Perspectives
Going the Last Mile: Accelerating Delivery of Multiple Myeloma Therapies to All Patients
Kathy Giusti, MBA
When I was diagnosed with multiple myeloma in 1996, I was given 3 years to live. At the time, there was little understanding of this disease, which was termed incurable. There were no new treatments, few drugs in the pipeline, hardly any clinical trials, and no multiple myeloma community or ecosys...
DESTINY-Lung01: Is Trastuzumab Deruxtecan the Answer for HER2-Mutant Lung Cancer?
Ibiayi Dagogo-Jack, MD
The human epidermal growth factor (HER) family of receptors are a well-established therapeutic target. Indeed, seminal studies conducted nearly 2 decades ago identified a key association between activating mutations in the kinase domain of the epidermal growth factor receptor (EGFR, also known as HE...
Immune Checkpoint Inhibitors in Neoadjuvant or Adjuvant Therapy for Triple-Negative Breast Cancer: The Paradigm Shifts
Lisa A. Carey, MD, ScM, FASCO
The “holy grail” of triple-negative breast cancer therapy has been effective incorporation of drugs to improve outcomes in the early nonmetastatic setting. Although outcomes have improved with better chemotherapy drugs and schedules, triple-negative breast cancer still carries the worst prognosis of...
Phase III Trials and Tribulations
Louis M. Staudt, MD, PhD, and Wyndham H. Wilson, MD, PhD
Imagine this. You are a large pharmaceutical company that launches an international randomized phase III trial to assess whether one of your drugs improves the outcome of patients with a common type of cancer. The trial was solidly backed by preclinical evidence that the drug target was essentia...
MEK Inhibition Is Now a Standard of Care in Recurrent Low-Grade Serous Ovarian Cancer: What Next?
Rachel N. Grisham, MD
As summarized in this issue of The ASCO Post, the highly anticipated results of the GOG 281/LOGS study, which randomly assigned patients with recurrent low-grade serous ovarian cancer to the MEK inhibitor trametinib vs standard-of-care chemotherapy or endocrine therapy, have now been reported by G...
RELATIVITY-047: Relatlimab Plus Nivolumab Worthy of Further Study in Advanced Melanoma and Beyond
James W. Smithy, MD, MHS, and Margaret K. Callahan, MD, PhD
In the recently published results of the RELATIVITY-047 trial,1 summarized in this issue of The ASCO Post, the addition of relatlimab to nivolumab monotherapy was associated with improved progression-free survival compared with nivolumab alone in patients with previously untreated advanced, unre...
Reflections on the Evolution of Clinical Care Since the Passage of the National Cancer Act of 1971
Neal J. Meropol, MD, FASCO
Recently, I had the honor of coauthoring a chapter with Eric P. Winer, MD, President-Elect of ASCO, on the evolution of clinical cancer care since the enactment of the National Care Act of 1971 for the book A New Deal for Cancer: Lessons From a 50-Year War, by Abbe R. Gluck and Charles S. Fuchs, M...
Deciphering Clinical Outcomes Through Molecular Profiling: The IMmotion151 Trial
RENEE MARIA SALIBY, MD, MSc; CHRIS LABAKI, MD; RANA R. McKAY, MD; ELIEZER M. VAN ALLEN, MD; TONI K. CHOUEIRI, MD; DAVID A. BRAUN, MD, PhD
Over the past decade, an improved understanding of kidney cancer biology together with the development of novel systemic therapies have substantially improved the outcomes of patients with metastatic clear cell renal cell carcinoma (RCC).1 Following extensive clinical investigations, combinations of...
Should Patients Aged 80 and Older Receive Single-Agent Immune Checkpoint Inhibitor Treatment?
STUART M. LICHTMAN, MD, FACP, FASCO
The checkpoint inhibitors are among the most important advances in oncology in recent times. They have changed the natural history of many tumors, particularly melanoma. They have a favorable toxicity profile, which for most patients is manageable and tolerable. However, there are several toxicities...
Peptide Receptor Radionuclide Therapy for Gastroenteropancreatic Neuroendocrine Tumors: Implications for Current Practice
Namrata Vijayvergia, MD, FACP, and Pamela L. Kunz, MD
The rising incidence and prevalence of gastroenteropancreatic endocrine tumors make them the second-most prevalent gastrointestinal cancer.1 Although most of these tumors are relatively slow growing, their histologic grade and differentiation are closely correlated with their clinical behavior.2,3 M...
War Is Hell. It’s Also a Public Health Disaster, Especially for People With Cancer
Robert Peter Gale, MD, PhD, DSc (hc), FACP, FRCPI (hon), FRSM
We are all following the ongoing Russian invasion of Ukraine with surprise and horror. I’m sure few readers of The ASCO Post imagined the invasion of a European country by its European neighbor was possible again, naively thinking wars like this ended with the Allied victory in World War II. But the...
(My) German Hodgkin Story
Volker Diehl, MD
Nearly 200 years ago, Thomas Hodgkin for the first time described a peculiar disease with undulating fever, enlarged lymph nodes, and a big spleen. Its nature was obscure. It was a fatal illness, affecting mainly young adults and children. In 1865, Samuel Wilks named this illness Hodgkin’s disease...
Time for a Radical Change in the Treatment of Endometrial Cancer: KEYNOTE-775 and Beyond
B.J. Rimel, MD
I had the privilege of sitting in a meeting on the treatment of endometrial cancer as a junior investigator in January 2015 where a representative from the U.S. Food and Drug Administration was present. The topic of the meeting was on how to design the next endometrial cancer trials. I remember dist...
Cancer in the Arab World: Addressing Challenges to Improve Outcomes
Humaid O. Al-Shamsi, MD, MRCP (UK), FRCP (C), FACP
I returned home to the United Arab Emirates in 2017, following my oncology fellowship training and work experience in the United States. I immediately realized that I am now dealing with a considerably different cancer patient population in terms of age of onset, stage at presentation, awareness and...
The Greek Alphabet in Waves
Samuel A. Kareff, MD, MPH
The first 6 months of fellowship in a nutshell: Waves. July A move back to the waves of the Atlantic Calmly and incessantly recoiling while The Greek alphabet regains traction. August The fallout of Delta. Telemedicine for goals of care, While reciting the ABCs of chemotherapy. Septembe...
Circadian Timing of Immune Checkpoint Inhibitors: Beyond Good Times and Bad Times
Francis Lévi, MD, PhD
After almost a century of limited efficacy of cancer immunotherapy,1 the breakthrough happened in 2012 with the discovery of immune checkpoint inhibitors,2,3 leading to the 2018 Nobel Prize in Physiology or Medicine for James P. Allison and Tasuku Honjo. Yet about 40% of patients on immune checkpoin...
RxPONDER Trial: Another Step in Defining Which Patients With Breast Cancer May Be Spared Adjuvant Cytotoxic Chemotherapy
Gini F. Fleming, MD, FASCO
As reported by Kalinsky et al and summarized in this issue of The ASCO Post, an interim analysis of the phase III RxPONDER trial showed that the addition of adjuvant chemotherapy to endocrine therapy improved invasive disease–free survival among premenopausal—but not postmenopausal—women with hormon...
In All Candor, What Does CANDOR Bring to the Table in Relapsed or Refractory Multiple Myeloma?
Sarah A. Holstein, MD, PhD
An updated analysis of the phase III CANDOR study—recently reported by Usmani et al and summarized in this issue of The ASCO Post—confirmed a significant progression-free survival benefit for the combination of daratumumab, carfilzomib, and dexamethasone (KdD) over carfilzomib and dexamethasone (K...
How to Rein in Oncology Costs and Save Physician-Owned Practices
Barbara L. McAneny, MD, FASCO, MACP
I was honored to contribute a chapter on the cancer care delivery system and how to improve it for the book A New Deal for Cancer: Lessons From a 50 Year War, edited by Abbe R. Gluck and Charles Fuchs, MD, MPH (Public Affairs, 2021). The book chronicles what has been accomplished in the 50 years sin...
Oncology Drugs With Accelerated Approval: Is It Time for a Reset?
Charles L. Bennett, MD, PhD, MPP, and Jeromie Ballreich, PhD, MHS
Regulations that are developed by the U.S. Food and Drug Administration (FDA) must have some shelf-life before revisions are considered. The FDA has several mechanisms to provide patients with more rapid access to medicines. One such pathway is accelerated approval. Backward Glance at Accelerated A...
PALLAS Trial in Hormone Receptor–Positive, HER2-Negative Breast Cancer: Defining the Role of Adjuvant CDK4/6 Inhibition
Gabriel N. Hortobagyi, MD, MACP, FASCO
Over the past 7 years, the introduction of combined endocrine therapy with cyclin-dependent kinase (CDK) 4/6 inhibitors resulted in a dramatic improvement in outcomes for patients with metastatic, hormone receptor–positive, HER2-negative breast cancer. Early attempts to modulate the cell cycle with ...
Pembrolizumab Plus Chemotherapy in Advanced Esophageal Cancer: Good News for Some, but More Work to Be Done
Michael K. Gibson, MD, PhD
Multiple comparisons of traditional cytotoxic chemotherapy combinations that began decades ago led to the adoption of the platinum plus fluorouracil doublet as the standard of care for treatment of recurrent or metastatic esophageal cancer.1 Other combinations created by the addition and/or substitu...
Adjuvant Atezolizumab in IMpower010: Moving the Needle in Early-Stage NSCLC
James P. Stevenson, MD
Adjuvant platinum-based chemotherapy for early-stage non–small cell lung cancer (NSCLC) is currently almost an afterthought and is taken for granted as a standard of care for patients with stage II to IIIA NSCLC after resection. The earliest meta-analysis, published in 1995,1 gave the first hint of ...
Promise and Need for More Progress in Treatment of Squamous Cell NSCLC
Charu Aggarwal, MD, MPH
A greater understanding of the mutational landscape in non–small cell lung cancer (NSCLC) has identified key oncogenes, such as EGFR, ALK, ROS, RET, and BRAF, among others. These discoveries, coupled with the availability of specific targeted small-molecule inhibitors, have transformed the managemen...
Better Federal Agency Coordination Is Needed to Accelerate Progress Against Cancer
Richard L. Schilsky, MD, FACP, FSCT, FASCO
President Richard M. Nixon signed the National Cancer Act into law on December 23, 1971. The unprecedented legislation granted sweeping authority to the Director of the National Cancer Institute (NCI) to develop a national cancer program that included the NCI, other research institutes, and federal ...
How Medical Oncology Came to Be
James O. Armitage, MD, FASCO
For many, the way things are when you learn about them is assumed to be the way things have always been. For example, antibiotics are wonderful—but if you were practicing medicine when penicillin was discovered, it would have seemed like a miracle. For most of us, there have always been chemical t...
Maintenance Daratumumab After Initial Therapy for Transplant-Eligible Multiple Myeloma: More Questions Than Answers From CASSIOPEIA Part 2
Ajay K. Nooka, MD, MPH, FACP
Bortezomib, thalidomide, and dexamethasone (VTd) is an acceptable, effective standard-of-care induction treatment in Europe for patients with newly diagnosed myeloma who are eligible for autologous stem cell transplantation. CASSIOPEIA is a two-part, open-label, randomized, phase III trial in transp...
Daratumumab in Front-Line Treatment of Newly Diagnosed Transplant-Ineligible Multiple Myeloma: Questions Emerge From MAIA Trial
Monique Hartley-Brown, MD, MMSc
In the past decade, use of immunotherapy has arisen as a novel adjunct to multiple myeloma therapy. Daratumumab is the first anti-CD38 monoclonal antibody to be approved by the U.S. Food and Drug Administration (FDA), in November 2015, for use in treating relapsed or refractory multiple myeloma.1 Si...
Potential Impact of Nurse Navigation Program in Achieving Equitable Care and Outcomes in Patients With Aggressive Large B-Cell Lymphoma
Chijioke Nze, MD, MPH, and Christopher R. Flowers, MD, MS, FASCO
In a single-institution study reported in the journal Cancer, and reviewed in the September 10, 2021, issue of The ASCO Post, Bei Hu, MD, and colleagues from Levine Cancer Institute/Atrium Health found that the use of a dedicated nurse navigation program aided in producing similar patterns of ca...
The Cancer Research Institute in Morocco: A Center of Excellence Illustrating Progress in Africa in the Age of Global Oncology
Khalid El Bairi, MD
The enthusiasm behind the open access initiative sprang from the need for scientific research that is accessible to everyone worldwide. Open knowledge based on open access also aimed to increase good research practices such as reproducibility and transparency.1 This movement was launched by develope...
Taking Akt-ion Against Prostate Cancer?
Hannah Dzimitrowicz, MD, and Andrew J. Armstrong, MD, ScM, FACP
Inhibition of the androgen receptor pathway (AR) with novel hormonal therapies such as abiraterone acetate has greatly improved outcomes for patients with metastatic castration-resistant prostate cancer in recent years. However, through numerous mechanisms, tumors ultimately develop resistance withi...
Adjuvant Immunotherapy: The Next Chapter in Advancements in Renal Cell Carcinoma
Rana R. McKay, MD
Renal cell carcinoma is a common malignancy among men and women in the United States.1 The incidence continues to increase with the ever-increasing use of contemporary medical imaging. Although many patients who present with localized disease are cured with definitive surgery, some patients develop ...
Duration of Endocrine Therapy in Breast Cancer: How Much of a Good Thing Is Too Much?
Dario Trapani, MD, and Harold J. Burstein, MD, PhD, FASCO
Estrogen receptor–positive breast cancer is the most common type of breast cancer, diagnosed in more than 2.3 million women around the world each year, including more than 200,000 in the United States alone. Adjuvant endocrine therapy is a mainstay of treatment for these millions of women and is a m...
Durable Responses in Metastatic NSCLC: Are We Getting Closer to a Cure?
Suresh S. Ramalingam, MD
In the United States, the incidence-based mortality related to non–small cell lung cancer (NSCLC) has decreased by approximately 3% each year since 2008 in men; during the same period, the mortality in women decreased by 2% to 4% annually.1 Although multiple factors are likely responsible for the re...
Living in Survival Mode
Nagi S. El Saghir, MD, FACP, FASCO
About 10 years ago, on a flight to Detroit, while returning from the San Antonio Breast Cancer Symposium, I had a conversation with Lori Pierce, MD, FASTRO, FASCO, radiation oncologist at the University of Michigan, who went on to become ASCO President for the 2020–2021 term. I recall inviting her t...
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...
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...
