Oncology On The Go

Through elaborate multidisciplinary collaboration, institutions with National Accreditation Program for Rectal Cancer (NAPRC) standards can deliver a “high level of care” in the surgical treatment of patients with rectal cancer, according to Steven Wexner, MD, PhD, and Arielle Kanters, MD. In a conversation with CancerNetwork®, Wexner and Kanters detailed the history and advancement of the NAPRC as an interdisciplinary initiative to improve the outcomes of those undergoing surgery for rectal cancer. Wexner is the chair in the Department of Colorectal Surgery and director of the Ellen Leifer Shulman & Steven Shulman Digestive Disease Center at Cleveland Clinic, Florida, the founding chair of the NAPRC for the American College of Surgeons Commission on Cancer, and part of the executive committee of the Commission on Cancer. Kanters is a colorectal surgeon, associate fellowship program director, and surgeon leader of the NAPRC program at Cleveland Clinic Main Campus. Wexner spoke about the inspiration for developing the NAPRC as a mission to elevate the level of surgical outcomes in patients with rectal cancer across the United States to those he observed in European countries such as the United Kingdom and Scandinavia. He enlisted leaders from organizations including the Society of Surgical Oncology and the College of American Pathologists to outline and apply appropriate standards for surgical care in rectal cancer. Additionally, Kanters highlighted how enforcing precise guidelines and compliance measures through the NAPRC program facilitates multidisciplinary efforts with colleagues who specialize in radiology and pathology. She stated that these principles help individuals develop their skills across each department, thereby maintaining a high level of treatment for patients with rectal cancer. Findings from a study published in the Journal of the American College of Surgeons indicated that mortality and complication rates appeared to be lower for patients who received surgery for rectal cancer at NAPRC-accredited institutions compared with those who were treated at non-accredited practices. Wexner and Kanters also discussed how potential advancements related to the use of neoadjuvant or adjuvant therapy may further improve patient outcomes in the field. Additionally, they spoke about updated research on immunotherapy and other modalities that they anticipate at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. Reference Harbaugh CM, Kunnath NJ, Suwanabol PA, Dimick JB, Hendren SK, Ibrahim AM. Association of National Accreditation Program for Rectal Cancer Accreditation with outcomes after rectal cancer surgery. J Amer College Surg. Published March 28, 2024. doi:10.1097/XCS.0000000000001064

In a conversation with CancerNetwork® at Memorial Sloan Kettering Cancer Center (MSKCC), Neil M. Iyengar, MD, spoke about developments and challenges in his career as a medical oncologist and clinical investigator as well as ongoing research efforts in improving outcomes among patients with breast cancer. Iyengar, a breast oncologist in in the Department of Medicine at MSKCC and Weill Cornell Medicine in New York City, New York, as well as the co–editor-in-chief of the journal ONCOLOGY®, detailed his work in the emerging field of exercise oncology. Based on preclinical data supporting the potential anti-tumor effects of exercise, he and his colleagues are organizing several clinical trials to validate whether exercise intervention can improve cancer-specific end points. Although some findings may support implementing exercise as part of a cancer treatment plan, Iyengar noted the observational and self-reported nature of the prior data and said that it would be necessary to test exercise intervention in the same way “you would develop any new drug for treating cancer.” Additionally, Iyengar discussed the fulfillment of ensuring patient care, a passion that has fueled his interest in lifestyle interventions such as exercise oncology. He highlighted how his cancer treatment philosophy extends beyond the goal of reducing tumor volumes to safeguarding the patient’s physical and emotional well-being. “You can certainly hammer away at a tumor and give all kinds of chemotherapy and anti-cancer therapies, but if that [patient] is feeling miserable and has no quality of life and a short duration of response to that therapy, that’s not necessarily the type of outcome that I would consider to be successful,” Iyengar said. “If you’re able to either control or cure a cancer while also improving a [patient’s] quality of life and general well-being, that’s the kind of outcome that I strive for. When I see that in my patients and in the patients of my colleagues, that certainly brings a lot of fulfillment.” Iyengar also highlighted how he found excitement and passion in off-hours responsibilities to help achieve work-life balance. Looking ahead, he spoke about data on anti-estrogen agents, antibody drug conjugates, and other breast cancer treatment strategies that he is looking forward to hearing at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting.

In a discussion with CancerNetwork® at John Theurer Cancer Center, Gregory Charak, MD, highlighted advancements in surgical treatment strategies for patients with colorectal cancer (CRC) as well as other ongoing challenges in the field. Specifically, Charak, a board-certified colorectal surgeon at Palisades Medical Center and Hackensack University Medical Center of Hackensack Meridian Health, described how minimally invasive strategies such as laparoscopic and robotic surgery have become more prevalent in the field, which have appeared to confer improvements in pain and length of hospital stay for patients. Although these minimally invasive techniques are typically preferred in this population compared with open surgery, Charak stated that he would still employ the latter depending on factors such as tumor size. Charak also discussed the rise in CRC incidence among younger populations, which has impacted how practices conduct screening. He highlighted that patients who are in their late 20s or 30s receive recommendations to undergo colonoscopy in the event of weight changes or blood appearing in their stool, noting that he would not hesitate to perform screening even if there’s a small but real possibility of disease. Regarding other treatment modalities in this population, Charak emphasized the potential benefits of neoadjuvant therapy. Administering neoadjuvant treatment with agents including cytotoxic chemotherapy and immunotherapy, for example, may help achieve negative-margin resections, thereby yielding less morbidity for patients. “It’s a very exciting time to be a surgical oncologist. [There are] tremendous new treatment modalities coming down the pike. Immunotherapy, in particular, is extremely exciting because it’s such an elegant way to treat cancer: to harness and augment the body’s own defense system to eliminate a cancer rather than using cytotoxic chemicals or invasive surgery,” Charak said. “It’s a beautiful thing. If we can get it to apply to more and more tumors and figure out how to make it work, it couldn’t be more exciting.”

During the 2024 Oncology Nursing Society Congress, CancerNetwork® spoke with multiple registered nurses about research they presented on safely administering treatment options such as CAR T-cell therapy and bispecific T-cell engager (BiTE) therapy in patients with multiple myeloma and other malignancies. Ishmael Applewhite, BSN, RN-BC, OCN, a registered nurse at the University of Rochester Medical Center, highlighted the management of adverse effects including peripheral neuropathy in patients with multiple myeloma undergoing treatment with ciltacabtagene autoleucel (cilta-cel; Carvykti). He discussed these treatment strategies in the context of a presentation he gave on findings from the phase 3 CARDITUDE-4 trial (NCT04181827), in which investigators assessed treatment with cilta-cel in those who were refractory to lenalidomide (Revlimid).1 According to Applewhite, cilta-cel may offer “another path” aside from standard treatment options such as chemotherapy and give “more time” to patients with multiple myeloma. Additionally, Leslie Bennett, MSN, RN, a nurse coordinator at Stanford Healthcare, highlighted the importance of identifying and mitigating cranial nerve palsy (CNP) in patients with multiple myeloma who are treated with cilta-cel. At the conference, Bennett presented data on CNP outcomes across various studies, which included the phase 1/2 CARTITUDE-1 trial (NCT03548207), phase 2 CARTITUDE-2 trial (NCT04133636), and phase 3 CARTITUDE-4 trial (NCT04181827).2 According to findings from this presentation, patients had CNP onset at a median of approximately 3 weeks after beginning treatment with cilta-cel. Most cases of CNP tended to occur in male patients. Kathy Mooney, MSN, RN, ACNS-BC, BMTCN®, OCN®,clinical program director at Johns Hopkins Hospital and Johns Hopkins Health System, spoke about a study designed to evaluate the feasibility and safety of using BiTE therapy to treat those with cancer in an outpatient setting.3 Mooney emphasized multidisciplinary collaboration among nurses, pharmacy providers, and social workers as part of monitoring patients for toxicity as they undergo treatment with BiTE agents. References 1. Applewhite I, Elfrink G, Esselmann J, Lonardi C, Florendo E, Sidiqi MH. Efficacy and adverse events after ciltacabtagene autoleucel treatment in the CARTITUDE-4 as-treated population consisting of patients with lenalidomide-refractory multiple myeloma who received 1-3 prior lines of therapy. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC. 2. Bennett L, Kruyswijk S, Sidana S, et al. Incidence and management of cranial nerve impairments in patients with multiple myeloma treated with ciltacabtagene autoleucel in CARTITUDE studies. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC. 3. Mooney K, Allen N, Anderson K, Zukas A. Taking a BiTE out of hospital admission days using a team approach to managing patients at risk for treatment related toxicities. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

In a conversation with CancerNetwork® at John Theurer Cancer Center, Timothy Chen, MD, highlighted various novel treatment strategies that have impacted his care of patients with brain tumors and other types of cancer. Chen, a board-certified radiation oncologist and medical director of the Central Nervous System Program at Jersey Shore University Medical Center and the director of Proton Therapy in the Department of Radiation Oncology at Hackensack Meridian Health, first discussed his use of the novel stereotactic radiosurgery modality ZAP-X for patients with brain tumors. According to Chen, this tool may allow for practices to administer radiation at submillimeter precision, which can spare normal tissue from receiving excess radiation. Another technology that Chen highlighted included GammaTile, a radiation treatment that was developed for the management of brain tumors. He said that this collagen tile may help with administering strong radiation to precisely where the tumor is located, while also protecting healthy tissues to minimize the adverse effects from radiation therapy. Specifically, Chen stated that GammaTile may be beneficial for those with larger, difficult-to-treat tumors. Finally, Chen discussed the potential applications of proton therapy and how it may improve outcomes in patients compared with standard radiotherapy. According to Chen, proton therapy serves a “great purpose” with what he described as a precise depth charge that can minimize toxicity during treatment. Additionally, Chen described how proton therapy may help reduce the probability of developing mutations or secondary cancers among pediatric patients. He highlighted the potential benefit of this modality based on a specific case in which a pediatric patient with myxopapillary ependymoma experienced improvements in pain and urinary control following proton therapy. Regarding these novel forms of therapy, Chen emphasized the notion of multidisciplinary care and said that practices should “work together as a team” when operating these technologies. “[With] all this technology, it's not just used as it is; the technology brings us to work together,” Chen said. “I think multidisciplinary care is the future. People are no longer siloed…. We all work together.”

The robotic-assisted biopsy platform Ion is a “game-changer” for patients with lung cancer, as it provides a quicker, less invasive surgical method for conducting a lung biopsy, according to Richard Lazzaro, MD. In a conversation with CancerNetwork, Lazzaro, the chief of Thoracic Surgery at the Southern Region of RWJBarnabas Health, spoke about his experience with adopting the Ion robotic bronchoscopy platform for the early detection of lung cancer at Monmouth Medical Center. He highlighted how the tool may enable practices to acquire tissue and perform disease staging with fewer complications, which may particularly benefit those who plan to undergo induction chemotherapy or immunotherapy. In terms of other potential advancements in the lung cancer surgery field, Lazzaro discussed how he anticipates the use of video-assisted thoracoscopic (VATS) surgery to evolve. Specifically, he mentioned the development of technologies such as augmented reality as tools that may help minimize the variability of surgical procedures. Regarding his practice, Lazzaro highlighted how a multidisciplinary thoracic tumor board—including medical oncologists, radiologists, pathologists, and pulmonary physicians, among others—has helped in producing long-term survival improvements. He emphasized collective discussions and shared decision-making as part of determining appropriate courses of care for his patients. When it comes to a multidisciplinary approach, Lazzaro stated that “you want to take care of patients” like they were part of “your family.” Overall, Lazzaro noted how the lung cancer treatment landscape has changed over time. He emphasized referring patients for CT scans as well as evaluations at nodule or thoracic oncology clinics as part of a multidisciplinary strategy. “The management of lung cancer is different than it was even 5 years ago. If we can detect lung cancer early, we have options for treating patients today that we never had before,” Lazzaro said. “This is the time where we really need to make a huge difference in lung cancer.” Reference Latest most advanced treatments for lung cancer now available at Monmouth Medical Center. News release. RWJBarnabas Health. January 22, 2024. Accessed April 17, 2024. https://tinyurl.com/ty8st3hm

During the 2024 Society of Surgical Oncology Annual Meeting (SSO), CancerNetwork® spoke with a variety of surgical oncology experts regarding the topline data they presented. Each conversation also expanded upon how these results can be implemented into the clinical space and the next research steps. First, Adrienne Bruce Shannon, MD, a complex general surgical oncology fellow at Moffitt Cancer Center, discussed findings from her presentation highlighting responses to neoadjuvant immune checkpoint inhibitors among select patients with mismatch repair deficient (dMMR) gastroesophageal cancer.1 Looking ahead, Shannon described her aim to optimize treatment strategies for this patient population, which may include assessing whether single-agent treatment can be efficacious while avoiding toxicity associated with combination regimens. Next, Sean Dineen, MD, an associate member in the Gastrointestinal Department, section leader for Peritoneal Disease, and the program director for the Complex General Surgical Oncology Fellowship at Moffitt Cancer Center, spoke about his session, which was aimed at determining appropriate conditions for using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for those with colorectal cancer (CRC) and peritoneal metastases.2 Dineen highlighted that there is “good evidence” in support of HIPEC as a “valid treatment option” and emphasized the need to encourage medical oncologists to refer patients for consideration of surgery. Additionally, he spoke about other advancements he hopes to see in this patient population, including the development of markers of various disease volumes that can help identify potential recurrence in those who receive surgery. Finally, Muhammad Talha Waheed, MD, a research fellow in the Department of Surgical Oncology at City of Hope National Medical Center in Duarte, California, detailed findings from a retrospective analysis indicating disparate treatment access and cancer-related mortality based on racial-economic segregation.3 Specifically, data showed that those who lived in Black and poor majority areas were less likely to receive care that was in accordance with various treatment guidelines while having worse overall survival outcomes. Regarding the next steps, Waheed described his intentions of sharing his findings with policymakers who may create legislature intended to mitigate the disparities observed in the analysis. References 1. Shannon AB, Mehta RJ, Mok SR, et al. Pathologic response to neoadjuvant immunotherapy in DNA mismatch repair protein-deficient gastroesophageal cancers. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. Abstract 94. 2. Dineen S. Optimal tumor burden for CRS/HIPEC in colorectal cancer. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. 3. Waheed MT, Sullivan KM, Haye S, et al. Impact of racialized residential segregation on guideline concordant cancer care and survival. Presented at the Society of Surgical Oncology (SSO) 2024 Annual Meeting; March 20 – 23, 2024; Atlanta, GA; abstract E126.

As part of Breaking Barriers: Women in Oncology, Maha H. Hussain, MD, and Sarah E. Fenton, MD, PhD, spoke with CancerNetwork® about developments in their careers and the evolution of research in the genitourinary oncology (GU) field. Additionally, they discussed their personal experiences in the field, which ranged from applying key pieces of advice from former mentors, handling challenges, and maintaining a healthy work/life balance. Hussain is a Genevieve E. Teuton Professor of Medicine at Northwestern Medicine, and her mentee and fellow colleague, Fenton, is an assistant professor of Medicine at Northwestern Medicine. The conversation partly focused on how the GU oncology landscape has evolved over time. According to Hussain, funding for new research and clinical trials has grown due to partnerships with pharmaceutical companies, which has accompanied a growth in median survival for patients with metastatic castration-resistant and metastatic hormone-sensitive prostate cancer. Looking ahead, Fenton said she hopes to see a greater proportion of patients achieve improved disease control, thereby leading to more treatment discontinuations or longer treatment-free intervals. Additionally, Fenton described some of the advice she received that impacted the trajectory of her career and helped her decide to specialize in GU oncology. “You need to stick with things that are important to you, worth your time, and are going to help people,” Fenton said. “That is the best piece of advice that Maha has given me as I’ve been moving through and thinking about what projects I’m going to start and where I am going to work hard.” Hussain and Fenton also spoke about some of the personal challenges they have encountered in genitourinary oncology, including the difficulty of balancing their personal lives with professional aspirations. Both spoke to the importance and possibility of caring for their families while establishing priorities for their work. “You can parallel-track your career and your personal life. I would say motherhood is wonderful; it’s a wonderful opportunity to be a mother,” Hussain said. “At the same time, it was a wonderful opportunity to be a physician and move the field there and work hard. Don’t forget that your personal life is very important because a happy personal life also reflects on your work life.”

In a conversation with CancerNetwork®, Rian M. Hasson Charles, MD, MPH, FACS, spoke about her career in thoracic surgery and her visions for increasing equitable care in the field as part of a new, first-of-its-kind role at Brigham and Women’s Hospital. She will serve as the inaugural vice chair for Diversity, Equity, and Inclusion (DEI) in the Department of Surgery as well as an associate surgeon in the Division of Thoracic Surgery. Hasson contextualized the acceptance of her new role by highlighting her previous experiences in lung cancer surgery, which included pursuing a psychology major at University of California, Berkeley and working as an attending physician at Dartmouth Hitchcock Hospital. At Dartmouth, she formed a DEI program for the public health school and pursued initiatives designed to spread access to care for patients with lung cancer. As part of her new role at Brigham and Women’s Hospital, Hasson aims to reduce significant disparities in care across areas surrounding the academic center, grow a diverse workforce, and form connections with members in the community. Hasson also described some of the barriers she experienced and overcame as a woman in oncology. She offered advice to other aspiring surgeons in the field, emphasizing the importance of paying attention to the family, friends, and partners who can support them during their journey. “The world is your oyster. This position is a dream position for me because it’s bringing together everything that I love to do,” Hasson said. “I encourage people to find their focus, find their passion, find the thing that keeps them up at night or that wakes them up in the morning. You can do whatever you set your mind to. With today’s resources, there should be nothing that limits you. There may be things that seem like they’re discouraging, but you have the power to overcome those and collaborate with people that will help generate success,” she added.

In a conversation with CancerNetwork®, Gregory Peter Kalemkerian, MD, spoke about the publication of updated guidelines for managing small cell lung cancer (SCLC) with systemic therapy, which was developed by the American Society of Clinical Oncology (ASCO) in collaboration with Ontario Health (Cancer Care Ontario).1 Kalemkerian, a clinical professor at The University of Michigan and senior author of the guidelines, discussed developments in the SCLC field that inspired the creation of the revised guidelines since the last publication from ASCO in 2015.2 Although the latest guidelines contained recommendations concerning treatment modalities such as surgery and radiotherapy, Kalemkerian said that the biggest advances related to the integration of immunotherapy into frontline treatment for patients with extensive-stage SCLC (ES-SCLC). Specifically, Kalemkerian highlighted the use of immunotherapeutic agents such as durvalumab (Imfinzi) and atezolizumab (Tecentriq), which have demonstrated long-term improvements in survival of those with ES-SCLC. The guideline authors issued a strong recommendation backed by high-quality evidence for the frontline use of carboplatin plus etoposide or cisplatin plus atezolizumab or durvalumab followed by maintenance immunotherapy in patients with ES-SCLC who have no contraindications to immunotherapy.1 Additionally, there was no evidence supporting the continuation of immunotherapy for those with relapsed SCLC and progressive disease following maintenance immunotherapy based on an informal consensus. With respect to other updates in the guidelines, Kalemkerian spoke about optimal treatment strategies for patients with poorer performance statuses as well as the potential role of biomarkers in SCLC. Although there are currently no validated biomarkers that have demonstrated utility in the management of SCLC, he stated that it was necessary to overhaul how practices understand how diseases like SCLC develop and grow to help improve patient outcomes. “I would like people to pay attention to SCLC a little bit,” Kalemkerian said. “Non–small cell lung cancer has gotten a lot of the press and hype over the last 20 years or so since targeted therapy came out for that disease. Before that, we all thought SCLC was where we were going to be making advances, and we were wrong. We’re on the cusp of understanding the disease better and utilizing that understanding to advance newer strategies for trying to treat these patients.” References 1. Khurshid H, Ismaila N, Bian J, et al. Systemic therapy for small-cell lung cancer: ASCO-Ontario Health (Cancer Care Ontario) guideline. J Clin Oncol. 2023;41(35):5448-5472. doi:10.1200/JCO.23.01435 2. Rudin CM, Ismaila N, Hann CL, et al. Treatment of small-cell lung cancer: American Society of Clinical Oncology endorsement of the American College of Chest Physicians Guideline. J Clin Oncol. 2015;33(34):4106-4111. doi:10.1200/JCO.2015.63.7918.

CancerNetwork® collaborated with OncLive® to speak with Edward S. Kim, MD, MBA, and Richard T. Lee, MD, about ongoing initiatives to expand integrative oncology for patients with cancer at City of Hope. Kim is the physician-in-chief and senior vice president at City of Hope Orange County as well as the Construction Industries Alliance City of Hope Orange County physician-in-chief chair. Lee is the Cherng Family Director’s Chair of the Center for Integrative Oncology and a medical director of Supportive & Integrative Medicine in the Department of Supportive Care Medicine as well as a clinical professor of Supportive & Integrative Medicine at City of Hope. The discussion partly focused on how integrative oncology is practiced at City of Hope. The institution’s style of integrative care derives inspiration from traditional Eastern medicine and encompasses modalities such as acupuncture, meditation, yoga, and massages to help treat patients with cancer more holistically. Lee cited updates in integrative therapy guidelines published by the Society for Integrative Oncology (SIO) in partnership with the American Society of Clinical Oncology (ASCO) to illustrate how integrative care can benefit patient quality of life.1 For example, he highlighted that there was strong evidence in support of implementing mindfulness-based interventions to help reduce anxiety and stress among patients. “These types of integrative therapies are a great way to complement many of the standard-of-care options that we have and provide even further benefit in controlling these symptoms and allowing patients to have a better quality of life as they go through treatment and as they head into survivorship,” Lee said. The conversation also pertained to the institution’s efforts to expand the Cherng Family Center for Integrative Oncology, a first-of-its-kind national integrative oncology program, following receipt of a $100 million gift from Andrew and Peggy Cherng, co-founders and co-chief executive officers at Panda Express, supporting its creation.2 This initiative will include conducting rigorous research in a clinical program that may inform future integrative oncology guidelines, pursuing natural product drug development, and instituting educational programs that may train future integrative oncologists. "The only way we're going to be able to increase access to these important programs to more people is to do the rigorous, level 1 research that’s needed in order to prove that there is a benefit of any particular area,” Kim said. “Because if we’re rigorous and we show the results are positive, then we would expect them to be on the guidelines like the National Comprehensive Cancer Network, and then payers would then provide support to patients who want to have these services.” References 1. Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2023;41(28):4562-4591. doi:10.1200/JCO.23.00857 2. Logsdon Z. City of Hope receives $100 million gift to create first-of-its-kind national integrative oncology program. News release. City of Hope. September 12, 2023. Accessed March 13, 2024. https://tinyurl.com/26y3xj87

Monique Gary, DO, MSc, FACS spoke with CancerNetwork® about estimated increases in cancer burden across the world and the potential rises in cancer inequities among underserved populations, and discussed mitigating these disparities from an oncology and primary care perspective. Gary, a board-certified breast surgical oncologist and medical director of the Grand View Health/Penn Cancer Network cancer program, talked about growing cancer burden in the context of a World Health Organization (WHO) survey that projected future cancer risks. According to findings from the survey, there was an estimated 20 million new cancer cases and 9.7 million deaths from cancer in 2022. Authors estimated that 1 in 5 people will develop cancer, with 1 in 9 men and 1 in 12 women estimated to die from their disease. Additionally, more than 35 million new cancer cases were projected in 2050, representing a 77% increase from the estimated 20 million cases in 2022. In particular, Gary highlighted a rise in cancer diagnoses among younger patients, including those without family history or hereditary mutations. In addition to environmental factors such as poor air quality and health conditions like obesity, she emphasized health system inequities in certain countries as obstacles that may contribute to rising cancer burden. Due to a lack of financial protection, some patients may lack adequate access to early detection and therapy for cancer. Part of addressing these inequities, Gary said, requires primary care physicians redefining their perspective of cancer and not dismissing younger people who present with cancer symptoms. In addition to increasing screening for younger populations, she stated that it was necessary for oncologists to lean into available research and encourage patients to enroll on clinical trials. “It's not just the job of advocacy groups and societies; it's the job of every clinician,” Gary said regarding what needed to be done to address the growth in cancer incidence and disparities. “The individuals who have been disadvantaged already, those [patients] who have a higher mortality and are diagnosed at a later stage of disease…don't have the access. This disparity is going to get wider and wider; we'll do something about it. And that should inspire everyone because there's something for everyone to do.” Reference World Health Organization. Global cancer burden growing, amidst mounting need for services. February 1, 2024. Accessed March 5, 2024. https://shorturl.at/pLNU7

In a conversation with CancerNetwork®, Robert A. Winn, MD, spoke about current obstacles in achieving equitable care for patients with cancer and discussed how initiatives from community health centers and federal bodies alike may help increase access to anti-cancer therapy. Winn, director and Lipman Chair in Oncology at Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center, senior associate for Cancer Innovation, and professor of pulmonary disease and critical cancer medicine at VCU School of Medicine, began the discussion by defining health equity as a principle. By eliminating disparities that impact access to treatment for certain populations, it may be possible for all patients to receive the same kind of care and potentially experience the same outcomes as part of an “even playing field.” According to Winn, initiatives that may promote health equity in oncology include the ruling from the Centers for Medicare & Medicaid Services (CMS) allowing for the reimbursing of navigation services to help patients and their families access treatment for cancer and other serious diseases.1 Although Winn said that the field was trending towards the goal of health equity, he stated that more progress was necessary for biomarker testing in lung cancer and other malignancies. Additionally, increasing access to new treatments, technologies, and screening mechanisms across different communities represented another challenge concerning progress. Winn also spoke about educating others on cancer-related disparities, including his colleagues and other resourceful groups in cancer care. He detailed his experiences with working on the yearly American Association for Cancer Research (AACR) Cancer Disparities Progress Reports since the first was published in 2020, which he described as an element that he hopes will educate people and spread awareness. In addition to collaboration among professional bodies including the Association of American Cancer Institutes and the American Society of Clinical Oncology, Winn highlighted local efforts in spreading awareness and improving progress towards health equity. “By not sitting on our heels and waiting for the community to come to us, but by going out to the community and talking about the importance of screening, talking about the importance of finding a new drug and what that means, and talking about these new technologies, we've actually gotten a very robust group of community members who are actually by our sides and actually making other people aware out in the community,” Winn said regarding Facts & Faith Fridays, an initiative from Massey Comprehensive Cancer Center in collaboration with local faith-based leaders designed to spread awareness of anti-cancer treatment.2 “That has resulted in very positive outcomes for us.” References 1. CMS finalizes physician payment rule that advances health equity. News release. Centers for Medicare & Medicaid Services. November 2, 2023. Accessed February 27, 2024. http://tinyurl.com/4p7dhr7h 2. Facts & Faith Fridays. VCU Massey Comprehensive Cancer Center. Accessed February 27, 2024. http://tinyurl.com/5wetmdyz

Starting April 1, 2024, Diane M. Simeone, MD will start her new position as director of the University of California San Diego (UCSD) Health Moores Cancer Center.1 In a conversation with CancerNetwork®, Simeone highlighted her excitement to be working with an institution that she said aligns with her goals and values. During her time as director, she said that she wants to focus more on early detection of pancreatic cancer, which may help save many patients. Additionally, some of her short- and long-term goals include submitting a Cancer Center Support Grant to the National Institutes of Health and expanding clinical trial efforts at UCSD. She also discussed ongoing projects she will aim to work on, such as the UC Pancreatic Cancer (UCPCC) Consortium and the Pancreatic Cancer Early Detection (PRECEDE) Consortium.2,3 Prior to beginning her new position at UCSD, Simeone has been the Laura and Isaac Perlmutter Professor of Surgery, director of the Pancreatic Cancer Center, and the associate director of translational research at Perlmutter Cancer Center at New York University Langone Health. Additionally, she was previously the chair of the scientific and medical advisory board of the Pancreatic Cancer Action Network and a member of the scientific advisory board for the Let’s Win Pancreatic Cancer online community. “It was clear that everybody is aligned with this mission and understands the importance of how we care for patients with cancer and do research at the cancer center,” Simeone said during the interview. “There seems to be a clear commonality of thinking on their vision of being at the forefront of advancing science and, most importantly, how we apply to take care of patients. Patients are always the driving force. That's always the center of what we need to be thinking about.” References 1. World-renowned surgeon named new director of Moores Cancer Center at UC San Diego Health. News release. University of California San Diego. January 8, 2024. Accessed January 25, 2024. http://tinyurl.com/4986f4cb 2. UC Pancreatic Cancer Consortium. University of California Health. Accessed January 25, 2024. http://tinyurl.com/3szdvyxv 3. PanCAN’s Precision Promise adaptive clinical trial platform –. Pancreatic Cancer Action Network. Published April 27, 2016. Accessed January 25, 2024. http://tinyurl.com/fpax5hhd

After the 2024 Gastrointestinal Cancers Symposium, Jun Gong, MD, and Daneng Li, MD, sat down to discuss the most relevant trial data to have come from the conference. They convened for a live X Space hosted by CancerNetwork®. During the discussion, they covered different trials across the gastrointestinal space, which included those evaluating different disease states from hepatocellular carcinoma (HCC) to colorectal cancer (CRC), and those assessing circulating tumor DNA (ctDNA) dynamics. Gong, a hematologic oncologist focusing on gastrointestinal and genitourinary cancers at Cedars-Sinai Medical Center, and Li, an associate professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, each gave their perspective on the clinical trial data and discussed if they had implemented any of these study treatments into clinical practice. The studies they covered included: 1. Phase 3 NETTER-2 Trial (NCT03972488)1: - Investigated lutetium Lu 177 dotatate (Lutathera) plus octreotide vs octreotide alone for advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs). - Lutetium Lu 177 significantly improved progression-free survival (PFS) and overall response rate (ORR) compared with octreotide alone. - The agent may be considered for patients with high-grade GEP-NETs who desire significant tumor shrinkage. 2. Phase 3 EMERALD-1 Trial (NCT03778957)2: - Studied transarterial chemoembolization (TACE) plus durvalumab (Imfinzi) with or without bevacizumab (Avastin) for unresectable HCC. - Durvalumab/bevacizumab plus TACE improved PFS compared with placebo plus TACE. - TACE may be preferred over transarterial radioembolization (TARE) due to faster patient recovery. 3. Phase 3 CheckMate-8HW Trial3: - Evaluated nivolumab (Opdivo) plus ipilimumab (Yervoy) vs chemotherapy for first-line treatment of microsatellite instability-high/mismatch repair deficient metastatic CRC. - Nivolumab/ipilimumab demonstrated superior PFS compared with chemotherapy. - Chemotherapy may no longer be the standard first-line treatment for this patient population. 4. BESPOKE Study (NCT04264702)4: - Assessed the impact of minimal residual disease (MRD) detected by ctDNA on disease recurrence in patients with stage II and III CRC receiving adjuvant chemotherapy. - MRD positivity was associated with worse disease-free survival (DFS). - ctDNA clearance at 12 weeks indicated improved DFS. 5. GALAXY Trial5: - ctDNA is a promising biomarker that can be used to predict recurrence in patients with CRC. - Patients with ctDNA-positive disease had a worse DFS than patients with ctDNA-negative disease. - This suggests that ctDNA may be useful for making treatment decisions, but more research is needed before it can be used in clinical practice. 6. Phase 3 FRESCO-2 Trial (NCT04322539)6: - Fruquintinib (Fruzaqla) improved the quality of life in patients with metastatic CRC when combined with best supportive care and significantly improved quality-adjusted time without symptoms of disease or toxicity compared with placebo and best supportive care. - The study showed positive effects on PFS, response rate, disease control, and duration of response with the fruquintinib combination. - The findings from this trial supported the FDA approval of fruquintinib for metastatic CRC in November 2023.7 References 1. Singh S, Halperin D, Myrehaug S, et al. [177Lu]Lu-DOTA-TATE in newly diagnosed patients with advanced grade 2 and grade 3, well-differentiated gastroenteropancreatic neuroendocrine tumors: primary analysis of the phase 3 randomized NETTER-2 study. J Clin Oncol. 2024(suppl 3):LBA588. doi:10.1200/JCO.2024.42.3_suppl.LBA588 2. Lencioni R, Kudo M, Erinjeri J, et al. EMERALD-1: a phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable...

In a conversation with CancerNetwork®, Lisa Carter-Bawa PhD, MPH, APRN, ANP-C, FAAN, spoke about factors that may contribute to feelings of stigmatization surrounding a lung cancer diagnosis, which may impact an individual’s decision to undergo screening for potential disease. Specifically, Carter-Bawa, director of the Cancer Prevention Precision Control Institute at the Hackensack Meridian Health Center for Discovery and Innovation, detailed the stigmatization related to smoking and how public discourse in the context of lung cancer may impart feelings of shame or blame surrounding the development of one’s disease. As part of an effort to combat the stigmatization that at-risk populations may experience, she discussed the use of a digital, public-facing health communication and decision support tool named LungTalk. The tool was designed to provide an individually tailored experience that can help people understand more about lung health and lung cancer screening while encouraging shared decision-making with an informed clinician. According to findings published in JTO Clinical Research and Reports, applying the Lung Cancer Stigma Communications Assessment Tool to LungTalk as part of a language, imagery, and context audit led to a revision of the digital tool in which potentially stigmatizing terms such as “smoker” were replaced with person-first language. Authors of the report concluded that adjusting public messaging surrounding at-risk individuals to be more empathic in conjunction with outreach and education efforts from clinicians may play a role in destigmatizing lung cancer. Carter-Bawa also spoke about ongoing initiatives intended to address the low rates of lung cancer screening among screening-eligible African-American patients. Efforts such as community advisory councils and interactions with churches and other faith-based organizations aim to spread knowledge about lung cancer even beyond screening-eligible individuals. “I would love for my colleagues to take away envisioning a world where stigma in lung cancer doesn't exist—that it's just a historical blip that we look back on—and that we are treating people equitably across the board,” Carter-Bawa said. “[A world where] we're using person-first language and not referring to people as smoker and nonsmoker in our scientific communication, our medical communication, or layman communications.” Reference Carter-Bawa L, Ostroff JS, Hoover K, Studts JL. Effective communication about lung cancer screening without iatrogenic stigma: a brief report case study using the lung cancer stigma communications assessment tool of LungTalk. JTO Clin Res Rep. 2023;4(11):100585. doi:10.1016/j.jtocrr.2023.100585

Although strides have been made with Bruton tyrosine kinase (BTK) inhibitors and CAR-T cell therapy, relapse and resistance remain significant hurdles in treating patients with mantle cell lymphoma (MCL). The Lymphoma Research Foundation's 2023 MCL Scientific Consortium and Workshop addressed these complexities, aiming to dissect the intricate biology of MCL and propel progress towards a cure. CancerNetwork® spoke with leaders in the MCL field to better understand the aim of the consortium and the advancements they hope to see in the space. The journal ONCOLOGY® published these findings in the February 2024 issue. The interviews included Elias Campo, MD, PhD, research director and professor of anatomic pathology at the Hospital Clinic of the University of Barcelona; Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at The University of Texas, MD Anderson Cancer Center; Martin Dreyling, MD, PhD, professor of Medicine in the Department of Medicine and head of the Medical Clinic 3 at the University of Munich-Grosshadern in Germany; and Julie M. Vose, MD, MBA, Neumann M. and Mildred E. Harris Professor and division chief in the Division of Hematology at the University of Nebraska Medical Center and coeditor in chief of ONCOLOGY. The consortium touched on t(11;14), which dysregulates cyclin D1 and fuels uncontrolled cell growth. Additionally, research presented at the consortium revealed other molecular pathways contributing to treatment resistance and relapse, highlighting the heterogeneous nature of the disease. This heterogeneity underscored the need for personalized treatment strategies and biomarker-based prognostics, a notion further emphasized by multiple findings on the predictive value of specific gene mutations. Beyond understanding the inner workings of MCL, presentations also focused on novel therapeutic avenues. Specifically, there were encouraging data on the potential of next-generation BTK inhibitors including acalabrutinib (Calquence) to overcome resistance. Challenges such as the limitations of current risk stratification models remain, underscoring the need for robust biomarkers to guide early interventions and optimize treatment selection. Additionally, the consortium featured a discussion on addressing a lack of diversity in clinical trial populations, which may help increase treatment access for those with various medical conditions. “…The patient population that has a disease is not always [represented] in the clinical trials. That’s why it’s important to be able to have a diversity of patients in clinical trials: to test these new therapies because [patients] may have other medical conditions that would change the outcome of trials and not be necessarily representative of the entire patient population with that disease,” Vose said. “It’s important to try to advance the treatment of a very diverse patient population through these clinical trial mechanisms.”

Integrative therapies have been proven to help reduce the adverse effects (AEs) of anxiety and depression in patients with cancer, according to Linda E. Carlson, PhD, RPsych. Carlson, Enbridge Research Chair in Psychosocial Oncology and a professor in the Department of Oncology, Cumming School of Medicine at the University of Calgary, explained how different therapies such as mindfulness-based interventions, yoga, and relaxation could work to manage anxiety and depression in patients with cancer. Specifically, she talked about the new recommendations published by The Society for Integrative Oncology (SIO) in collaboration with the American Society of Clinical Oncology (ASCO), which highlighted integrative approaches to managing AEs related to anxiety and depression.1 During the interview, Carlson spoke about the current guidelines, which recommendations clinicians can begin to use in their everyday practices, and what aspects future research should focus on. Specifically, she highlighted the benefits of yoga, tai chi, and relaxation as possible therapies that can help mitigate the AEs of anxiety and depression. “For the clinician, [it’s important to understand] that these options are available and that they’re evidence-based,” Carlson said. “Then, [it’s important to figure] out where in your local area these kinds of treatments are available. Many comprehensive cancer centers have integrative therapies; they have yoga, tai chi, mindfulness-based interventions, relaxation, and imagery. Many counselors can offer those kinds of services and cognitive behavioral therapy. Being aware that [these options are] effective and that they are first-line treatments, finding out where they’re available, knowing how patients can access them, facilitating the treatments in whatever way [clinicians] can, and advocating for more of these programs within cancer treatment centers will be important.” Carlson is also the past president of SIO and a current editorial advisory board member of ONCOLOGY®. Reference Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2023;41(28):4562-4591. doi:10.1200/jco.23.00857

In a conversation with CancerNetwork® prior to the FDA approval of pembrolizumab (Keytruda) plus chemoradiotherapy in FIGO stage III to IVA cervical cancer, Jyoti S. Mayadev, MD, spoke about how the regimen’s approval would be a “major step” for the aforementioned population and how she planned to integrate it into her care.1 Mayadev, a board-certified radiation oncologist and professor of radiation medicine and applied sciences at the University of California, San Diego School of Medicine, stated that the approval would be a “huge win” with respect to progression-free survival (PFS) based on supporting findings from the phase 3 KEYNOTE-A18 trial (NCT04221945). According to data presented at the 2023 Annual Global Meeting of the International Gynecologic Cancer Society (IGCS), treatment with pembrolizumab plus chemoradiotherapy produced a significant PFS benefit compared with chemoradiation alone (HR, 0.70; 95% CI, 0.55-0.89; P = .0020).2 Additionally, findings from a subgroup analysis highlighted that the PFS benefit with the pembrolizumab-based combination extended to those with FIGO stage III to IVA disease (HR, 0.58; 95% CI, 0.42-0.80).1 Mayadev also described the tolerability and quality-of-life benefits associated with the pembrolizumab combination in the KEYNOTE-A18 trial. Additionally, she stated that potential next steps for research may involve integrating adaptive technology to potentially reduce toxicity following chemoradiation among patients with cervical cancer. “Uptake of any new agent requires a multidisciplinary team approach. It requires workflows,” Mayadev said regarding her strategy for adopting the newly approved regimen in her clinic. “For our particular institution, we would somewhat seamlessly go into the FDA approval. At the same time, we would try to help others in the community. We, as a scientific global community for gynecologic oncology and radiation oncology, will come together and start to incorporate how we can move forward with the FDA approval.” References 1. FDA approves pembrolizumab with chemoradiotherapy for FIGO 2014 stage III-IVA cervical cancer. News release. January 12, 2024. Accessed January 15, 2024. https://bit.ly/3NZNGPb 2. Lorusso D, Xiang Y, Hasegawa K, et al. ENGOT-cx11/GOG-3047/KEYNOTE-A18: A randomized, double-blind, phase 3 study of pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer. Presented at 2023 Annual Global Meeting of the International Gynecologic Cancer Society; November 5-7, 2023; Seoul, South Korea. Abstract SE004/1614.

In a conversation with CancerNetwork®, Sarah Donahue, MPH, NP, discussed strategies for managing adverse effects (AEs) associated with different drug classes for patients with metastatic breast cancer, ranging from antibody drug conjugates (ADCs) to CDK4/6 inhibitors. With respect to ADCs, Donahue, a nurse practitioner at University of California, San Francisco, and member of the Oncology Nursing Society, highlighted common AEs following treatment with trastuzumab deruxtecan (T-DXd; Enhertu) and sacituzumab govitecan-hziy (Trodelvy). In particular, she spoke about the necessity of managing nausea associated with T-DXd by helping patients schedule doses with antiemetic drugs, as well as mitigating fatigue and improving quality of life in the process. For those who are treated with sacituzumab govitecan, Donahue spoke about mitigating abdominal cramping at her infusion center and administering loperamide to help patients manage acute diarrhea. Donahue also discussed her methods for managing toxicity related to CDK4/6 inhibitors including palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenios). Among patients with hormone receptor (HR)–positive breast cancer, treatment with palbociclib and ribociclib, when given in combination with hormonal therapy, may result in fatigue, hot flashes, and arthralgia. According to Donahue, encouraging patients to exercise often may combat fatigue while mitigating arthralgia associated with an aromatase inhibitor. Moreover, she stated that loperamide may help manage potential diarrhea following treatment with abemaciclib. Overall, Donahue underscored the importance of keeping patients on treatments with CDK4/6 inhibitors and other treatments by being communicative with them regarding the potential to alleviate AEs. She suggested that such openness may give patients the confidence to ask providers for guidance on how to manage their disease. “The main thing that I find most helpful for my patients is to explain the potential [adverse] effects, explain that there’s something that we can do about them—that we can intervene. If they reach out to us sooner, we can help them more,” Donahue concluded. “I hope that the providers who are listening to this now can help to empower their patients to reach out and to ask for advice. That’s the best thing that they can do to keep them on these medications longer. They can work well; we can show that in studies. But if we can’t keep [patients] on the medications, then what are we doing?”