Perspectives
United Against Cancer to Accelerate Progress for Patients
Howard A. ‘Skip’ Burris III, MD, FACP, FASCO
When I chose my Presidential theme for the 2020 ASCO Annual Meeting, “Unite and Conquer: Accelerating Progress Together,” in early 2019, I never imagined it would take on a new meaning 12 months later. The world is grappling with the COVID-19 pandemic, and, even as we practice social distancing, I c...
PARP Inhibitors in Maintenance Treatment for Advanced Ovarian Cancer
David M. O’Malley, MD, and Antonio Castaneda, MD
Based on multiple phase III prospective trials, there is evidence that both PARP inhibitors and antiangiogenic therapies such as bevacizumab provide benefit when utilized in a maintenance strategy in the first-line treatment of advanced epithelial ovarian cancer (GOG 218, ICON7, SOLO-1, PRIMA, VELIA...
Conference Highlights From the 2018 American Society of Hematology Annual Meeting & Exposition
Krishna Gundabolu, MBBS
In sunny San Diego, the 2018 American Society of Hematology (ASH) Annual Meeting & Exposition welcomed nearly 30,000 attendees who were eager to present, learn, network, and cheer the joint achievements of many researchers. The packed meeting was filled with important information from thousand...
Evolving Standards and Quality Metrics Ensure High-Quality Cancer Programs
Lawrence N. Shulman, MD
Dr. Shulman is Deputy Director, Clinical Services, and Director of the Center for Global Cancer Medicine, Abramson Cancer Center; and Professor of Medicine, Hospital of the University of Pennsylvania, Philadelphia. IN 2008, WHEN ALLEN LICHTER, MD, FASCO, then Chief Executive Officer of ASCO, call...
A Tribute to Two Amazing Scientists
Francis S. Collins, MD, PhD
Dr. Collins is Director of the National Institutes of Health. Originally posted on March 19, 2018, to the National Institutes of Health (NIH) Director’s Blog (https://directorsblog. nih.gov). OVER THE PAST couple of weeks, we’ve lost two legendary scientists who made major contributions to our w...
New Agents for Initial Treatment of Metastatic Prostate Cancer: A New Standard of Care?
Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
FOR DECADES, the status of metastatic prostate cancer trials was not particularly exciting. With an absence of high-impact novel agents, the focus of cancer trial groups was on the improvement of standard care. Well-crafted, large trials of hormonal therapy demonstrated the utility of combined and...
Why Right-to-Try Laws Are Dangerous
Ellen V. Sigal, PhD
Why wouldn’t you support a patient with a terminal illness the “right to try” any therapy that may save his or her life? The answer to this question—one engulfed in a political debate in Congress—seems simple. It is not. [Editor’s Note: On May 30, 2018, the President signed into law the Trickett W...
Alexander Fleming Would Have Loved Our Success With Cancer Immunotherapy
John F. Smyth, MD
THE UNIVERSITY of Edinburgh Medical School was established in 1726 during the Scottish Enlightenment. As one of the oldest medical schools in the English-speaking world, it is interesting to reflect on the seminal contributions made centuries ago by several alumni that are still relevant to the pr...
PARP Inhibitors in BRCA-Related Ovarian Cancer—and Beyond!
Ursula A. Matulonis, MD
Poly (ADP ribose) polymerase (PARP) inhibitors are among the most exciting new classes of oncology drugs, and their development has coincided with the increasing recognition of the therapeutic vulnerability in targeting DNA damage response and DNA repair. The initial clinical testing of PARP inhibit...
Smashing the Glass Ceiling in Medicine
Elizabeth L. Travis, PhD, FASTRO, and Ethan Dmitrovsky, MD
IT IS A SAD TRUTH that academic medicine, like many other professions, has a glass ceiling that hampers its ambitions. In medicine, this glass ceiling blocks women and minority faculty from reaching the highest ranks of leadership. Even if the root cause is not yet known, we want to eliminate th...
Can We Have a Successful Vaccine Against Cancer?
Electra D. Paskett, PhD
EARLY IN our careers, few of us imagined that a vaccine could one day prevent cancer. Now, there is a vaccine that keeps the risks from human papillomavirus (HPV) at bay, and yet universal adoption of the HPV vaccine has been incomplete. As a result of misinformation about the vaccine—and its admi...
Adoptive Cell Therapy—Act 1: The Beginning
Frederick R. Appelbaum, MD
ON AUGUST 30, 2017, the first genetically engineered T-cell therapy (tisagenlecleucel [Kymriah]) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of patients up to 25 years of age with B-cell precursor acute lymphoblastic leukemia that is refractory or in second or lat...
For the Impoverished, Health Care Is a Luxury
Chandrakanth Are, MBBS, MBA, FRCS, FACS
Cancer is the second leading cause of death worldwide, and the global burden is on an inexorably upward trajectory. For the year 2012, there were 14.1 million new cancer cases and 8.2 million cancer-related deaths worldwide.1 It is predicted that by the year 2035, there will be 23.9 million new canc...
Fighting Misinformation in HPV-Related Cancer Prevention
Lois Ramondetta, MD
FAKE NEWS, junk science, and alternative facts seem pervasive in our current culture, to the detriment of important, verified scientific advancements. One area where this is quite evident is the vaccine against human papillomavirus (HPV). Although we have had a safe, effective vaccine since 2006 t...
Tissue Specimens in Clinical Trials: A Double-Edged Sword
Apar Kishor Ganti, MD, MS, FACP
AN INCREASING number of clinical trials require the submission of tissue specimens, either from archived specimens or increasingly from fresh biopsies taken after enrollment into the trial. These specimens can be either mandatory, required to determine whether a given patient has the required biom...
Maintaining Predictable Increases in NIH Funding for Cancer Research
Richard L. Schilsky, MD, FACP, FASCO
CONGRESS RECENTLY passed its fiscal year (FY) 2017 spending bill, which contains an additional $2 billion for the National Institutes of Health (NIH). This marks the first time in more than a dozen years that Congress funded back-to-back increases for the NIH, demonstrating the bipartisan consensu...
The Emperor’s New Clothes: Biosimilars and Cost in Oncology
Kevin Knopf, MD, MPH, and Charles Bennett, MD, PhD, MPP
Biosimilars are biologic products similar to the parent (branded) molecule in structure and function—such as erythropoietin and filgrastim (Neupogen).1 To truly bend the cost curve, we want to see a dramatic economic savings achieved as oncology biosimilars for rituximab (Rituxan), trastuzumab (...
Will the UK’s Departure From the EU Impact Oncology in Europe?
John F. Smyth, MD
“No man is an island entire of itself; any man’s death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.” —John Donne (1624) This statement is almost certainly true—and sadly in a negative way not just for the UK but for ...
My Year of Living Wonderfully: 12 Months as ASCO President
Daniel F. Hayes, MD, FACP, FASCO
EACH YEAR, the ASCO President chooses a theme for his or her term, which is not a trivial pursuit. Trying to think up something novel and catchy, yet not schmaltzy, is quite a challenge. However, in my year as Chair of the Scientific Program Committee for the 2010 ASCO Annual Meeting, th...
FALCON Trial Informs the Evolving Role of Fulvestrant in Advanced Hormone Receptor–Positive Breast Cancer
Aman U. Buzdar, MD, FACP
Endocrine therapy for breast cancer has evolved over the years. Initial endocrine therapies consisted of ablative procedures (oophorectomy, adrenalectomy, and hypophysectomy). With the availability of pharmaceutical estrogens, progestins, and androgens, ablative procedure utilization begin to decr...
Medicare Access and CHIP Reauthorization Act: The Final Rule
Philip J. Stella, MD
It is gratifying to see the Centers for Medicare & Medicaid Services (CMS) does listen to public comments regarding new proposals. Since CMS opened the comment period for its Quality Payment Program, which repeals the Sustainable Growth Rate Formula and was proposed to implement the ...
Another Step Forward for Genomic Assays in Early-Stage Breast Cancer: Findings With MammaPrint in the MINDACT Trial
Harold J. Burstein, MD, PhD
Genomic assays have had a powerful influence on the management of early-stage breast cancer, particularly estrogen receptor–positive tumors. The mainstay of adjuvant treatment for early-stage, hormone receptor–positive breast cancer has been endocrine therapy, either with tamoxifen and a...
The Need for Solid Data During a Global Pandemic
Giorgio V. Scagliotti, MD, PhD
The rapid outbreak of COVID-19 disease on a global scale found the community of clinicians and scientists largely unprepared to face the devastating effects of the pandemic. The stress on health-care systems revealed their weaknesses and brought about associated financial crises. Defining the cli...
April Is the Cruelest Month
Jame Abraham, MD, FACP
April is the cruelest month, breeding Lilacs out of the dead land, mixing Memory and desire, stirring Dull roots with spring rain. Winter kept us warm, covering Earth in forgetful snow, feeding A little life with dried tubers. —T.S. Eliot, The Burial of the Dead, The Waste Land, 1922 I start...
Gut Bacterial Diversity: A Marker or Driver of Outcomes After Hematopoietic Cell Transplantation?
David N. Fredricks, MD
Previous single-center studies have linked the gut microbiota (via stool sample analysis) to outcomes after hematopoietic cell transplantation (HCT), such as overall mortality, transplant-related mortality, graft-vs-host disease, and graft-vs-host–related mortality.1-4 Although intriguing, these stu...
Practicing Oncology in the Era of COVID-19
Chandrakanth Are, MBBS, MBA, FRCS, FACS
The coronavirus-related pandemic has affected nearly every corner of the globe. What originated in one country is on course to likely affect every country in the world. In a few countries, the disease has peaked and is on the downward trend. In some, including the United States, the disease is on th...
Practicing Wellness to Reduce Burnout
Nathalie D. McKenzie, MD, MSPH, and Sarfraz Ahmad, PhD
Numerous wellness strategies are accessible to busy physicians and oncologists, which can be incorporated into their daily routine. Here we discuss such aspects as stress reduction, mindfulness, eating well, sleeping well, and spirituality for the wellness of oncologists. Those who regularly adhere ...
Front-Line Therapy in Advanced Renal Cell Carcinoma: Developing a New Standard
Rana R. McKay, MD
THE FRONT-LINE systemic treatment landscape for metastatic renal cell carcinoma has undergone tremendous movement over the past several years. A better understanding of the current management paradigm for therapy-naive patients warrants a reflection of historic landmark clinical trials that have c...
The Relevance of the RELEVANCE Trial in Follicular Lymphoma
Jonathan W. Friedberg, MD, MMSc
We have seen remarkable progress in the outcomes of patients with advanced-stage follicular lymphoma over the past 2 decades.1 Recent manuscripts and presentations describing long-term follow-up of randomized trials comparing various chemotherapy platforms (all combined with anti-CD20 antibodies) ...
Treating Nonmetastatic Castration-Resistant Prostate Cancer: Implications of the PROSPER Trial
Konrad H. Stopsack, MD, MPH, and Philip Kantoff, MD
A MAN in his early 70s sits in our office. His general health is good, and he is feeling well. Yet he is deeply worried. Four years ago, when his prostate-specific antigen (PSA) level rapidly increased after radical prostatectomy and subsequent radiation therapy, he was started on androgen-depri...
Treatment of Triple-Negative Breast Cancer With BRCA1/2 Mutations: More to Learn From Ongoing Trials
William J. Gradishar, MD, FASCO, FACP
The treatment of triple-negative breast cancer remains a clinical challenge with no single validated target, though numerous pathways are druggable and are being investigated. In the subset of BRCA-mutated triple-negative breast cancer, the approval of the first poly (ADP-ribose) polymerase (PARP) i...
Why Oncologists Should Decline to Participate in the Right to Try Act
Thaddeus Mason Pope, JD, PhD
ON MAY 30, 2018, President Donald J. Trump signed into law the Trickett Wendler, Frank Mongiello, Jordan McLinn, and Matthew Bellina Right to Try Act of 2017.1 This law creates an additional and alternative pathway for patients with a “life-threatening disease or condition” to access investigational...
Promise and Challenges of CAR T-Cell Therapy for Diffuse Large B-Cell Lymphoma: ZUMA-1 Trial Results
Kieron Dunleavy, MD
Advancing therapeutics and augmenting curability in diffuse large B-cell lymphoma (DLBCL) have been very challenging. Although many novel approaches have offered promise and continue to be developed, we have not yet identified a clearly superior approach to R-CHOP (rituximab [Rituxan], cyclophospham...
A New Triumvirate in Estrogen Receptor–Positive Metastatic Breast Cancer
Neil Vasan, MD, PhD, and Maura N. Dickler, MD
THE BODY OF EVIDENCE supporting the use of cell-cycle inhibitors in combination with endocrine therapy for estrogen receptor–positive metastatic breast cancer now has another agent in the spotlight. The phase III MONARCH 2 trial—reported at the 2017 ASCO Annual Meeting and by Sledge et al in the...
Recent Progress and Concepts in Pancreatic Cancer
Robert Peter Gale, MD, PhD, DSc(hc), FACP, FRSM
November is National Pancreatic Cancer Awareness Month, the impetus for this article. Pancreatic cancer is a huge health challenge. It's the eighth most common cancer in the United States and the fourth most common cause of cancer deaths but is expected to become the second most common c...
Risk of Metastasis With Active Monitoring in PSA-Detected Localized Prostate Cancer: The ProtectT Trial
Anthony V. D’Amico, MD, PhD
The ProtecT study findings1 are provocative. Despite having a control arm of active monitoring with serial prostate-specific antigen (PSA) testing, as compared with watchful waiting in the prior randomized trials (ie, SPCG-42 and PIVOT3), and also enrolling men with more favorable-risk d...
Immune Checkpoint Inhibitors March to First-Line Treatment in Advanced NSCLC
Karen Kelly, MD
For the majority of patients who are diagnosed with advanced-stage non–small cell lung cancer (NSCLC), platinum-based doublets have been the standard of care for over 30 years. Recently, the immune checkpoint inhibitors nivolumab (Opdivo) and pembrolizumab (Keytruda) demonstrated superio...
Hypofractionated Radiotherapy for Localized Prostate Cancer: A New Standard of Care?
Talha Shaikh, MD, and Eric M. Horwitz, MD
For at least the past quarter of a century, radiobiologists and radiation oncologists have debated the role of hypofractionation (fewer total fractions with a higher dose per fraction) for prostate cancer. The debate stems from the unique radiobiology of prostate cancer and the best means to e...
The POPLAR Trial: PD-L1 Blockade With Atezolizumab in Second- or Third-Line Non–Small Cell Lung Cancer
Jean-Charles Soria, MD, PhD
The randomized phase II POPLAR trial—reported by Fehrenbacher and colleagues and reviewed in this issue of The ASCO Post—is another key piece of information for the medical community regarding the value of immune checkpoint blockers in second/third-line treatment of patients with non–small cell lun...
Chronic Lymphocytic Leukemia: The Golden Drug Only for Golden Agers?
Stephan Stilgenbauer, MD, PhD
As reviewed in this issue of The ASCO Post, Burger and colleagues recently reported findings of the RESONATE-2 trial of ibrutinib (Imbruvica) vs chlorambucil (Leukeran) as initial therapy for elderly patients with chronic lymphocytic leukemia (CLL).1 The study met its primary endpoint of independent...
The 340B Drug Pricing Program: Background, Concerns, and Solutions
Hagop Kantarjian, MD, and Robert Chapman, MD
The 340B Drug Pricing Program was created by Congress through the Veterans Health Care Act of 1992 to allow some health-care entities—including safety-net providers with large shares of uninsured and low-income patients and other “covered entities”—to obtain drugs at discounted prices.1,2 Congress g...
Filial Gaze at Our Noble Profession
Chandrakanth Are, MBBS, MBA, FRCS, FACS
As we stood outside patient X’s room going over the vitals, from a distance, I saw the father of the patient by the side of her bed. I saw him standing there and looking down at his child conveying what I guess were words of reassurance and reinforcing the pillars of strength needed for her recovery...
Does Low-Dose Radiation Cause Leukemia?
Robert Peter Gale MD, PhD, DSc(hc), FACP, FRSM, and F. Owen Hoffman, PhD
Data from A-bomb survivors, persons with ankylosing spondylitis and neoplasms treated with radiation therapy, and many other sources show a strong association between exposure to ionizing radiation (particles or electromagnetic waves with sufficient energy to cause an ionization such as photons and ...
Elotuzumab Ushers in a New Era in Myeloma Therapy
S. Vincent Rajkumar, MD
The long wait for monoclonal antibodies for the treatment of multiple myeloma is over. In the landmark ELOQUENT-2 study, reviewed in this issue of The ASCO Post, Lonial and colleagues convincingly demonstrate the effectiveness of elotuzumab, a monoclonal antibody directed against SLAMF7, in the trea...
Immune Checkpoint Inhibitors: The Dawn of a New Era for Lung Cancer Therapy
Suresh S. Ramalingam, MD
The therapeutic paradigm for lung cancer has changed rapidly over the past few years toward individualized therapy. For certain subsets of patients, molecularly targeted agents have resulted in robust gains in overall survival and quality of life. However, for the majority of patients with nonsquamo...
PRIME II and the Omission of Radiation Therapy in Low-Risk, Elderly Patients Undergoing Breast Conservation: The Time Has Come
Meena S. Moran, MD
Despite the high prevalence of breast cancer worldwide, it is important to recognize that > 40% of all cases occur in women aged 65 years or older in both the United States and the United Kingdom.1,2 Breast cancers in older patients are more often associated with indolent features and with overal...
Clinical Trial Participation: ‘Is It All Worth It?’
Lee M. Krug, MD
Clinical trials have become increasingly complex over the past several years, and unfortunately, this has resulted in the typical scenario described below. We are fortunate that there are so many promising agents available for patients, and we want to encourage their participation in clinical trials...
Big Data and the Promise of Precision Medicine in Cancer
Peter Paul Yu, MD, FACP, FASCO
Precision medicine—and its promise to revolutionize how we understand disease and care for our patients—is a concept that oncology has understood and embraced for well over a decade. But millions of Americans recently heard about the concept for the first time when President Obama announced a high-p...
Transplants for AML in First Remission: A Great Leap Forward, Sideways, or Backward?
Robert Peter Gale, MD, PhD, DSc(hc), FACP, Hillard M. Lazarus, MD, FACP, and Peter H. Wiernik, MD, FACP, FASCO
“All great truths begin as blasphemies.” —George Bernard Shaw (Annajanksa, 1918) Until about 15 years ago, persons with acute myelogenous leukemia (AML) were considered candidates to receive a blood cell or bone marrow allotransplant in first remission only if they had had an HLA-identical sib...
When Should We Stop Prescribing?
John F. Smyth, MD
This year’s European Society for Medical Oncology (ESMO) meeting held in Madrid was attended by 19,000 delegates, and it was encouraging to see among that number so many young oncologists being given time off for education and discussion. There has never before been a time when so much new informati...
