Podcasts about Yale Cancer Center

Connecticut launched a recent initiative to eliminate medical debt for 100,000 CT residents and low-income families. We got a better understanding about financial toxicity and how it impacts patients from Dr. Rachel Greenup. She is co-director at the Center for Breast Cancer, Yale Cancer Center and Smilow Cancer Hospital.  IMAGE CREDIT:  iStock / Getty Images Plus

Skin Cancer Awareness Month with guest Dr. Kelly Olino May 25, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Advancing Urologic Cancer Treatment with Cutting-Edge Technology with guest Dr. Preston Sprenkle May 18, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Innovative Techniques for Preventing and Treating Lymphedema with guest Dr. Siba Haykal May 11, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

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.

Innovations in Melanoma Treatment: The Role of TIL Therapy with guest Dr. Harriet Kluger May 4, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Novel Treatments for Blood Cancers with guest Dr. Amer Zeidan April 27, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Dr William Oh from the Yale Cancer Center in New Haven, Connecticut, discusses recent updates on available and novel treatment strategies for genitourinary cancers. CME information and select publications here.

Breaking Barriers in the Future of Brain Tumor Treatment with guest Dr. James Hansen April 21, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Hole in the Wall Gang Camp with guest Hilary Axtmayer April 13, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Tens of millions of Americans smoke cigarettes regularly and something that has become clear in the last couple of decades is the direct correlation between smoking and cancer diagnoses. But is that message actually resonating enough with the general public? Nearly half of patients diagnosed with cancer in 2023 had a history of smoking, and 15% were smokers at the time of their diagnosis. That's according to new Yale Cancer Center-led research published in in JAMA Oncology. We spoke with Yale Cancer Center's Dr. Dan Boffa, the study's senior investigator. Image Credit: Getty Images

Building Relationships through Outpatient Palliative Care with guest Dr. Dmitry Kozhevnikov April 6, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Breakthroughs in the Surgical Care of Thoracic Cancers and how Early Detection is Saving Lives with guest Dr. Dan Boffa March 30, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu

In today's episode, OncLive teamed up with CURE to present a discussion with David A. Braun, MD, PhD, about his research on determinants of response to immune checkpoint inhibition (ICI) in patients with renal cell carcinoma (RCC). Dr Braun is an assistant professor of medicine (medical oncology), the Louis Goodman and Alfred Gilman Yale Scholar, and a member of the Center of Molecular and Cellular Oncology at Yale Cancer Center in New Haven, Connecticut. In this exclusive interview, Dr Braun discussed the rationale for investigating molecular factors that contribute to exceptional ICI responses among patients with RCC, as well as the key findings from this study. He also shared how these findings may affect cancer care and influence shared decision-making strategies for patients receiving immunotherapy.

Breast Cancer in Young Women: Optimizing Knowledge and Care to Improve Outcomes with guest Dr. Ann Partridge March 23, 2025 Yale Cancer Center visit: http://www.yalecancercenter.orgemail: canceranswers@yale.educall: 203-785-4095

50 Years of Cancer Progress: Medical Oncology with guest Dr. Roy Herbst March 16, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

When a fire sparks or someone falls and can't get up, who do you call and expect to save the day? Firefighters! And despite reports of firefighters' exposure to cancer causing chemicals, Connecticut lawmakers do not allocate enough money to compensate them for their service if they develop cancer on the job. A new study uncovered an association between exposure to chemicals commonly used in firefighting and glioma risk (brain tumors). We spoke with Dr. Elizabeth Claus, who led the study and is a member of Yale Cancer Center. Image Credit: Getty Images 

Oncology Here & NowIn this interview, Dr. Elisa Agostinetto from the Jules Bordet Institute in Belgium speaks with Dr. Maryam Lustberg from Yale Cancer Center. Together, they dive deep into the use of CDK 4/6 inhibitors in the adjuvant treatment of breast cancer. Their discussion covers the use of Abemaciclib and Ribociclib following the monarchE and NATALEE trials, applications in the treatment of male breast cancer, and much more.Join us!

Advanced Reconstructive Surgery for Head and Neck Cancer with guest Dr. Saral Mehra March 9, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Robotic Surgery for Gynecologic Cancer: Transforming Patient Care with guest Dr. Elena Ratner March 2, 2025 Yale Cancer Center visit: https://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Kidney cancer is one of the deadliest cancers, and a therapeutic vaccine shows promising results, offering new hope for those suffering with the disease. Dr. David Braun, a medical oncologist and researcher at Yale Cancer Center is here – he was the principal investigator on the kidney cancer vaccine study that published in the medical journal, Nature. Image Credit: Getty Images

Improving Long-term Outcomes for Patients with Breast Cancer with guest Dr. Maryam Lustberg February 23, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

50 Years of Cancer Progress: Radiation Oncology with guest Dr. Peter Glazer February 9, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

50 Years of Cancer Progress - Survivorship with guest Dr. Tara Sanft February 2, 2025 Yale Cancer Center visit: http://www.yalecancercenter.orgemail: canceranswers@yale.educall: 203-785-4095

Healing and Hope in Pediatric Cancer Care with guest Dr. Prasanna Ananth January 26, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Advancing Breast Cancer Care for Hispanic Women with guest Dr. Monica Valero, January 19, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

The American Cancer Society released a new report this week showing younger women are nearly twice as likely to have cancer than men. It also showed middle-aged women are at a higher risk for cancer too. Medical oncologist and the director of the early onset cancer program at Yale Cancer Center, Dr. Veda Giri, shared what could be leading to these new trends and what women should be doing to prevent a cancer diagnosis. Image Credit: Getty Images

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.  

Increasing Access to Clinical Trials with guests Dr. Ian Krop and Alyssa Gateman, January 12, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Dr Erika Hamilton from the Sarah Cannon Research Institute in Nashville, Tennessee, Dr Kevin Kalinsky from the Winship Cancer Institute of Emory University in Atlanta, Georgia, Dr Ian E Krop from the Yale Cancer Center in New Haven, Connecticut, Dr Joyce O'Shaughnessy from the Sarah Cannon Research Institute in Dallas, Texas, and Dr Sara M Tolaney from the Dana-Farber Cancer Institute in Boston, Massachusetts, discuss available and novel treatment strategies for metastatic breast cancer, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/SABCS2024/mBC).

Dr Erika Hamilton from the Sarah Cannon Research Institute in Nashville, Tennessee, Dr Kevin Kalinsky from the Winship Cancer Institute of Emory University in Atlanta, Georgia, Dr Ian E Krop from the Yale Cancer Center in New Haven, Connecticut, Dr Joyce O'Shaughnessy from the Sarah Cannon Research Institute in Dallas, Texas, and Dr Sara M Tolaney from the Dana-Farber Cancer Institute in Boston, Massachusetts, discuss available and novel treatment strategies for metastatic breast cancer.

Cancer Risks and The Role of Patient Decision Making with guest Dr. Sarah Schellhorn January 5, 2025 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

As we begin 2025, many are also starting dry January to reduce alcohol intake and improve their health. Yale Cancer Center expert, Dr. Banini, explained the health benefits of reducing or eliminating alcohol altogether. She also shared why your drinking habits can be significant in preventing cancers. For more information: Alcohol and Cancer | Cancer | CDC Image Credit: Getty Images

In this two-part episode of the Precision Medicine Podcast, host Karan Cushman continues her deep dive into prostate cancer care with expert guest Dr. William Oh, a leading genitourinary oncologist, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Building on part one (episode 63), they explore the transformative role of precision medicine, advanced diagnostics, and targeted therapies—emphasizing the urgent need for greater awareness, understanding, and advocacy as prostate cancer continues to rise steadily. Karan opens the conversation by emphasizing the growing complexity of prostate cancer diagnostics and treatment. Dr. Oh discusses the wide array of diagnostic tools, from PSA tests and MRIs to the cutting-edge PSMA PET scan, which has revolutionized staging and treatment planning by providing detailed insights into cancer spread. He highlights how these tools are helping oncologists tailor treatment plans with unprecedented precision. The discussion shifts to molecular diagnostics, a burgeoning field that provides critical information about the aggressiveness of cancer. Dr. Oh explains how molecular tests, such as genomic profiling, are enabling personalized treatment decisions for prostate cancer patients, particularly those on the fence about options like surgery, radiation, or active surveillance. Karan and Dr. Oh also address disparities in access to these advanced diagnostics, underlining the need for wider implementation. Karan steers the conversation toward advancements in targeted therapies. Dr. Oh outlines breakthroughs in precision treatments, including PARP inhibitors for patients with BRCA mutations and the innovative LU-177-PSMA therapy, a “smart bomb” approach that targets cancer cells with remarkable specificity. He also explores the promise of immunotherapy, though he acknowledges its limited applicability for prostate cancer due to the disease's low mutational burden. The role of artificial intelligence in precision oncology is another key topic. Dr. Oh and Karan discuss how AI and machine learning are helping clinicians process complex data, from imaging to genomic profiles, to guide more informed treatment decisions. Dr. Oh envisions AI as an essential tool for streamlining oncology workflows while preserving the human connection between doctors and patients. Karan highlights the importance of effective communication in prostate cancer care, referencing a recent editorial co-authored by Dr. Oh. Together, they explore the need for more patient-centered terminology, such as replacing the term “castration-resistant prostate cancer” with “androgen deprivation-resistant prostate cancer,” to foster better understanding and improve patient experience. The episode concludes with a forward-looking discussion on clinical trials, the integration of new technologies like liquid biopsies, and the ongoing efforts to expand insurance coverage for biomarker testing. Dr. Oh emphasizes the critical role of collaboration, awareness, and education in advancing precision medicine and ensuring that patients benefit from the latest innovations. With Karan's thoughtful questions and Dr. Oh's expertise, this episode offers a comprehensive and accessible exploration of how precision medicine is reshaping the future of prostate cancer care. We hope you'll tune in to the series and share this important episode with others!

Patient Perspective: Living with Li-Fraumeni Syndrome with guest Amanda Antonelli December 29, 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Emerging Trends in Cancer Care Outcomes with guest Dr. Michaela Dinan December 22, 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

The original Golden Bachelor, Gerry Turner, revealed that he's been fighting Waldenstrom's macroglobulinemia, an incurable and rare slow-growing type of non-Hodgkin's lymphoma. Yale Cancer Center expert, Dr. Natalia Neparidze, explained risk factors, treatment strategy, and the prognosis. Image Credit: Reuters

Targeted Treatments for Head and Neck Cancer with guest Dr. Barbara Burtness, December 15, 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

In part one of a two-part series on prostate cancer, the Precision Medicine Podcast addresses critical challenges as well as new advancements in prostate cancer, the second leading cause of cancer-related deaths in men. Host, Karan Cushman, is joined by Dr. William Oh, Director of Precision Medicine at Yale Cancer Center and Chair of the American Cancer Society National Prostate Cancer Roundtable. Together, they shed light on the complexities of prostate cancer and how early screening can address rising incidence rates and persistent disparities, particularly among African American men. Subscribe to get Part 2 delivered straight to your inbox.Prostate cancer currently affects one in eight men in the US, with African American men facing a one-in-six risk and 70% higher incidence rate than White men. These disparities extend to earlier onset and more aggressive disease presentations. Globally, the disease is the most frequently diagnosed cancer in 112 countries and a leading cause of cancer-related deaths in 48 countries. The incidence of prostate cancer has been rising steadily. There has been a 3% annual increase in cases and a 5% annual rise in advanced prostate cancer diagnoses since 2014. Throughout the series, Dr. Oh discusses the role precision medicine can play in addressing these trends by tailoring prevention, diagnosis and treatment strategies to individual patient profiles. Karan and Dr. Oh begin the conversation by highlighting critical advances in prostate cancer care, including the development of over a dozen FDA-approved drugs in recent decades. Listeners will learn of the systemic barriers that often prevent men from accessing these treatments, resulting in just half of men with advanced prostate cancer receiving standard-of-care therapies—a fact that underscores the need to improve access and equity in treatment. Dr. Oh chairs the American Cancer Society National Prostate Cancer Roundtable, which aims to address these gaps by uniting diverse stakeholders—from patient advocacy groups to scientific organizations—to improve outcomes through collaborative efforts. The discussion also explores the role of environmental and epigenetic factors in prostate cancer risk. Dr. Oh discusses how stress, socioeconomic disparities, and toxic exposures, such as those experienced by 9/11 first responders, may alter DNA and increase cancer risk. He compares these findings to the higher incidence of prostate cancer among African American men who live in environments that exacerbate health disparities. Dr. Oh emphasizes the importance of identifying and mitigating these risks to improve outcomes. Screening is a key topic throughout the conversation, and Dr. Oh discusses the challenges of early detection and the controversies surrounding PSA (prostate-specific antigen) screening. While current guidelines recommend baseline PSA testing for most men between the ages of 50 to 55, new evidence supports earlier screening for high-risk populations, particularly African American men who should begin testing between ages 40 and 45. This shift toward earlier detection is critical for addressing aggressive cancers before they progress to advanced stages. Dr. Oh goes on to explain the importance of genetic testing, which reveals up to 10% of advanced prostate cancer cases involve BRCA or other DNA repair mutations. Recognizing these mutations early can inform targeted treatments like PARP inhibitors, yet Dr. Oh notes that many patients are not tested, underscoring the need for better implementation of precision diagnostics. By linking genetic data to clinical outcomes, precision medicine can help tailor treatments to the unique needs of each patient. The episode concludes with a call to action for improved education and collaboration. Dr. Oh emphasizes the need for patients to discuss family history and risk factors with their doctors and for primary care physicians to prioritize early conversations about prostate health. He advocates for a comprehensive approach that combines education, technology and multidisciplinary care to close gaps in prostate cancer treatment and ensure that advances in precision medicine benefit all populations, especially those at highest risk. Stay tuned for Part 2 with Dr. Oh coming out in late December 2024.

Lung Cancer Screening Guidelines and Care with guest Dr. Lynn Tanoue, November 24, 2024 Yale Cancer Center visit: www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

The American Lung Association just dropped its "State of Lung Cancer" report. The data looks at how lung cancer varies by state. How did Connecticut fare? Dr. Roy Herbst, lung cancer physician and expert at Yale Cancer Center gave us some key takeaways for our state. For the full CT report: https://www.lung.org/research/state-of-lung-cancer/states/connecticut Image Credit: Getty Images

Groundbreaking Treatment for a Rare Lymphoma with guest Dr. Francine Foss, November 17, 2024 Yale Cancer Center visit: yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

In this episode of the Oncology Brothers podcast, hosts Drs. Rohit and Rahul Gosain welcome Dr. Pamela Kunz, a world-renowned medical oncologist from the Yale Cancer Center, to discuss the complex landscape of neuroendocrine tumors (NETs). Join us as we explore: •⁠  ⁠The classification of neuroendocrine tumors based on grade, histological features, and the significance of KI-67. •⁠  ⁠The role of imaging modalities, including Gallium PET-CT and its importance in evaluating disease extent. •⁠  ⁠Treatment strategies for localized versus metastatic NETs, including the use of somatostatin analogs and the nuances of observation versus intervention. •⁠  ⁠Insights into the latest treatment options, including lutetium dotatate, Capecitabine-Temozolomide, and the anticipated approval of Cabozantinib. •⁠  ⁠The potential role of NGS testing and the challenges of combining chemotherapy with immunotherapy in high-grade neuroendocrine tumors. Whether you're a healthcare professional or someone interested in the latest advancements in oncology, this episode provides valuable insights into the management of neuroendocrine tumors. Don't forget to like, subscribe, and check out our other episodes for more discussions on current standard of care treatment options, conference highlights, and new drug approvals. We look forward to seeing you at GI ASCO in January 2025! #OncologyBrothers #NeuroendocrineTumors #CancerCare #MedicalOncology #Podcast #NETs Website: http://www.oncbrothers.com/ X/Twitter: https://twitter.com/oncbrothers Contact us at info@oncbrothers.com

Using Radiation to Treat Rare Brain Tumors with guest Dr. Joseph Contessa, November 10, 2024 Yale Cancer Center visit:

Improving Patient Outcomes with Innovations in Endocrine Surgery with guest Dr. Jennifer Ogilive, November 3 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

A Rise in Early Onset Cancers: What Does it Mean? with guest Dr. Veda Giri, Sunday, October 27, 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

Breaking Boundaries: The Science of Immune Tolerance with guest Dr. Mark Mamula, October 20, 2024 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095

In today's episode, supported by Citius Pharmaceuticals, we had the pleasure of speaking with Francine Foss, MD, to discuss the FDA approval of denileukin diftitox-cxdl (Lymphir) for the treatment of patients with relapsed/refractory cutaneous T-cell lymphoma (CTCL) who have received 1 or more prior systemic therapies. Dr Foss is a professor of medicine (hematology) and dermatology and the director of the Multidisciplinary T Cell Lymphoma Program at the Yale School of Medicine, as well as the scientific leader of Lymphoma CRT at Yale Cancer Center in New Haven, Connecticut.  On August 8, 2024, the FDA approved denileukin diftitox for the treatment of patients with relapsed/refractory CTCL who have received at least 1 prior systemic therapy. This regulatory decision was supported by findings from the phase 3 Study 302 (NCT01871727), in which patients who received the agent (n = 69) achieved an objective response rate of 36.2% (95% CI, 25.0%-48.7%) per independent review committee assessment, including a complete response rate of 8.7%. In our exclusive interview, Dr Foss discussed the significance of this approval, key efficacy and safety data from Study 302, and her excitement about reintroducing an agent to the CTCL treatment paradigm that can induce particularly robust responses.

Dr Pamela Kunz from the Yale School of Medicine and Yale Cancer Center in New Haven, Connecticut, and Dr Simron Singh from the Odette Cancer Centre and Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada, discuss optimizing the diagnosis and treatment of neuroendocrine tumors, moderated by Dr Neil Love. Produced by Research To Practice. CME information and select publications here (https://www.researchtopractice.com/InsideTheIssue2024/Neuroendocrine).

What is supportive care or supportive oncology? What is cancer-related distress? How might NET patients benefit from supportive care? Yale oncologist Dr. Maryam Lustberg suggests strategies to manage cancer-related fatigue, diarrhea, nausea, mouth sores, peripheral neuropathy, distress, anxiety, and anxiety. She also addresses considerations for fertility and sexual health.MEET DR. MARYAM LUSTBERGDr. Maryam Lustberg is an American breast oncologist. She is the Director of The Breast Center at Smilow Cancer Hospital and Chief ofBreast Medical Oncology at Yale Cancer Center. Dr. Lustberg previously served as the Medical Director of Cancer Supportive Care Services atOhio State's Comprehensive Cancer Center. She is the Immediate Past President of the Multinational Association of Supportive Care in Cancer. She is also an Associate Editor for the Journal of Cancer Survivorship.TOP TEN QUESTIONS ABOUT SUPPORTIVE CARE: What is supportive care in cancer (or supportive oncology)? What is survivorship? How do these concepts apply to the NET community?What is the 1st step for patients to get supportive care?What are the most common treated-related adverse events or side effects? What are risk factors for them? (Will all patients experience all potential side effects?)What causes cancer-related fatigue (CRF)? What are some strategies to manage cancer-related fatigue?What are some strategies to manage diarrhea?What are some strategies to manage nausea?What are some strategies to manage mouth sores?What is peripheral neuropathy? When do patients experience it and what can be done to prevent it?What should patients understand about sexual health and fertility?How can psychosocial needs such as distress, anxiety, and depression be addressed and supported?For more information, please visit https://www.lacnets.org/podcast/37. For more information, visit LACNETS.org.