Perspectives
Financial Impact of Cardiovascular Disease and Cancer Care: Overlapping Toxicities
Betty K. Hamilton, MD
The leading causes of mortality in the United States are cardiovascular disease (23%) and cancer (21%), accounting for more than 40% of total deaths reported.1,2 The increasing rise in health-care expenditures over the past several decades has driven the need for metrics to further evaluate the fina...
National Cancer Act and Lung Cancer Screening: An Example of Intended Impact
James L. Mulshine, MD, and Fred R. Hirsch, MD, PhD, FASCO
The National Cancer Act of 1971 established a national priority to address the widely shared dread of a cancer diagnosis. The goal of the National Cancer Act was to strengthen the National Cancer Institute (NCI) to more effectively carry out the national effort against cancer. After the Act was si...
BTK Inhibition in CLL: An Embarrassment of Riches
Gregory Bociek, MD, MSc
Chronic lymphocytic leukemia (CLL) is a B-cell lymphoproliferative disorder defined by a specific phenotype and the presence of more than 5,000 clonal B cells in the peripheral blood.1 In the absence of this number of circulating cells, its soft-tissue/bone-marrow counterpart is semantically referre...
Oncology Care Remains Under Strain in the Ongoing COVID-19 Pandemic
Govind Persad, JD, PhD
The resurging COVID-19 pandemic has reawakened challenges for patients and physicians—ones we all hoped were over—and presented stressful situations for patients and providers. Hospitals in some states, particularly those with lower vaccination rates, have faced levels of urgent illness that have re...
Nivolumab Plus Chemotherapy Improves Survival in Advanced Gastric and Esophageal Adenocarcinomas: Now to Figure Out the Details in These Heterogeneous Diseases
Mary F. Mulcahy, MD
There is no doubt that subsets of patients with esophageal and gastric cancers benefit from immune checkpoint inhibitor therapy. The complexity lies in identifying the appropriate histology, tumor location, expression of programmed cell death receptors and ligands, mechanism of checkpoint inhibition...
Treatment of Relapsed Myeloma: Options Include New Drugs, Novel Combinations
Shaji K. Kumar, MD
The treatment paradigm for multiple myeloma continues to evolve at a rapid pace with the introduction of new drugs and the development of drug combinations, particularly the initial approach to the treatment of newly diagnosed multiple myeloma.1 One major shift in the treatment of newly diagnosed mu...
Patients First
Bonnie J. Addario, as told to Jo Cavallo
By the time my non–small cell lung cancer was diagnosed in 2004, it had already reached stage IIIB, and I was told there was little that could be done for me. I was 56, a wife, the mother of 3 children, and at the peak of my career as president of Olympian Oil. Although my aunt, brother, and grandfa...
TITAN Confirms Survival Benefit of Apalutamide Plus ADT in Metastatic Prostate Cancer: Now, Move Therapy Forward
Neal D. Shore, MD, FACS
As reported in the Journal of Clinical Oncology by Chi et al1—and summarized in this issue of The ASCO Post—the prespecified final overall survival analysis of the phase III TITAN trial1-3 has confirmed a clear overall survival and radiographic progression-free survival benefit with the combination ...
Prevalence of Germline BRCA Mutations in Indian Women With Ovarian Cancer
Jame Abraham, MD, FACP
Ovarian cancer is one of the most common gynecologic cancers, with 313,959 new cases and 207,252 deaths reported worldwide in 2020.1 Since there is no effective screening method, ovarian cancer in general is diagnosed in its late stage. The 5-year survival rate in women with ovarian cancer is less t...
Lutetium-177–PSMA-617: A First-in-Class Radioligand Therapeutic in Metastatic Prostate Cancer
David R. Wise, MD, PhD
Based on the findings of the phase III VISION trial, reported by Sartor et al1 and summarized in this issue of The ASCO Post, lutetium-177–PSMA-617 (LuPSMA) is the first of the prostate-specific membrane antigen–targeted cancer theranostics to demonstrate a survival-prolonging benefit for men with m...
Assumptions, Data … and More Questions!
Syed Ali Abutalib, MD
I read with great interest the results from the phase II ZUMA-12 study of axicabtagene ciloleucel, presented during the 2020 American Society of Hematology (ASH) Annual Meeting & Exposition.1 But the results raised several questions for me. Axicabtagene ciloleucel, an autologous anti-CD19 chi...
Historic, Present, and Future Perspectives on Breast Cancer in Egypt
Aalaa Mahmoud, MBBCh, MSc
Breast cancer is the most frequently diagnosed cancer among women around the world, making it a significant public health problem.1 The disease affects both men and women, although it is rare in men, accounting for just 1% of all breast cancer diagnoses in the United States and less than 0.1% of can...
A New Era of Hope for Patients With Triple-Negative Breast Cancer
HEATHER L. McARTHUR, MD, MPH
Triple-negative breast cancer is a particularly devastating subtype of breast cancer, as it is often diagnosed in young women and is associated with an exceptionally poor prognosis. The “triple-negative” designation indicates that the three key features driving most breast cancers (estrogen receptor...
Benefits of Adjuvant Pembrolizumab in Melanoma Reinforced by EORTC 1325/KEYNOTE-054 Updates
RAVI AMARAVADI, MD, and LYNN SCHUCHTER, MD
Adjuvant anti–PD-1 antibody therapy is widely used for stage III melanoma, given the approvals of pembrolizumab and nivolumab. These approvals were based on significantly improved relapse-free survival in the CheckMate 238 trial of nivolumab compared with ipilimumab and the EORTC 1325/KEYNOTE-054 tr...
Low-Dose CT Screening for Lung Cancer and the Incidental Findings That May Improve Future Health
Inga T. Lennes, MD, MPH, MBA
Every interaction with patients is an opportunity to change the course of their lives. In the context of screening for disease, every encounter is an opportunity to detect the precursors or early changes that signal early pathophysiology. Smoking status and age are the factors that currently determi...
Salvage and Adjuvant Radiotherapy After Radical Prostatectomy for Prostate Cancer: What’s ‘Just Right’ for Our Patients?
Manuj Agarwal, MD
In the storied English fable “Goldilocks and the Three Bears,” a child enters a home and tastes three bowls of porridge. She prefers a bowl that is not too cold and not too hot but one that has just the right temperature. This “Goldilocks principle” of “just the right amount” can be applied to the d...
JAVELIN Head and Neck 100 Trial: When Failure Seems Fatal, Hope Is Not Lost
Francis Paul Worden, MD, and Michelle Lynn Mierzwa, MD
Data from KEYNOTE-048 showed that the combination of the checkpoint inhibitor pembrolizumab with platinum-containing therapy improved overall survival vs cetuximab plus chemotherapy in patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC).1 The findings provided hope th...
The Patient We See and the Person We May Not
Chandrakanth Are, MBBS, MBA, FRCS, FACS
A middle-aged patient was referred to our clinic with a mass in his liver. It had been detected the preceding year, and the patient underwent a battery of investigations with scans and biopsies to reach a diagnosis of metastatic lesion of the liver. After appropriate consultations with oncologists, ...
2021 ASCO Annual Meeting: Next-Generation Oncology Highlights
LUIS EDUARDO PINO VILLARREAL, MD, MSc, MBA
The 2021 ASCO Annual Meeting was presented totally virtually again due to the persistence of the COVID-19 pandemic. Nevertheless, the meeting held widespread interest, and we were able to attend an event with important changes for the practice of oncology. Compared with 2020, fewer “next-generatio...
Is Disease-Free Survival the Best Endpoint for Adjuvant Nivolumab in High-Risk, Muscle-Invasive Urothelial Carcinoma?
DEREK RAGHAVAN, MD, PhD, FACP, FRACP, FASCO
The role of adjuvant treatment for invasive, high-grade bladder cancer remains controversial and challenging. Sternberg et al reported a statistically significant progression-free survival benefit from adjuvant combination gemcitabine/cisplatin (GC) or MVAC (methotrexate, vinblastine, doxorubicin,...
Factoring Fertility Preservation Into Breast Cancer Treatment
Ayesha Munir, MBBS, and Ami Chitalia, MD
Breast cancer is the most commonly diagnosed cancer in women of reproductive age. Approximately 10% of breast cancers are diagnosed in this age group.1 Young age at diagnosis is an adverse prognostic factor, and most young women will be offered chemotherapy and/or endocrine therapy, both of whic...
Role of PI3K Inhibition in Indolent Lymphomas
Leo I. Gordon, MD
As reported by Fowler et al in the Journal of Clinical Oncology1—and summarized in this issue of The ASCO Post—the international phase IIb UNITY-NHL trial of 208 patients with marginal zone lymphoma (MZL; n = 69), follicular lymphoma (FL; n = 117), and small lymphocytic lymphoma (SLL; n = 22) evalua...
PI3K Inhibition With Copanlisib Plus Rituximab in Relapsed Indolent Non-Hodgkin Lymphoma
Tycel J. Phillips, MD
Better understanding of the mechanism behind the malignant transformation of B cells has led to an explosion of “targeted” therapy. With the growing knowledge of the role of the B-cell receptor and its downstream kinases, it appeared that we were entering a new era in the management of patients affl...
PSA Level Prior to Salvage Radiotherapy: Tailoring Delivery of ADT to Men With Prostate Cancer Most Likely to Benefit
Manuj Agarwal, MD
In a recent article in JAMA Oncology, reviewed in this issue of The ASCO Post, Dess et al present an important analysis to help guide decision-making in the setting of salvage radiotherapy in prostate cancer.1 This secondary analysis assessed the association of prostate-specific antigen (PSA) levels...
Lessons From Pneumococcal Vaccine Responses in Patients With CLL in an Evolving Vaccine Landscape
Raamis Khwaja, MD; Philip A. Thompson, MBBS (Hons); and Nitin Jain, MD
The role of vaccines in mitigating the significant morbidity and mortality associated with infections in chronic lymphocytic leukemia (CLL) is a developing field of study, punctuated by the advent of novel therapeutic agents and pressing questions regarding the global SARS–CoV-2 vaccination efforts....
Enfortumab Vedotin Represents a Community of Work in Antibody-Drug Conjugates Targeting Cancer
Christopher Hoimes, MD
The first known clinical trial report of an antibody-drug conjugate was a phase 0/I pharmacodynamic and safety study of a conjugate that targeted carcinoembryonic antigen and delivered a payload of vinca alkaloid in eight patients with ovarian or colorectal cancer.1 This work built on the work of ...
Sacituzumab Govitecan-hziy: Welcome Addition to Advanced Urothelial Cancer Treatments, but Time to Figure Out Sequencing and Combinations
Brendan J. Guercio, MD, and Jonathan E. Rosenberg, MD
The results of Cohort 1 of the phase II trial TROPHY-U-01 (IMMU-132-06; ClinicalTrials.gov identifier NCT03547973), published in the Journal of Clinical Oncology by Tagawa et al and reviewed in this issue of The ASCO Post, led to the recent accelerated U.S. Food and Drug Administration (FDA) app...
Reflections on Evolution of Breast Cancer Care in India Over the Past 4 Decades
Rakesh Chopra, MD; Kavita Yadav, BDS, MPH; Vivek Agarwala, MD, DM, DNB; and Ravi Mehrotra, MD, DPhil, FRCPath
India has witnessed a major paradigm shift in the field of breast cancer and its management over the past 4 decades. The discipline of medical oncology has evolved exponentially over this period—a growth that few other scientific disciplines have experienced. Interventions at the individual, institu...
Whispers Over My Shoulder
Mairéad Geraldine McNamara, MB, PhD
When I interviewed for my current post as a first-time consultant in medical oncology in the United Kingdom, I was asked about my 5-year career plan. I remember some detail of my reply, but I don’t think it even remotely encompassed the depth of insight I would gain from the patients I’ve treated ...
EMPOWER-Lung 1 Trial: New Options, No New Answers
Apar Kishor Ganti, MD, MS
The EMPOWER-Lung 1 trial, recently reported in The Lancet and reviewed in this issue of The ASCO Post, showed an improvement in progression-free and overall survival with cemiplimab-rwlc in patients with advanced non–small cell lung cancer (NSCLC) and high PD-L1 expression (tumor proportion score [T...
Dual Immune Checkpoint Blockade With Nivolumab and Ipilimumab for Treatment of Malignant Pleural Mesothelioma
Samuel Rosner, MD, and Patrick M. Forde, MBBCh
In recent years, immune checkpoint inhibitors in the treatment of mesothelioma have been a keen area of investigation for this immunogenic solid tumor. With recent publications, principally findings from CheckMate 743 by Baas et al1 (reviewed in this issue of The ASCO Post), combination immune check...
Pembrolizumab as Long-Term Treatment Option in Relapsed or Refractory Classical Hodgkin Lymphoma
Diana M. Byrnes, MD, and Craig H. Moskowitz, MD
For patients with relapsed or refractory classic Hodgkin lymphoma (HL), salvage chemotherapy followed by autologous hematopoietic stem cell transplant (HSCT) is the standard of care and can induce long-term remissions in at least 60% of patients.1,2 Patients with progression of disease after tra...
Disease-Free Survival Benefit With Adjuvant Immunotherapy in Resectable Esophageal Cancer: Practice-Changing for All Patients?
Florian Lordick, MD, PhD
The CheckMate 577 trial—reported in The New England Journal of Medicine by Kelly et al1 and reviewed in this issue of The ASCO Post—is the first global randomized controlled trial for patients with resectable esophageal cancer that showed a significant disease-free survival benefit for adjuvant immu...
Is High Tumor Mutational Burden Predictive of Immune Checkpoint Blockade Efficacy Across All Cancer Types?
Thierry André, MD, and Romain Cohen, MD, PhD
In a letter recently published in The New England Journal of Medicine and reviewed in this issue of The ASCO Post, Rousseau and colleagues reported data on the spectrum of benefit from immune checkpoint blockade in hypermutated tumors.1 Indeed, the U.S. Food and Drug Administration (FDA) recently ap...
Cabozantinib With Nivolumab for Metastatic Renal Cell Carcinoma: A New Front-Line Standard
Neal S. Chawla, MD, and Sumanta K. Pal, MD, FASCO
The pace of clinical research in metastatic renal cell carcinoma is faster than ever. Over the past 5 years, we have seen data from six phase III clinical trials evaluating combination strategies with checkpoint inhibitors. The era began with data from CheckMate 214, evaluating nivolumab with ipili...
Navigating the Post-Vaccine Pandemic
Sir Murray F. Brennan, MD
By now, most health-care workers have been vaccinated against COVID-19.* Physical immunity would appear to last for at least 6 months and probably longer. The physical pandemic for most oncologists is declining, with an end in sight. We are protected from the serious physical consequences of COVID-1...
Chernobyl at 35 Years: An Oncologist’s Perspective
Robert Peter Gale, MD, PhD, DSc (hc), FACP, FRCPI (hon), FRSM
Editor’s note: Dr. Gale is an authority on medical response to nuclear and radiation accidents and participated in rescue efforts at the Chernobyl disaster, as well as at Goiania, Tokaimura, and Fukushima, among other radiation and nuclear accidents. Anyone reading the popular press or even scienti...
Refining Cardiovascular Risk Assessment in Childhood Cancer Survivors
Saro Armenian, DO, MPH
There are an estimated 500,000 childhood cancer survivors in the United States, a number that will increase exponentially in the coming years. Over half of all childhood cancer survivors will have received cardiotoxic therapies during primary cancer treatment or relapse. For these survivors, there i...
Equitable Cancer Care: Steps Toward Meaningful Change
Lori J. Pierce, MD, FASCO, FASTRO
As President-Elect of ASCO, you are asked to choose a theme for your presidency. This can be a daunting task, as the theme will not only shape the discourse of your presidency, but also, more importantly, that of the Society. The subject should be one that reflects the needs of the cancer community ...
How MRD Assessment May Help Guide Treatment Selection for Patients With AML
Farhad Ravandi, MD
Complete morphologic remission is considered the first requirement for achieving long-term, leukemia-free survival and a potential cure in patients with acute leukemia, including acute myeloid leukemia (AML), and is the goal of all therapeutic strategies to date. Recognizing that the majority of pat...
Virtual Meetings Are Here to Stay
NAGI S. EL SAGHIR, MD, FACP, FASCO
In 2020, the 8th Annual Beirut Breast Cancer Conference (BBCC) was our last in-person meeting. The first cases of COVID-19 started in Lebanon around the end of February 2020, and the pandemic continues into its second year, with waves of rising cases following superspreader events and other likely c...
Squamous Cell Carcinoma of the Head and Neck: Current Status and Future Directions
Dan P. Zandberg, MD
Although head and neck cancers include multiple histologies and primary sites, squamous cell carcinomas (SCC) originating in the oropharynx, oral cavity, larynx, or hypopharynx are the most common. Today, we recognize different types of head and neck cancers, primarily those that are human papilloma...
Margetuximab-cmkb: A Novel Agent Overshadowed by an Abundance of Options in HER2-Positive Breast Cancer
Sara A. Hurvitz, MD, FACP, and Shiliang Zhang, MD
It is incredible to reflect upon the scientific advances in the treatment of HER2-positive breast cancer over the past 23 years. Once considered the worst subtype of breast cancer, HER2-positive disease is now associated with the best long-term outcomes in this age of targeted treatments. With a tot...
Shared Risk Factors for Preventing Cancer and Cardiovascular Disease: The Evolving Focus of Cardio-oncology
DAWN L. HERSHMAN, MD, MS, FASCO
Cardio-oncology represents the intersection of cancer and cardiovascular disease. Cancer therapies can result in cardiovascular complications, and some patients become less attentive to their chronic disease management after a diagnosis of cancer. As cancer patients are living longer, for some, thei...
Breast Cancer Screening With Clinical Breast Examination in Low- and Middle-Income Countries
Jame Abraham, MD, FACP
Globally, breast cancer surpassed lung cancer as the most common cancer among women, with an estimated 2.3 million cases in 2020.1,2 Approximately 685,000 women will die of breast cancer in 2020 around the world. Approximately 24.5% of all cancers in women are breast cancer, and 15.5% of cancer-re...
To Advance Health Equity, Put Real-World Cancer Data to Work
ROBERT S. MILLER, MD, FACP, FASCO, FAMIA
Despite decades of scientific progress against cancer, access to treatment remains highly unequal. Some of the reasons—like institutional racism and poverty—are a reflection of our broader society. Other inequities may go unrecognized but are no less damaging. People with underlying health condition...
CLEAR Trial: Is Lenvatinib Plus Pembrolizumab the Best First-Line Immunotherapy Doublet in Metastatic Renal Cell Carcinoma?
ANDREW W. HAHN, MD, PAVLOS MSAOUEL, MD, PhD, AND NIZAR M. TANNIR, MD, FACP
At the 2021 Genitourinary Cancers Symposium, Motzer et al presented the clinical results of the CLEAR trial, adding a novel regimen, lenvatinib plus pembrolizu-mab, to the growing armamentarium of first-line treatments for patients with metastatic clear cell renal cell carcinoma (RCC). The fin...
Nivolumab/Ipilimumab Plus Two Cycles of Histology-Based Chemotherapy: Another Option in First-Line Metastatic NSCLC
CHARU AGGARWAL, MD, MPH
Introduction of immunotherapy has revealed a paradigm shift in the management of patients with metastatic non–small cell lung cancer (NSCLC) that does not harbor a therapeutically targetable driver mutation. Over the past 5 years, several trials have informed treatment decisions, based on disease ch...
Evolving Landscape of First-Line Therapy for Metastatic Renal Cell Carcinoma
Chung-Han Lee, MD, PhD
In the past 3 years, we have seen a dramatic shift in the treatment paradigm for first-line therapy for metastatic clear cell renal cell carcinoma. Multiple phase III clinical trials have demonstrated improved efficacy with combinations compared with sunitinib, leading to the regulatory approval of ...
Cancer and COVID-19: Reflections at 1 Year
Nancy E. Davidson, MD, FASCO
We who live and work in Seattle recently took note of two milestones: the first death of a patient from COVID-19 reported in the United States in Seattle on February 28, 2020, and recognition of 5,000 deaths from COVID-19 in the state of Washington on March 2, 2021. The juxtaposition of these two so...
