Perspectives
How the COVID-19 Pandemic Can Help Improve Cancer Research
Richard L. Schilsky, MD, FASCO, and Nathan A. Pennell, MD, PhD, FASCO
The ripple effects of the coronavirus pandemic have been felt in every area of health care. In our medical specialty, oncology, clinical trials of new treatments were upended by COVID-19. In the early months of the pandemic, widespread interruptions in trial enrollment prevented some patients from...
COVID-19 and Cancer: A Toxic Combination
Richard J. Boxer, MD, FACS
COVID-19 has caused 475,000 deaths in America, disproportionately among communities of color, poverty, immigrants, and older age. It has exposed a variety of inequities within our health-care system. However, the patients at greatest risk of death from COVID-19 are those with cancer. While 1.8% of A...
High-Risk Cutaneous Squamous Cell Carcinomas: The Present and Future
Adam Sutton, MD, MBA, and Ashley Wysong, MD, MS
Cutaneous squamous cell carcinoma is the second most common type of skin cancer, with more than 1 million cases diagnosed in the United States annually.1 Historically, cutaneous squamous cell carcinoma is grouped together with basal cell carcinoma and collectively referred to as nonmelanoma skin can...
Empowering the FDA to Require Dose Optimization of All New Oncology Drugs
Mark J. Ratain, MD, FASCO, and Allen S. Lichter, MD, FASCO
The vast majority of drugs used outside of oncology are evaluated in randomized dose-ranging trials to optimize the therapeutic index prior to the pivotal phase III trial. No one would think of dosing a statin or an antibiotic at the highest dose patients could tolerate, especially if that dose resu...
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 ...
Challenges Related to Informed Consent and Information-Sharing for Minors With Cancer
Govind Persad, JD, PhD
Here we discuss a complex and often emotionally wrenching challenge related to informed consent in the provision of pediatric cancer care. For example, what legal and ethical claims do young patients have to information about their cancer diagnosis and treatment recommendations? What are the obstacl...
Life and Death Under COVID-19
David Irwin, PhD
Victoria was a 79-year-old woman living alone in a London suburb. Having no children of her own, she visited us regularly here in the United States. She was one of three sisters and my sister-in-law. I knew her for more than 50 years, and she always reminded me of Audrey Hepburn, both in looks and...
The Problem of Heterogeneity Within Stage
Murray F. Brennan, MD, and Mithat Gönen, PhD
The more senior of this duo grew up with prognostication by disease stage and was taught that all stage IV cancers behaved the same. In the past 3 decades, we have become much more cognizant of the heterogeneity in outcome within stage. Individual Kaplan-Meier plots by stage separate well but hide t...
What Is the Measure of Minimal Residual Disease in AML?
Jerald P. Radich, MD
Relapse is the primary obstacle to cure in leukemia. The term minimal residual disease (MRD) was coined in the early 1990s to describe finding a disease-specific marker in the context of a morphologic-appearing remission. The technique first used for MRD detection was the Southern blot (!), but the ...
Impact of COVID-19 on Cancer Care in India
Rakesh Chopra, MD; Kavita Yadav, BDS, MPH; and Ravi Mehrotra, MD, DPhil, FRCPath
With the announcement of a complete nationwide lockdown on March 25, 2020, to prevent the spread of COVID-19, a lot of unprecedented events came into being in India. The National Health Mission reported a 69% reduction in measles, mumps, and rubella vaccination in children; a 21% reduction in ...
What Is ‘Quality Oncology Care’ During the COVID-19 Pandemic?
Kathryn Hudson, MD
My patient with metastatic colon cancer was sitting across from me after being absent for several months. His cancer had been under excellent control on chemotherapy, but now he was having worse pain and shortness of breath. Despite our calls, he had not kept his appointments. We were 6 feet apart, ...
Lung Cancer: Precision Therapies at the Forefront
Suresh S. Ramalingam, MD, FACP, FASCO
What a difference 20 years have made! In the year 2000, the results of the ECOG 1594 trial were reported at the plenary session of the ASCO Annual Meeting. The study demonstrated comparable outcomes between four different platinum-based chemotherapy regimens for the treatment of metastatic non–small...
Beyond BROCADE3: Just the Beginning for Veliparib-Based Therapy in Advanced BRCA-Mutated Breast Cancer
Martine Piccart, MD, PhD
As recently reported in The Lancet Oncology and reviewed in the October 10, 2020, issue of The ASCO Post, the phase III BROCADE3 trial has shown that the addition of veliparib to carboplatin and paclitaxel improved progression-free survival in previously treated BRCA-mutated advanced breast cancer.1...
Should Body Mass Index Guide the Choice of Chemotherapy in Patients With Breast Cancer?
Kristen Whitaker, MD, MS, and Lori J. Goldstein, MD, FASCO
The rate of obesity is rising dramatically in the United States and Europe, with more than 60% of women in the United States1,2 and 50% of women in Europe3 classified as overweight or obese based on their body mass index (BMI). Obesity is associated with an increased risk of hormone receptor–pos...
COVID-19, Cancer, and the Older Adult
Erika Ramsdale, MD, Supriya Mohile, MD, and the Cancer and Aging Research Group
An inspiring case series of fit patients aged 98 and older who recovered from hospitalization for COVID-19, published by Huang et al, reminds us that older age may not be a barrier to recovery.1 On behalf of the Cancer and Aging Research Group, we do not support “ageism” in the care of older adu...
The Gut, Our Choices, and Gynecologic Cancers: Investigating an Unlikely Trio
Nathalie D. McKenzie, MD, MSPH, FACOG, DipABLM
Disturbance of the gut microbial metabolism is thought to be the root cause of human diseases. Bacteria, viruses, and fungi affect their human hosts in numerous ways. There is evidence to support the theory that microbes, through their genetic makeup, gene products, and metabolites, play a role in h...
Mobilizing for Greater Equity in Health Care Despite the Challenges of COVID-19
Princess Dina Mired
The lockdown phase of the coronavirus (COVID-19) pandemic and continued measures, such as social distancing, while necessary, are disrupting cancer care in ways that will have consequences for months, if not years, to come. Studies are showing that delayed or suspended cancer treatments, screenings,...
The New Face of Medical Visits
Rujuta Saksena, MD
“Good morning! I’m Dr. Saksena. It’s a pleasure to meet you.” I wave my introduction as I enter the room. Two women sit beside each other. One of them wears a mask that reads “lipstick optional,” and the other dons a surgical mask. This is a new visit for breast cancer, but I haven’t yet deciphered ...
Neratinib in Previously Treated HER2-Positive Metastatic Breast Cancer: Point of View From the NALA Trial
Kimberley T. Lee, MD, MHS, and Cesar A. Santa-Maria, MD, MSCI
Neratinib is an oral pan-HER tyrosine kinase inhibitor that is approved by the U.S. Food and Drug Administration (FDA) for two indications. The first is as adjuvant treatment of early-stage HER2-positive breast cancer following adjuvant trastuzumab therapy. The second is in combination with cape...
Developing Policies to Address Patient Racial Bias and Race-Based Provider Requests
Govind Persad, JD, PhD
Public momentum for efforts to address structural and systemic racism has led many health-care institutions to consider how they can work to bring about positive change. In this column, drawing on important recent work by Kimani Paul-Emile, JD, PhD, Professor of Law at Fordham University School of...
Growing Body of Evidence Supports Adjuvant Immunotherapy for Stage IV Melanoma With No Evidence of Disease
Pauline Funchain, MD
With incredibly paced approvals and clinical advancements in the systemic therapy of cutaneous melanoma, the efficacy of immunotherapy in this disease is clear. However, many important questions remain regarding timing and dosing—in other words, which drug (or drugs) makes the most sense and in whic...
A Moment to Pause, Reflect, and Act Amid a Pandemic
Rosa Nouvini, MD
In this period of time, more than ever before, I feel the dichotomy of being a non-Hispanic White American vs a person of color. Through the COVID-19 pandemic, I rode the subway to the Memorial Sloan Kettering Ralph Lauren Cancer Center clinic in Harlem, where I was often the only White person on ...
Pet Therapy: How the Cat I Never Wanted Saved My Life
Fumiko Chino, MD
My husband and I adopted our cat, Franklin, on a cold November day. It was one of the last days Andrew felt well enough to leave the house to go anywhere other than to chemotherapy or a doctor’s appointment. Our news at these appointments had shifted toward the negative, with disease progression o...
Switch Control Inhibitor for GISTs Harboring Drug-Resistance Mutations: The INVICTUS Trial
Heikki Joensuu, MD, PhD
In May 2020, the U.S. Food and Drug Administration (FDA) approved ripretinib for patients who have received prior treatment with three or more kinase inhibitors, including imatinib, for advanced gastrointestinal stromal tumors (GIST). The approval was largely based on the findings of the randomize...
Adding Immunotherapy to BRAF/MEK Inhibition in BRAF V600–Mutant Melanoma: First Step on the Journey
Omid Hamid, MD
As investigators, we were always determined to find the drug to work with BRAF/MEK inhibitor combination therapy. It had come on like a storm and showed us that we could help even those with the most advanced metastatic melanoma, as long as it harbored the magical BRAF V600E mutation.1 Unfortunate...
Final ASCEND Results Confirm Acalabrutinib as a Standard for Relapsed CLL
Seema A. Bhat, MD, and Jennifer A. Woyach, MD
The Bruton’s tyrosine kinase (BTK) inhibitors have been one of the most exciting advances in the tre atment of chronic lymphocytic leukemia (CLL) and have led to the development of chemotherapy-free treatments for both treatment-naive as well as relapsed or refractory CLL based on studies where ...
Nonmetastatic Castration-Resistant Prostate Cancer
Michael T. Schweizer, MD, and Daniel W. Lin, MD
Nonmetastatic castration-resistant prostate cancer arises in the subset of men with biochemically recurrent disease (ie, rising prostate-specific antigen [PSA] level after definitive therapy in the absence of metastases) who develop PSA progression after chronic exposure to androgen-deprivation ther...
TITAN Trial: Apalutamide Adds to Options for Men With Metastatic Hormone-Sensitive Prostate Cancer
Fred Saad, MD, FRCS
Androgen-deprivation therapy has been, and remains, the standard of care for patients with metastatic prostate cancer. Patients are often surprised to learn that was all we would do to control their disease and sometimes asked why they would not receive chemotherapy, as for other cancers. I would ta...
Many Choices Now for Men With Metastatic Hormone-Sensitive Prostate Cancer: How to Decide?
Andrew J. Armstrong, MD, ScM, FACP
Based on the recently published ENZAMET, ARCHES, and TITAN trials,1-3 we now have several choices of systemic combination therapies for men with metastatic hormone-sensitive prostate cancer. Today, men are faced with decisions of androgen-deprivation therapy alone or combinations with abiraterone, d...
Incorporating Immunotherapy Into Treatment of Early-Stage NSCLC
Neal Ready, MD, PhD
There is a strong rationale for incorporating immunotherapy into the treatment of early-stage non–small cell lung cancer (NSCLC), given the breakthrough results with PD-1 checkpoint inhibitors as monotherapy, combined with immunotherapy, or combined with chemotherapy in advanced-stage NSCLC. As revi...
Physicians, New Drugs, and Pharma
Robert Peter Gale, MD, PhD, DSc (hc), FACP, FRCPI (hon), FRSM, and Hillard M. Lazarus, MD, FACP
The U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) have approved record numbers of new cancer drugs recently. This is extraordinarily good news for physicians, patients, and drug companies, but it raises important questions as to how effective these drugs are, whether ev...
Improving Communication Skills for Oncology Clinicians During the COVID Pandemic
Deborah C. Marshall, MD, MAS, and Kavita Dharmarajan, MD, MSc
Living in the era of COVID-19 has heightened fear and anxiety among patients with cancer. On the one hand, they are at higher risk of serious COVID-related illness. On the other hand, delaying cancer-focused treatment raises concerns of disease progression. This pandemic has led to dramatic chan...
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...
Monumental Progress in the Treatment of Diffuse Large B-Cell Lymphoma
Bruce D. Cheson, MD, FACP, FAAAS, FASCO
Some monuments are difficult to topple. At least that was the case dating back to 1976, when investigators from the Southwest Oncology Group demonstrated the importance of doxorubicin in the treatment of patients with a group of lymphoid malignancies then referred to as diffuse aggressive lymphoma...
The Importance of Measuring Health-Related Quality of Life in Older Adults
Mazie Tsang, MD, MS, and Kah Poh (Melissa) Loh, MBBCh, BAO
Compared with younger patients, older patients with cancer face unique challenges because many of them have age-related decreases in health-related quality of life. This can be a result of many factors, such as comorbidities, mental health, physical impairment, and financial stressors. A diagnosis o...
Role of Rituximab in the Treatment of Children and Adolescents With Mature B-Cell Non-Hodgkin Lymphoma
Mitchell S. Cairo, MD
Minard-Colin et al recently reported for the European Intergroup for Childhood Non-Hodgkin Lymphoma/Children’s Oncology Group (EICNHL/COG) a significant improvement in event-free survival among children and adolescents (aged 6 months to 18 years) with high-risk mature B-cell non-Hodgkin lymphoma (B-...
Weathering the Storm: Personal Steps Toward Racial Equity in Oncology
Katherine Reeder-Hayes, MD, MBA, MSc; Lori J. Pierce, MD, FASTRO, FASCO; Manali I. Patel, MD, MPH; and Marjory Charlot, MD, MPH, MSc
“Of all the forms of inequality, injustice in health is the most shocking and the most inhumane because it often results in physical death. I see no alternative to direct action and creative nonviolence to raise the conscience of the nation.” —Martin Luther King, Jr, speaking before the Medical Com...
Geriatric Assessment: What Are You Waiting For?
Stuart M. Lichtman, MD, FACP, FASCO
The ASCO20 Virtual Scientific Program was the forum for an unusual but profoundly important event in oncology. Four studies that should be practice-changing were presented.1-4 These studies provided irrefutable evidence that we can improve the quality of life of older patients by reducing toxicity. ...
IMbrave150: A New Standard of Care to Treat Hepatocellular Cancers?
A. Craig Lockhart, MD, MS
In 2007, sorafenib became the first approved systemic therapy for hepatocellular cancers and the first agent to improve overall survival in these patients.1 In a similar multikinase inhibitor strategy, lenvatinib was found to be noninferior to sorafenib in overall survival in the same patient popula...
A Visiting Resident Oncologist’s Training During the COVID-19 Pandemic
Shannon Ugarte, MD
A visiting away elective is a resident’s designated time to visit another academic program to foster the growth of medical knowledge through patient care from the perspective of another health-care system and educational experience. The time dedicated to make this dream happen is grueling. First ...
Repeat Breast Preservation: First Consideration in a Second Ipsilateral Breast Tumor Event
Mark Trombetta, MD, FACR, and Jean-Michel Hannoun-Levi, MD, PhD, MSD
Worldwide, nearly 1.7 million women will be diagnosed with breast cancer. Of that number, nearly 300,000 Americans and more than 500,000 Europeans will be diagnosed with both invasive and in situ breast cancers.1,2 Breast-preserving surgery will initially be performed on approximately 60% of the...
ASCO20 Virtual Scientific Program: Next-Generation Oncology Highlights
Luis Eduardo Pino Villarreal, MD, MSc, MBA
The ASCO20 Virtual Scientific Program was different in many ways, not only because of the virtual modality forced by the COVID-19 pandemic, but also because of the resilience of the scientific society and my colleagues around the world. I’m in the plenary session of the ASCO 2025 Annual Meeting. ...
COVID-19 and Patients With Cancer: A Call to Action for Trainees
Arielle Elkrief, MD; Aakash Desai, MBBS, MPH; Amit Kulkarni, MBBS; Ali Raza Khaki, MD; and Samuel Rubinstein, MD
As oncology trainees, we develop skills to synthesize complex data and communicate this information with empathy as we accompany our patients through the trenches of a cancer diagnosis. With the current COVID-19 pandemic, an unprecedented layer of challenges has surfaced, as our patients who are liv...
When Is It Time to Pass?
Sir Murray F. Brennan, MD
Assisted suicide gets a lot of press, as if it were a new event. About 20 to 30 years ago, it was ever present but neither defined nor acknowledged. When patients left the hospital for what they and I believed to be the last time, I did one or both of two things: gave them my home number or, if they...
Breastfeeding: A Public Health Strategy for Reducing Risk of Ovarian Cancer
Mary B. Daly, MD, PhD
Although early-stage disease is highly curable, most ovarian cancers are diagnosed at later stages due to a lack of effective screening. As a result, less than 50% of women survive beyond 5 years. Improving prevention by identifying modifiable risk factors could dramatically change the outcome of th...
Addition of CD38-Directed Antibody Isatuximab to Multiple Myeloma Armamentarium
Shaji K. Kumar, MD
The treatment approaches to multiple myeloma have significantly changed over the past decade with the introduction of many new active agents. Among them, the monoclonal antibodies have been one of the most exciting advances in myeloma, complementing their success in other hematologic cancers. In p...
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...
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...
How the Lung Cancer Community Came Together During the COVID-19 Pandemic
Fred R. Hirsch, MD, PhD; Paul A. Bunn, Jr, MD; and John D. Minna, MD
The COVID-19 pandemic (caused by infection with the SARS-CoV-2 coronavirus) has created a host of diagnostic, treatment, and follow-up problems for patients with cancer of all types, and this is particularly true for patients with lung cancer, their families, and providers. Everyone wanted to ...
On the Shoulders of Giants
Mohammad K. Khan, MD, PhD, and Clayton B. Hess, MD, MPH
Before the dawn of the modern antibiotic era and amid the chaos of World War II, future Professor of Radiology and Founding Dean of two American medical colleges, Dr. George T. Harrell,* penned what could now be argued was far too bold a statement. As the opening lines of his nonrandomized study...
