines the vision for the project and how it brings together multiple disciplines to tackle one of the most challenging forms of cancer. Steven De Vleeschouwer, MD, PhD, Neurosurgeon and expert in immunotherapy trials, shares how surgical intervention plays a key role not only in treatment but also in advancing research. Paul M. Clement, MD, Medical Oncologist specializing in adult neuro-oncology, discusses the complexities of post-surgical care and how GLIOMATCH is helping improve decision-making. Sandra Jacobs, MD, Pediatric Neuro-Oncologist, highlights the unique challenges in treating children and the need for tailored research approaches. Thierry Voet, PhD, Chair of the Leuven Institute for Single-Cell Omics, explains how cutting-edge spatial omics is transforming our understanding of glioblastoma biology. Abhishek D. Garg, PhD, Tumor Immunology Specialist, shares how data science and deep immune profiling are driving new insights into overcoming immunotherapy resistance. GLIOMATCH is a testament to the power of collaboration in pushing the boundaries of glioblastoma research and offering hope for patients and families worldwide. This work is funded by the European Union. Views and opinions expressed are those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them. This work is also supported by Innovate UK [grant number 10113516] and the Swiss State Secretariat for Education, Research and Innovation (SERI) under the contract number 23.00607. Learn more at www.gliomatch.eu This episode is intended for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider for guidance specific to your health or treatment plan.

When your doctor says you need “cancer treatment,” do you know what that actually means?Most people immediately think of chemotherapy. But if you or someone you love is facing a cancer diagnosis, understanding the full range of treatment options could be the difference between feeling overwhelmed and feeling empowered.Dr. Katie Deming sits down with Dr. Jason Konner, a medical oncologist at Memorial Sloan Kettering Cancer Center, to break down the three main types of systemic cancer treatment used today: chemotherapy, targeted therapies, and immunotherapies.Chapters:03:43 – Three Main Types of Cancer Treatment16:34 – Why First-Line Therapies Matter20:48 – Combining Holistic and Conventional Care31:23 – Essential Questions to Ask Your Oncologist43:42 – When and Why to Seek a Second OpinionDr. Konnor shares the insider perspective on second opinions, what those complex drug names really mean, and how to build the kind of relationship with your medical team that leads to better outcomes.You'll learn how some patients unknowingly sabotage their own care and what questions can instantly make you a more informed patient. Listen and learn how to walk into any oncologist's office with confidence, ask the right questions, and truly understand your options.Don't let medical jargon and complex choices keep you in the dark when clear thinking matters most.Reserve Your Spot for the June PSYCH-K® Online Workshop: https://www.katiedeming.com/psych-k-june-2025 Transform your hydration with the system that delivers filtered, mineralized, and structured water all in one. Spring Aqua System: https://springaqua.info/drkatieMORE FROM KATIE DEMING M.D. Download Your Free Webinar & Ultimate Guide to Water Fasting to Heal Cancer and Chronic Illness https://www.katiedeming.com/prolonged-water-fasting/ Work with Dr. Katie: www.katiedeming.comEmail: INFO@KATIEDEMING.COM 6 Pillars of Healing Cancer Workshop Series - Click Here to Enroll Follow Dr. Katie Deming on Instagram: https://www.instagram.com/katiedemingmd/ Please Support the Show Share this episode with a friend or family member Give a Review on Spotify Give a Review on Apple Podcast DISCLAIMER: The Born to Heal Podcast is intended for informational purposes only and is not a substitute for seeking professional medical advice, diagnosis, or treatment. Individual medical histories are unique; therefore, this episode should not be used to diagnose, treat, cure, or prevent any disease without consulting your healthcare provider.

Send us a textWelcome to the latest Series of Supportive Care Matters, a podcast hosted by Medical Oncologist and International Cancer Survivorship Expert, Professor Bogda Koczwara AM.The landscape of cancer survivorship is evolving before our eyes. As treatment advances allow people with metastatic cancer to live longer, we're witnessing the emergence of a population that exists in what medical oncologist Dr Lori Spoozak calls "the place in between" – not curable but not actively dying.In this eye-opening conversation, researchers Associate Professor Nick Hart and Dr. Andrea Smith (who herself lives with metastatic breast cancer) explore the unique challenges faced by those living with advanced cancer. While survivorship programs have traditionally focused on post-treatment care, metastatic patients are typically on treatment for life, navigating constant healthcare interactions, accumulating side effects and facing the certainty rather than just the fear of disease progression.The discussion reveals how metastatic cancer patients have often fallen through the cracks – excluded from survivorship programs yet not appropriately served by palliative care services that focus primarily on end-of-life needs. This growing population faces what Dr. Smith describes as supportive care needs "on steroids" – intensified physical, psychological, financial and practical challenges that require specialised approaches.Hart and Smith share their ground-breaking work developing the first international standards for metastatic cancer survivorship care, now translated into 14 languages to guide implementation worldwide. They emphasise that improving care requires action on multiple fronts: better education for healthcare professionals, redesigned care models, dedicated peer support programs and recognition that survivorship care is everyone's responsibility rather than the domain of any single provider.Whether you're a healthcare professional, researcher, patient advocate or someone living with cancer, this conversation challenges conventional thinking about survivorship and offers a compelling vision for more inclusive, responsive care. Discover why supporting those living for years with incurable cancer represents both an urgent challenge and a tremendous opportunity to enhance quality of life for this overlooked population.Visit www.oncologynews.com.au for show notes and more information about Supportive Care Matters.This conversation is proudly produced by the Podcast Team at The Oncology Podcast, part of the Oncology Media Group Australia.

Host Dr. Davide Soldato and guest Dr. Harriet Kluger discuss the JCO article "Phase II Trial of Pembrolizumab in Combination With Bevacizumab for Untreated Melanoma Brain Metastases." Transcript The guest on this podcast episode has no disclosures to declare. Dr. Davide Soldato Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato, Medical Oncologist at Ospedale San Martino in Genoa, Italy. Today, we are joined by JCO author Dr. Harriet Kluger. Dr. Kluger is a professor of medicine at Yale School of Medicine, Director of the Yale SPORE in Skin Cancer, and an internationally recognized expert in immuno-oncology for melanoma and renal cell carcinoma. She leads early-phase and translational trials that pair novel immunotherapies with predictive biomarkers to personalized care. Today, Dr. Kluger and I will be discussing the article titled "Phase 2 Trial of Pembrolizumab in Combination with Bevacizumab for Untreated Melanoma Brain Metastases." In this study, Dr. Kluger and colleagues evaluated four cycles of pembrolizumab plus the anti-VEGF antibody bevacizumab followed by pembrolizumab maintenance in patients with asymptomatic non-hemorrhagic melanoma brain metastases that had not previously received PD-1 therapy. Thank you for speaking with us, Dr. Kluger. Dr. Harriet Kluger Thank you for inviting me. The pleasure is really all mine. Dr. Davide Soldato So to kick off our podcast, I just wanted to ask if you could outline a little bit the biological and clinical rationale that led you to test this type of combination for patients with untreated brain metastases from metastatic melanoma. Dr. Harriet Kluger Back in approximately 2012, patients who had untreated brain metastases were excluded from all clinical trials. So by untreated, I mean brain metastases that had not received local therapy such as surgery or radiation. The reason for it was primarily because there was this fear that big molecules wouldn't penetrate brain lesions because they can't pass the blood-brain barrier. Turns out that the blood-brain barrier within a tumor is somewhat leaky and drugs sometimes can get in there. When PD-1 inhibitors were first identified as the next blockbuster class of drugs, we decided to conduct a phase 2 clinical trial of pembrolizumab monotherapy in patients with untreated brain metastases. We actually did it also in lung cancer, and we could talk about that later on. Responses were seen. The responses in the brain and the body were similar. They were concordant in melanoma patients. Now, at approximately that time, also another study was done by the Australian group by Dr. Georgina Long, where they did a randomized trial where patients who didn't require immediate steroid therapy received either nivolumab alone or nivolumab with ipilimumab, and the combination arm was substantially superior. Subsequently, also, Bristol Myers Squibb also conducted a large phase 2 multicenter trial of ipilimumab and nivolumab in patients with untreated brain metastases. And there, once again, they saw that the responses in the brain were similar to the responses in the body. Now, somewhere along the line there, we completed our anti-PD-1 monotherapy trial. And when we looked at our data, we still didn't have the data on ipilimumab and nivolumab. And our question was, “Well, how can we do better?” Just as we're always trying to do better. We saw two really big problems. One was that patients had a lot of perilesional edema. And the other one was that we were struggling with radiation necrosis in lesions that were previously Gamma Knifed. The instance of radiation necrosis was in excess of 30%. So the rationale behind this study was that if we added bevacizumab, maybe we could treat those patients who had some edema, not requiring steroids, but potentially get them on study, get that PD-1 inhibitor going, and also prevent subsequent radiation necrosis. And that was the main rationale behind the study. We had also done some preclinical work in mouse models of melanoma brain metastases and in an in vitro blood-brain barrier model where we showed that bevacizumab, or anti-VEGF, really tightens up those leaky basement membranes and therefore would be very likely to decrease the edema. Dr. Davide Soldato Thank you very much for putting in context the combination. So this was a phase 2 trial, and you included patients who had at least one lesion, and you wanted lesions that were behind 5 and 20 millimeters. Patients could be included also if the brain metastasis was higher in dimension than 20 millimeters, but it had to be treated, and it was then excluded from the evaluation of the primary objective of the trial. So regarding, a little bit, these characteristics, do you think that this is very similar to what we see in clinical practice? And what does this mean in terms of applicability of these results in clinical practice? Dr. Harriet Kluger So that's an excellent question. The brain metastasis clinical research field has somewhat been struggling with this issue of inclusion/exclusion criteria. When we started this, we showed pretty clearly that 5 to 10 millimeter lesions, which are below the RECIST criteria for inclusion, are measurable if you use MRIs with slices that are 1 to 2 millimeters. Most institutions in the United States do use these high-resolution MRIs. I don't know how applicable that is on a worldwide scale, but we certainly lowered the threshold for inclusion so that patients who have a smattering of small brain metastases would be eligible. Now, patients with single large brain metastases, the reason that we excluded those from the trial was because we were afraid that if a patient didn't respond to the systemic therapy that we were going to give them, they could really then develop severe neurological symptoms. So, for patient safety, we used 20 millimeters as the upper level for inclusion. Some of the other trials that I mentioned earlier also excluded patients with very large lesions. Now, in practice, one certainly can do Gamma Knife therapy to the large lesions and leave the smaller ones untreated. So I think it actually is very applicable to clinical practice. Dr. Davide Soldato Thank you very much for that insight, because I think that sometimes criteria for clinical trials, they have to be very restrictive. But then we know that in clinical practice, the applicability of these results is probably broader. So, going a little bit further in the results of the study, I just wanted a little bit of comment from you regarding what you saw in terms of intracranial response rate and duration of response among patients who obtained a response from the combination treatment. Dr. Harriet Kluger So we were actually surprised. When we first designed this study, as I said earlier, we weren't trying to beat out ipilimumab and nivolumab. We were really just trying to exclude those patients who wouldn't have otherwise been eligible for ipilimumab and nivolumab because of edema or possibly even previous radiation necrosis. So it was designed to differentiate between a response rate of 34%, and I believe the lower bound was somewhere in the 20s, because that's what we'd seen in the previous pembrolizumab study. What we saw in the first 20 patients that we enrolled was actually a response rate that far exceeded that. And so we enrolled another cohort to verify that result because we were concerned about premature publishing of a result that we might have achieved just by chance. The two cohorts were very similar in terms of the response rates. And certainly this still needs to be verified in a second study with additional institutions. We did include the Moffitt Cancer Center, and the response rate with Moffitt Cancer Center was very similar to the Yale Cancer Center response rate. Now, your other question was about duration of response. So the other thing that we started asking ourselves was whether this high response rate was really because the administration of the anti-VEGF will decrease the gadolinium enhancement and therefore we might actually just be seeing prettier scans but not tumor shrinkage. And the way to differentiate those two is by looking at the duration of the response. Median progression-free survival was 2.2 years. That's pretty long. The upper bound on the 95% confidence interval was not reached. I can't tell you that the duration is as good as the duration would be when you give ipilimumab. Perhaps it is less good. This was a fairly sick population of patients, and it included some who might not have been able to receive ipilimumab and nivolumab. So it provides an alternative. I do believe that we need to do a randomized trial where we compare it to ipilimumab and nivolumab, which is the current standard of care in this patient population. We do need to interpret these results with caution. I also want to point out regarding the progression-free survival that we only gave four doses of anti-VEGF. So one would think that even though anti-VEGF has a long half-life of three or four weeks, two years later, you no longer have anti-VEGF effect, presumably. So it does something when it's administered fairly early on in the course of the treatment. Dr. Davide Soldato So, in terms of clinical applicability, do you see this combination of pembrolizumab and bevacizumab - and of course, as we mentioned, this was a phase 2 trial. The number of patients included was not very high, but still you saw some very promising results when compared with the combination of ipilimumab and nivolumab. So do you see this combination as something that should be given particularly to those patients who might not be able to receive ipilimumab and nivolumab? So, for example, patients who are very symptomatic from the start or require a high dose of steroids, or also to provide a quicker response in terms of patients who have neurological symptoms, or do you think that someday it could be potentially used for all patients? Dr. Harriet Kluger The third part of your question, whether it can be used someday for all patients: I think we need to be very careful when we interpret these results. The study was substantially smaller than the ipilimumab/nivolumab trial that was conducted by Bristol Myers Squibb. Also going to point out that was a different population of patients. Those were all frontline patients. Here we had a mix of patients who'd had previous anti-CTLA-4 and frontline patients. So I don't think that we can replace ipilimumab and nivolumab with these results. But certainly the steroid-sparing aspect of it is something that we really need to take into consideration. A lot of patients have lesions in locations where edema can be dangerous, and some of them have a hard time coming off the steroids. So this is certainly a good approach for those folks. Dr. Davide Soldato And coming back to something that you mentioned in the very introduction, when you said that there were two main problems, which was one, the problem of the edema, and the second one, the problem of the radionecrosis. In your trial, there was a fair percentage of patients who received some type of local treatment before the systemic one. So the combination of pembrolizumab and bevacizumab. And most of the patients received radiosurgery. So I just wanted a brief comment regarding the incidence of radionecrosis in the trial and whether that specific component of the combination with bevacizumab was reduced. And how do you think that this fares in terms of what we see in clinical practice in terms of radionecrosis? Dr. Harriet Kluger I'm not sure that we really reduced the incidence of radiation necrosis. We saw radiation necrosis here. We saw less of it than in the trial of pembrolizumab monotherapy, but these were also different patients, different time. We saw more than we thought that we were going to see. It was 27%, I believe, which is fairly high still. We only gave the four doses of bevacizumab. Maybe to really prevent radiation necrosis, you have to continue to give the bevacizumab. That, too, needs to be tested. The reason that we gave the four doses of bevacizumab was simply because of the cost of the bevacizumab at the time. Dr. Davide Soldato Thank you very much for that comment on radionecrosis. And I really think that potentially this is a strategy, so continuing the bevacizumab, that really makes a lot of sense, especially considering that the tolerability of the regimen was really very, very good, and you didn't see any significant or serious adverse events related to bevacizumab. So just wondering if you could comment a little bit on the toxicities, whether you had anything unexpected. Dr. Harriet Kluger There was one patient who had a microperforation of a diverticulum, which was probably related to the bevacizumab. It was conservatively managed, and the patient did fine and actually remains alive now, many years later. We had one patient who had dehiscence of a previous wound. So there is some. We did not see any substantial hypertension, proteinuria, but we only gave the four doses. So it is possible that if you give it for longer, we would see some side effects. But still, relative to ipilimumab, it's very, very well tolerated. Dr. Davide Soldato Yeah, exactly. I think that the safety profile is really different when we compare the combination of ipilimumab/nivolumab with the pembrolizumab/bevacizumab. And as you said, this was a very small trial and probably we need additional results. But still, these results, in terms of tolerability and safety, I think they are very interesting. So one additional question that I think warrants a little bit of comment on your part is actually related to the presence of patients with BRAF mutation and, in general, to what you think would be the best course of treatment for these patients who present with the upfront brain metastases. So this, it's actually not completely related to the study, but I think that since patients with BRAF mutation were included, I think that this warrants a little bit of discussion on your part. Dr. Harriet Kluger So we really believe that long-term disease control, particularly in brain metastases, doesn't happen when you give BRAF/MEK inhibitors. You sometimes get long-term control if you've got oligometastatic disease in extracranial sites and if they've previously been treated with a lot of immune checkpoint inhibitors, which wasn't the case over here. So a patient who presents early in the course of the disease, regardless of their BRAF status, I do believe that between our studies and all the studies that have been done on immunotherapy earlier in the course of disease, we should withhold BRAF/MEK inhibitors unless they have overwhelming disease and we need immediate disease control, and then we switch them very quickly to immunotherapy. Can I also say something about the toxicity question from the bevacizumab? I have one more comment to make. I think it's important. We were very careful not to include patients who had overt hemorrhage from brain metastases. So melanoma brain metastases relative to other tumor types tend to bleed, and that was an exclusion criteria. We didn't see any bleeding that was attributable to the bevacizumab, but we don't know for sure that, if this is widely used, that that might not be a problem that's observed. So I would advise folks to use extreme caution and perhaps not use it outside of the setting of a clinical trial in patients with overt hemorrhage in the melanoma brain metastases. Dr. Davide Soldato Thank you very much. I think that one aspect that is really interesting in the trial is actually related to the fact that you collected a series of biomarkers, both circulating ones, but also some that were collected actually from the tissue. So just wondering if you could explain a little bit which type of biomarkers you evaluated and whether you saw any significant results that could suggest higher or lower efficacy of the combination. Dr. Harriet Kluger Thank you for that. So yes, the biomarker studies are fairly exploratory, and I want to emphasize that we don't have anything that's remotely useful in clinical practice at this juncture. But we did see an association between vessel density in the tumors and improved response to this regimen. So possibly those lesions that are more vascular are more fed by or driven by VEGF, and that could be the reason that there was improved response. We also saw that when there was less of an increase in circulating angiopoietin-2 levels, patients were more likely to respond. Whether or not that pans out in larger cohorts of patients remains to be determined. Dr. Davide Soldato Still, do you envision validation of these biomarkers in a potentially additional trial that will evaluate, again, the combination? Because I think that the signals were quite interesting, and they really make sense from a biological point of view, considering the mechanism of action of bevacizumab. So I think that, yeah, you're right, they are exploratory. But still, I think that there is very strong biological rationale. So really I wanted to congratulate you on including that specific part and on reporting it. And so the question is, really, do you envision validation of these biomarkers in larger cohorts? Dr. Harriet Kluger I would hope to see that, just as I'd like to see validation of the clinical results as well. The circulating biomarkers are very easy to do. It's a simple ELISA test. And the vessel density on the tumor is essentially CD34 staining and units per area of tumor. Also very simple to do. So I'd love to see that happen. Dr. Davide Soldato Do you think that considering the quality of the MRI that we are using right now, it would be possible to completely bypass even the evaluation on the tissue? Like, are we going in a direction where we can, at a certain point, say the amount of vessels that we see in these metastases is higher versus lower just based on MRI results? Dr. Harriet Kluger You gave me an outstanding idea for a follow-up study. I don't know whether you can measure the intensity of gadolinium as a surrogate, but certainly something worth asking our neuroradiology colleagues. Excellent idea. Thank you. Dr. Davide Soldato You're welcome. So just moving a step further, we spoke a lot about the validation of these results and the combination. And just wanted your idea on what do you think it would be more interesting to do: if designing a clinical trial that really compares pembrolizumab/bevacizumab with ipilimumab and nivolumab or going directly for the triplet. So we know that there has been some type of exploration of triplet combination in metastatic melanoma. So just your clinical impression: What would you do as an investigator? Dr. Harriet Kluger So it's under some discussion, actually. It's very difficult to compare drugs from different companies in an investigator-initiated trial. Perhaps our European colleagues can do that trial for us. In the United States, it's much harder, but it can be done through the cooperative groups, and we are actually having some discussions about that. I don't have the answer for you. It would be lovely to have a trial that compared the three drugs to ipi/nivo and to pembrolizumab/bevacizumab. So a three-arm trial. But remember, these are frontline melanoma patients. There aren't that many of them anymore like there used to be. So accrual will be hard, and we have to be practical. Dr. Davide Soldato Yeah, you're right. And in the discussion of the manuscript, you actually mentioned some other trials that are ongoing, especially one that is investigating the combination of pembro and lenvatinib, another one that is investigating the combination of nivolumab and relatlimab. So just wondering, do you think that the molecule in terms of VEGF inhibition, so bevacizumab versus lenvatinib, can really make a difference or is going to be just a mechanism of action? Of course, we don't have the results from this trial but just wondering if you could give us a general comment or your opinion on the topic. Dr. Harriet Kluger So that's a really great question. The trial of pembrolizumab and lenvatinib was our answer to the fact that bevacizumab is not manufactured by the same company as pembrolizumab, and we're trying to give a practical answer to our next study that might enable us to take this approach further. But it does turn out from our preclinical studies that bevacizumab and VEGF receptor inhibition aren't actually the same thing in terms of the effects on the blood-brain barrier or the perilesional tumor microenvironment in the brain. And these studies were done in mice and in in vitro models. Very different effects. The lenvatinib has stronger effect on the tumors themselves, the tumor cells themselves, than the bevacizumab, which has no effect whatsoever. But the lenvatinib doesn't appear to tighten up that blood-brain barrier. Dr. Davide Soldato Thank you. I think that's very interesting, and I think it's going to be interesting to see also results of these trials to actually improve and give more options to our patients in terms of different mechanism of action, different side effects. Because in the end, one thing that we discussed is that some combination may be useful in some specific clinical situation while others cannot be applicable, like, for example, an all immunotherapy-based combination. Just one final comment, because I think that we focused a lot on the intracranial response and progression-free survival. You briefly mentioned this but just wanted to reinforce the concept. Did you see any differences in terms of intracranial versus extracranial response for those patients who also had extracranial disease with the combination of pembro and bevacizumab? Dr. Harriet Kluger So the responses were almost always concordant. There were a couple of cases that might have had a body response and not an intracranial response and vice-versa, but the vast majority had concordant response or progression. We do believe that it's a biological phenomenon. The type of tumor that tends to go to the brain is going to be the type of tumor that will respond to whatever the regimen is that we're giving. In the previous trial also, we saw concordance of responses in the body and the brain. Dr. Davide Soldato Thank you very much. Just to highlight that really the combination is worth pursuing considering that there was not so much discordant responses, and the results, even in a phase 2 trial, were very, very promising. So thank you again, Dr. Kluger, for joining us today and giving us a little bit of insight into this very interesting trial. Dr. Harriet Kluger Thank you for having me. Dr. Davide Soldato So we appreciate you sharing more on your JCO article titled "Phase 2 Trial of Pembrolizumab in Combination with Bevacizumab for Untreated Melanoma Brain Metastases," which gave us the opportunity to discuss current treatment landscape in metastatic melanoma and future direction in research for melanoma brain metastasis. If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

The Inn at Dromoland is the venue for this evening's launch of a new book on Clare's Brian O' Looney. Brian O' Looney, who lived during the 19th century, was a scholar, poet and Gaelic Revivalist'. The author of the book, entitled Brian O'Looney 1828-1901 –Clareman, scholar, poet and Gaelic revivalist, is Professor Peter Daly. Peter, who hails from Kilmaley, is a retired Medical Oncologist and Associate Professor of Medicine from St. James's Hospital and Trinity College, Dublin respectively. To discuss this further, Alan Morrissey was joined by Peter Daly. Photo(C): ClareFM

In this episode of Onc Now, Jonathan is joined by Dr Dave Cescon, a Medical Oncologist and Clinician Scientist at the Princess Margaret Cancer Centre, Toronto, Canada. Together, they explore the transformative impact of CDK4/6 inhibitors, challenges in liquid biopsy research, and the potential of mRNA vaccines in oncology.  Timestamps: (02:44) -Swimming in Toronto: Competitive vs. Open Water  (08:06) -From Internal Medicine to Breast Cancer Research  (14:09) -Translational research and circulating tumour DNA  (19:53) -The role of CDK4/6 inhibitors in breast cancer  (29:04) -FDA approval of ribociclib for high-risk early breast cancer  (31:45) -The future of mRNA vaccines for personalised cancer care  (37:34) -Dave's research challenges and innovations  (39:13) -Three wishes for healthcare 

Recorded live from the 13th Australasian Symposium of the Perioperative Medicine Special Interest Group, in collaboration with Summit III and the PeriOperative Quality Initiative (POQI). The theme of the meeting is ‘Improve the quality, enhance the value, protect the future'. This piece provides insights into our guest's career, the intersection of medicine and writing and the importance of compassion in healthcare. She discusses her background, including her education, her writing for The Guardian, and the content of her recent plenary session about shared decision-making and medical paternalism. We end with some focus on empathy and kindness in patient care, illustrated by a poignant email our guest received from a terminally ill patient. Presented by Desiree Chappell with Ranjana Srivastava, OAM, Medical Oncologist, Monash Health, Melbourne, Fulbright Scholar, Harvard University, a two-time recipient of the Fulbright Award, writer and columnist for The Guardian Newspaper. Enjoy our guest's writing here: https://www.theguardian.com/profile/ranjana-srivastava Buy our guest's books here: https://www.amazon.co.uk/stores/Dr.-Ranjana-Srivastava/author/B00IMYJJPI

I sit down with Dr William Oh, newly appointed Precision Medicine Director at Yale Cancer Center.  Dr Oh is a Medical Oncologist who has focused mainly on Genitourinary cancers, so we of course talk about prostates.  We discuss high risk populations and of course finding cancer early, knowing family histories and decision making about having surgery.  

Alcohol is a leading cause of cancer, a risk that should be clearly labeled on drinks Americans consume, U.S. Surgeon General Vivek Murthy proposed on Friday. The proposed advisory would require approval from congress, an approval that is rarely granted by the federal government. Dr. Katie Kerrigan, a Medical Oncologist at the Huntsman Cancer Institute, joins D2 to discuss the extent of alcohol on your physical health and its role in causing cancer.  

In this episode, we continue with a special series close to my heart: Decoding Destiny: Navigating Breast Cancer with Genetic Insight. Dr. Eleonora Teplinsky unpacks the challenges of living with a BRCA-positive diagnosis and the critical role of genetic testing in managing hereditary breast cancer risk. Dr. Teplinsky offers actionable advice for individuals and families, covering when to begin testing for younger generations, managing long-term risks, and addressing the emotional complexities of genetic knowledge while making proactive health choices. Whether you're a BRCA carrier, a breast cancer survivor, or considering genetic testing, this episode delivers expert insights and practical guidance to help you take charge of your health and future. Don't miss this important discussion about genetic awareness and building a foundation of health for the next generation. Thank you to AstraZeneca for making this episode possible!  

In this episode of Lung Cancer Considered host Dr. Narjust Florez discusses the future of lung cancer research in Brazil and the largest lung cancer screening program in South America. The episode was recorded during the IASLC 2024 Latin America Conference on Lung Cancer held in Bogota, Columbia. Guests: Clarissa Baldotto is a Medical ) Oncologist at D'Or Rio De Janeiro and President Elect for the Brazilian Society of Clinical Oncology (SBOC) Guest: Dr. Francisco Sarmento is a Thoracic Radiologist from Hospital Royal Portuguese in Brazil.

Listen to ASCO's Journal of Clinical Oncology Art of Oncology poem, "Episteme” by Dr. Michael Slade, who is a medical oncologist at Washington University School of Medicine. The poem is followed by an interview with Slade and host Dr. Lidia Schapira. Dr Slade highlights the tension between what is known and unknown and what spoken and unspoken as physicians try to care for our patients without destroying their ability to live with their disease. TRANSCRIPT Narrator: Episteme, by Michael J. Slade, MD, MSCI  I know you know, must know. The tides have woken you night after night after night, borrowed blood flowing in and now out, unaided by your dwindling marrow. You must know your story is read and written in a perfecta tense. You must know the end somewhere deep in your empty bones.   Still, you speak of summers, of fish caught or lost beneath the calm surface of a distant lake. “There's nothing to do in December,” you say, skin pale in the cool light leaking from the door. It's late now, deep in the evening and my knees ache as I nod and wonder about a different world where you were not you and this was all decided months ago.   “Day by day,” I mutter and shuffle to my next door, leaving you alone to wait on the cataclysm, on that night when the blood of strangers runs wild and catches your breath, that night in the ICU, where they wait, tube in hand as you sweat and shake, where I still promise to care for you knowing, knowing you will never wake again. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories, the Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira. I'm a Professor of Medicine at Stanford University. Today we are joined by Dr. Michael Slade, a Medical Oncologist at Washington University School of Medicine. In this episode, we will be discussing his Art of Oncology poem, “Episteme.”  Our guest's disclosures will be linked in the transcript.  Mike, welcome to our podcast and thank you for joining us. Dr. Michael Slade: Thank you, Lidia. It's great to be here. Dr. Lidia Schapira: It's a pleasure to have you. Let's start by talking a little bit about your relationship to writing prose, poetry. Is this something that you've always done? Do you want to share with us a little bit about what it means to you and when you have time to write? Dr. Michael Slade: I'd say, I have absolutely no formal training as a poet or honestly in anything else, but this is something I've done since college. And especially starting in medical school, this was really a deliberate practice for me to try to find a way to unload some of the harder experiences that we can go through as medical providers. Dr. Lidia Schapira: It's interesting to hear you say that. Many of our authors have talked about using their writing as a way of processing emotionally difficult experiences and just very important meaningful experiences. But there's so much artistry in your work. I just wanted to ask you a little bit more about that. How do you find the relationship to not just the writing as a way of processing, but as art that you want to share and publish. I've seen that you've published poems, quite a few of them in the last year alone. Dr. Michael Slade: Yeah, I would say the publishing piece of this came very far down the road for me, that I've been writing for over a decade before I think I even submitted anything for publication. And for me, the ability to publish is more of a- Is a way of putting yourself out there and as a motivation to really re-examine what you've written and not just scrawl it on a piece of paper and sort of stick it back on a shelf somewhere, but to be able to go back to some of these experiences and really delve a little bit deeper, both with the language, but also what was the experience? Why was this meaningful? And often things that end up in print for me are things that I've been playing with for a number of years. It is just sort of an ability to go deeper there is the reason why I have published some of these works. Dr. Lidia Schapira: I am very interested in the theme of time and your use of pronouns. There's a lot of negotiating. What is yours and what is your patients'? I assume the “I” is the oncologist, right? In this particular case, since the readership of JCO are mostly clinical oncologists, it's sort of meant to be an affiliation with a reader. And there's a lot of “I,” but then there's a lot of mine. Can you talk a little bit about how you have chosen to address the patient directly and your colleagues directly and put yourself out there using first person as well? Dr. Michael Slade: I think certainly, as I wrote this, and I tend to write a lot as I come off of sort of tough stretches of clinical work, and as I wrote this, I think, I was trying to capture a little bit of the anguish that I think a lot of us feel as oncologists, especially around this question of what we know and what is knowledge for the oncologist. The reality is the things that we know sort of above the neck tend to be very statistical, that we say, “Oh, the chances of you responding,” “The chances of you surviving,” “The chances of you being cured,” it's very numbers based, but it's probabilistic. And when we talk to patients and often when we talk to ourselves, we really use this idea of knowing in a very different way, that we know that something's going to happen because of our past experience or because of what we're seeing right in front of us. I think that's something that I think a lot of oncologists probably identify with very closely is that what do we do when we feel like we know something in a way that's almost deeper than the academic way that we speak of knowing. Dr. Lidia Schapira: Let's talk about that. And that is, in fact, the title you chose for your poem. Why not just use the word knowledge? Tell us a little bit about that choice. Dr. Michael Slade” When we talked about knowing, both academically and my background before I came to medicine, as I trained in philosophy, we talked about epistemology or episteme. Often, we talk about knowing both in medicine and in sort of the wider philosophical discussions, we talk about it in this very abstract way that if you were to sit down with a patient and really try to unpack it, they're not going to have any idea. This isn't relevant to practical life in a lot of ways. They want to know, “Am I going to be cured?” “Am I going to have this side effect?” “Am I going to make it out of the hospital?” And the type of knowing that we do within science is not that type of knowing. It's all probabilistic. And to me, I think, trying to pull back a little bit, and by using the sort of Greek root, it sort of places this idea of knowledge at a remove that I think is useful. Dr. Lidia Schapira: Mike, I've often used the analogy that poetry is almost like abstract art sometimes, because it invites the reader to imagine things. So if we think of this poem sort of as art, can we walk through this together and take it from the top and see what we see or what these ideas trigger? You start directly by addressing the I know, you know, you must know. And then you present the case, if I got this right, of somebody with a dwindling marrow, that's an empty bone, so an inefficient marrow. And I assume, since you're a bone marrow transplanter, that means this patient had a disease that was incurable here, and you sort of insist that you must know. Tell me a little bit about that tension, that emotional tension that comes up for me as I read that, those opening lines where you're sort of insisting that you must know something that you're not sharing with me that you know. Dr. Michael Slade: I think for me, that's really trying to express the gap that can emerge between those of us who do this professionally and our patients who have to live through these experiences. And we can say, “I have seen this story play out so many times, and I know things are not going well. I know how this is going to end.” But for the patient, this is, obviously, every patient is an n-of-1 with their own experience, and they may have had family members with similar diseases, they may have had friends. They may join these really wonderful patient support groups where people can sort of talk about what the process of cancer treatment is. But for the patient, they are living through it day to day. And we may feel with our accumulated knowledge that it's very clear how things are going and that either their optimism or pessimism or sort of whatever the patient's base emotional reaction is to the clinical situation is fundamentally incorrect. It's like you have to put these pieces together in the way that I do. And the reality is that there is a huge gap that can emerge between us and our patients, and it can lead to frustration and anguish and a lot of negative emotions, I think, from clinicians that aren't aimed at the patient, but they're really aimed at the fact that we feel like we're not talking about the same situation. I think that's what that first piece of the poem is really trying to capture, is that anguish at that type of gap. Dr. Lidia Schapira: And you say it very clearly. You say, “You must know your story is read and written in the perfect tense.” It's almost like you're shouting it here, right? Dr. Michael Slade: But in sort of a weird, obscure way that if you tried to tell a patient sort of a grammatical metaphor for how poorly their hospitalization was going. Most patients, unless they're English literature professors, will look at you as sort of with this, “What are you talking about?” I think, again, it's that gap. It's this very academic, removed way that we often look at this, especially when we're trying to shield ourselves from this very human anguish of knowing that there's this real person in front of you who's not doing well and that you feel like you kind of know how the story is going to end. Dr. Lidia Schapira: Let's go a little deeper into that then. It's really about your feelings then here. It's your frustration. You want the patient to mirror back to you that they get how bad this is, and they can't because they are trapped in that body, in that situation. And as you just say, and then you say in the lines that follow, “they are coming up for air.” They're thinking of the summer and the fish that may be caught or not caught. They may know it somewhere, but they can't quite recite that back to you. And that leads the writer, the author, to voice this inner tension. Did I get that right? Dr. Michael Slade: I think that's exactly it. And sort of towards the end of that verse, there's also sort of this counterfactual that certainly different choices can always be made in the course of treatment. And especially for us clinicians when we're encountering a patient who interprets their disease a little bit differently than we do, and they say, “Oh, I feel fine. Why do I need chemo after surgery?” Or, “Oh, I feel fine. Why do I need a bone marrow transplant?” And sometimes people will make choices which makes their immediate life better, but we are always stuck in this sort of feeling of, “Oh, man. If only we had done things a little bit differently.” I acknowledge that we just can't align our views of the world, but still at the same time saying, “Well, I don't know, things would have been better if you'd listened to me. Maybe you made the right choice for you and your disease process.” So it's always that gap between what we know academically and what we sort of know below the neck. And then for patients, their experience is often very different from ours because they have to live through this. Dr. Lidia Schapira: I'm interested in the physician narrator experience here, and I was really impressed by the fact that you convey the tension on the emotional load. But the only thing that you write and communicate directly to the reader is the physical aching, when you say, “it's the evening and my knees ache,” and then you say “I shuffle,” suggesting that you're physically tired. I just wonder if you could talk a little bit more about that, the way that you have inserted the fatigue factor of the narrator here, but through the description of physical symptoms. Dr. Michael Slade: I think there's a little bit of blending there, because I think on the one hand, certainly this emotional anguish, mental anguish can certainly manifest as fatigue, and sometimes can be sort of a little bit of a metaphorical blend there. But I think the other thing that we often really struggle with as physicians and as other providers is how much are we letting ourselves get into the story that the patient is experiencing, but even the story that we're trying to objectively put together. And because, for example, we had a patient who tried a treatment and they had a rare side effect, a lot of us will admit, “Hey, I had a patient with a bad outcome when they got X,Y,Z.” Even if the data looks really good because of my own emotional processing or I do my best. And I know a lot of other physicians talk about this, but if you are tired, hungry, under or over caffeinated, having bad things going at home a lot of times for us, we worry about letting our personal lives bleed into our interactions with patients. And that's really challenging because I think we are at our best when we bring our humanness into the clinic room, into the hospital room. We also have to make sure that we're not saying, “Oh, am I just down because I'm tired, and that's why I think this patient's going to do poorly?” Or is it actually supported by the evidence in front of us? So I think the way that the narrator kind of moves in and out of this piece and how much they are a part of the story is a big piece of the poem. Dr. Lidia Schapira: It is a very big piece of the poem. And as I read some of the other poems you've written, I think that I was also impressed by this construction of the boundaries and the separateness between the patient and the physician narrator and how you negotiate that when you're waiting for a result, when you're waiting for time, when you say it's really the patient's story, but it's yours too. There's a fluidity about this perspective. Did I get that right? Dr. Michael Slade: I think that's an absolutely wonderful way to describe it. I think fluidity in particular is, yeah, that we think of things as very separate from each other and that I'm me and you're you and there's your family and there's the rest of the team. But all of this stuff, not to get too sort of hippie with it, but there's so much resonance when you're in these relationships that you have with patients. And especially in cancer care, we have very deep, often very prolonged and somewhat intense relationships with patients and their families as they go through this stuff. Boundaries can become blurred. And again, I think it's challenging because sometimes we are at our best when we blur those boundaries a little bit. But there's certainly- you can be pulled into a patient's story in a way that is not helpful for you long term, but even not helpful for the patient short term. And I think that's the challenge. And you're right. I spend a lot of my work sort of thinking about this. And a lot of my professional life is also thinking about this. Dr. Lidia Schapira: I would say it a little differently. And it's that you are co-constructing an ‘us' that is between you and they, or you and he or she, or however you see this. And that's the mind part. Others have talked about cases where there is a deep connection between physician and patient, where the physician is invited to be a co-editor of that patient narrative. I think there's a lot of richness in that. And I think that your work and your poetry certainly takes us right there.  And so with that, I want to take us to the end of the poem, which is terrifying.There's going to be, you use the word ‘cataclysmic', which means, this is an upheaval, something violent about to happen. And the way I interpret it is your patient is neutropenic and septic and shaking and rigoring and is getting transfused. And the “They,” which isn't you or your team, it's the ‘they' are waiting for it too and going into probably an intubation in the ICU. And then there's this promise that you won't abandon the patient while ‘they' are going to be doing these things. And we already know how this story is going to end. Is that what you are trying to convey? Dr. Michael Slade: It's funny because until you sort of read it out, I was like, I didn't realize how much I threw our ICU colleagues under the bus as part of this poem. So if any of you guys are listening, I have immense respect and value for what you do. But no, and this is sort of the big question that we run into with these patients and what's the right response when we feel like we can see the future and then we turn out to be correct. How do we not, I guess, insulate ourselves from that in a way that's not helpful for us and it's not helpful for the patient? And yeah, so that's sort of, as I said, you read the story sort of as it was laid down, but yeah. What do you do? What's the right response when you feel like you're getting to the end and that you feel like you've seen it coming for weeks? And I think that's really the challenge. And the poem sort of suggests an answer to that question. But I think everybody kind of has their own process that they have to go through. As you see, unfortunately, as an oncologist, case after case of folks that- cancer is tough and our treatments are getting better, but I'm a myeloma physician. I have cured zero patients so far. And that's hard at the end of the story. It's always hard. Dr. Lidia Schapira: It is hard. Can you tell us a little bit about your choice of language and why you keep repeating the ‘knowing' and then italicize it at the end, just to add another dimension of emphasis there? Dr. Michael Slade: As someone who loves language and has always been interested in it from a philosophical perspective, but literary perspective as well, there's really, really sharp limitations to what language can express. And we can unpack and define and redefine and suggest. But there's something- often, we in these situations, run up into a place where words are totally insufficient. And I feel like often what we end up doing and what I end up doing in writing but I think even in our interactions with people, we just sort of use the same words over and over again, hoping that somehow the meaning will morph mid-interaction and suddenly we'll have that connection with someone where they'll hear what we're trying to say. And for me, I kept coming back to this idea of knowing, knowing, knowing. The narrator's trying to express something that they just can't quite get their arms around. And I think the best and the closest I can get to in similar situations is something like this, is trying to write out these experiences in a way that kind of captures that feeling. I hope I at least captured a piece of it. Dr. Lidia Schapira: Certainly. I loved your writing and I think you did. Despite how difficult it is to talk about this and how difficult it must have been for you to live through it, there's a real gentleness about the way you take the reader through this. And it evolves. Really, it flows beautifully. So thank you for that. Dr. Michael Slade: I very much appreciate the writing. And I will say to the folks who read the original version of this poem, both in my personal life and then at JCO, this is not the original form the poem was in. So I think other people have layered in their experiences here. And again, I love to see this come out on the other end and say, this is more beautiful than what I started with. So I have a lot of gratitude to folks who have given me some pointers about how to improve this. Dr. Lidia Schapira: It's lovely to hear you say that. To end this, I would love to hear you tell me a little bit about comments, perhaps, that colleagues or even patients may have made based on work that you've published or what you hope that people will take away from this. Dr. Michael Slade: I had published maybe one poem back in medical school, and then I published something as a fellow. And I remember in our program, we have this big office and we basically all have cubicles, and we have sort of the computers all set up, and we're in and out, you know, seeing consults and everything else. And I had published something in JCO a few years ago, that was about indirectly the experience of trying to be on call and triage patients and all this. I had maybe three or four different fellows within the week that that was published, sort of stick their head over and be like, “I never read poetry, but I saw your name on this. So I flipped to the back of the JCO magazine and read it.” And that captured so many of the feelings that I've had this year in a way that I couldn't put on paper. Again, I've been writing stuff since college and most of it sits in a folder somewhere and it's never read by anybody. So the idea that it could go out into the world and could make people have that sort of sense of catharsis that I'm not alone in this. Somebody else has had this experience and had this feeling.  I've had that same experience with some of my very brilliant colleagues who paint or who participate in other sorts of artistic endeavors. And it's nice to know that there's a community of people out here. We're all just trying to navigate the same stuff. And if we can sort of help each other, if we can capture these experiences and retranslate them in a way that people can process their own, sometimes, grief. I think it's really wonderful. Dr. Lidia Schapira: Yes. To create a thoughtful community and accompany one another. Well, thank you for sharing your art and your wisdom and your knowing with us today, and please keep writing.  And for our listeners, until next time, thank you for listening to JCO's Cancer Stories, the Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.  Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.   Guest Bio: Dr. Michael Slade is a Medical Oncologist at Washington University School of Medicine.

Women's health continues to be an important issue for many of us, and more and more medical technoplogy startups are getting on board with turning their attention to women's health issues across the globe. Dr. Vinona Bhatia, a trailblazer in medicine, technology, and global health, is here this week to discuss her work in cancer screening and care both here and in Africa, as well as advocating for inclusive leadership, networking, and mentorship. This week's episode 143 of How Women Inspire Podcast is about unlocking barriers to cancer screening and care! This episode was created in partnership with the Nasdaq Foundation. Together, we are working to educate, inspire, and engage women from diverse backgrounds on venture investing and entrepreneurship. Did you know that only 2% of venture funding goes to women-led companies? Together, we are working to show that women are the new face of venture investing.In this episode of How Women Inspire Podcast, Vinona Bhatia is sharing the importance of  innovation to meet women's needs and wants in healthcare and actionable steps you can take right now to seek opportunities to make a difference. Vinona Bhatia is a Medical Oncologist trained at U Penn and UCSF, with an MPH in Global Health and Population from Harvard. Vinona is the Founder of Partnering for Cancer Innovation, an organization working to improve outcomes and quality of life for cancer patients, and ensure that cancer is treated equitably in all parts of the world. Her primary goal is to unblock millions of individuals from the barriers they face accessing cancer screening and care.Some of the talking points Julie and Vinona go over in this episode include:The shift in focus from general women's health to specific issues like menopause and perimenopause.The importance of not being elitist about innovation and recognizing that innovation can take many shapes and forms.The need for clinical studies pre-launch of medical technologies to ensure effectiveness and cost-effectiveness.Seeking opportunities and educating oneself to make a difference.Thank you for listening! If you enjoyed this episode, take a screenshot of the episode to post in your stories and tag me!  And don't forget to follow, rate, and review the podcast and tell me your key takeaways!Learn more about How Women Inspire at https://www.howwomenlead.com/podcast CONNECT WITH VINONA BHATIA:LinkedInPartnering for Cancer InnovationCONNECT WITH JULIE CASTRO ABRAMS:LinkedIn - JulieHow Women LeadHow Women InvestHow Women GiveInstagram - HWLLinkedIn - HWLFacebook - HWL

  Clement Manyathela speaks to Specialist Physician & Medical Oncologist, Dr Omondi Ogude about the effects of chemotherapy on the body and brain.See omnystudio.com/listener for privacy information.

In this episode, we speak with Dr. Fauzia Riaz, a Clinical Assistant Professor of Oncology at Stanford University. We'll discuss the common misconceptions surrounding breast cancer care and the critical role of screening and diagnosis. We will explore treatment options for early-stage and invasive cancers as well as examine how to manage breast cancer during different times in a women's life. Additionally, we'll review personalized care plans and the importance of adhering to treatment guidelines. Dr. Riaz will share insights on managing side effects and navigating sensitive conversations with patients regarding fertility preservation. We'll address quality of life issues from the initial stages of breast cancer through more aggressive diagnoses. Lastly, we will highlight the latest advancements in the field and discuss emerging therapies that are shaping the future of breast cancer care. Read Transcript CME Information: https://stanford.cloud-cme.com/medcastepisode91 Claim CE: https://stanford.cloud-cme.com/Form.aspx?FormID=3103

Tumor profiling or genomic testing can give us information about the genes in a person's cancer cells and can help guide doctors to the best possible treatment plan by predicting the risk of recurrence, or when breast cancer returns after initial treatment. If a low risk of recurrence is shown, people with breast cancer and their doctors can choose to pursue a less aggressive treatment plan with confidence. Here today to empower us with information about the power of genomics and to give further insight into how it can positively affect treatment decisions is Medical Oncologist, specializing in Breast Cancer and Cancer Genomics, and Chief Medical Officer at Agendia, Dr. William Audeh.

Dr Charles B. Simone.  I am an Internist, a  Medical Oncologist, a Radiation Oncologist, and an Immunologist, trained at the Cleveland Clinic, the National Cancer Institute, and the University of Pennsylvania. Dr. Simone begins by letting us know that the virus was created on purpose and the DOD created the vaccine and then it was sold to Big Pharma. This was planned false flag to remove the President of the US. The cures have always existed but Big Pharma has kept it from the people. Now the people are learning that they do exist and that the Big Pharma and the Gov has been trying to hide from us.

Dr. Elizabeth Comen learned at a very early age that two women can have the same diagnosis with breast cancer, but how they experience it, feel in their bodies, what they want to feel whole, and to thrive in the world, is completely different. Since then, she has dedicated her medical career to saving the lives of women. Her latest book All In Her Head uncovers the truth and lies early medicine taught us about women's bodies and why it matters today. This episode is to empower women, of all ages, to take their health into their own hands and become their greatest advocates for themselves and one other.Mentioned in this episode:All in Her Head Written by Elizabeth ComenChantecaille Tinted MoisturizerYSE Beauty Wide Awake Eye CreamSponsors:From now until May 31st you can shop Macy's Gold Jewelry Month at macys.com. Don't wait the sale ends soon and you won't want to miss these insane deals.Fatty15 is on a mission to replenish your C15 levels and restore your long-term health. You can get an additional 15% off their 90-day subscription Starter Kit by going to fatty15.com/ LIPSTICK and using code LIPSTICK at checkout.Start your Spring and Summer shopping hauls now and get 15% off your order of $100 or more at HillHouseHome.com with code LIPSTICK15. Again that's code LIPSTICK15 for 15% off your order at HillHouse Home.comGet 30% off your first product order or subscription on Biosil's website www.biosil.beauty with code LIPSTICK. Go to signos.com and get up to 20% off select plans with code LIPSTICK.Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.Produced by Dear Media.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.