Perspectives
Navigating Uncharted Waters in the Post-Chevron Sea Change
BLASE N. POLITE, MD, MPP, FASCO; MARTIN PALMERI, MD, MBA; DOMINIC SAWAYA, JD, MPPA; and REBECCA SPENCE, JD, MPH
It is not often that the oncology community looks to the Supreme Court to forecast its future. In 2024, two decisions seemingly unrelated to health care were issued that are likely to have a monumental impact on oncology care delivery. The Court’s rulings—on June 28, Loper Bright Enterprises...
The Formative Years of Medical Oncology in the United States: A Rough and Tumble Road, Part 2
VINCENT T. DEVITA, MD, AND GEORGE P. CANELLOS, MD
Medical oncology had a turbulent beginning, as we explained in part 1 of this commentary published in the September 25, 2024, issue of The ASCO Post. And although no other specialty we know of struggled as much, with perseverance and time, it had become a stable specialty of internal medicine by...
The Formative Years of Medical Oncology in the United States: A Rough and Tumble Road, Part 1
VINCENT T. DeVITA, MD, AND GEORGE P. CANELLOS, MD
Medical oncology had a turbulent beginning. No other specialty we know of struggled as much. But by 1980, it had become a stable specialty of internal medicine and was off and running—with the major problem of how to marshal available resources to freely test the myriad opportunities presented b...
IDEA Awardees’ Reflections on the 2024 ASCO Annual Meeting
the recipients of ASCO's 2024 IDEA Award (scroll down to see the complete list of authors)
It happened! We received the International Development and Education Award (IDEA) from Conquer Cancer®, the ASCO Foundation, and it was a journey of growth, global collaboration, leadership, mentorship, and more. We have much to share after this breakthrough in our careers. The ASCO Annual Meeting ...
Too Much, Too Little, Just Right: Optimizing Cancer Care for Older Adults
Ramy Sedhom, MD; Bobby Green, MD; and Julia Frydman, MD, MS
Imagine walking into a fancy restaurant only to find a menu consisting mostly of kids’ dishes. It would make no sense. Just 25% of restaurant diners are younger than age 12, and they rarely write Yelp reviews. But when it comes to cancer treatment, this is not very far from what we do. The median a...
Gift of Truth: Reflections on a Father’s Cancer Journey
Ilana Hellmann, MBBCh
It was a hot and humid Tuesday in July, and I distinctly remember being grateful for the air conditioning in the pastel-shaded waiting room of the oncology outpatient clinic. My father sat silently beside me. We knew this room well, as we did the doctor we had arrived to see. He had been my mother...
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...
Breast Implant–Related Cancers: Should Our Patients Be Concerned?
CONNOR J. KINSLOW, MD; DAVID P. HOROWITZ, MD; AND ALFRED I. NEUGUT, MD, PhD, MPH
The U.S. Food and Drug Administration (FDA) issued a safety communication,1 which was updated2 on March 22, 2023, informing the public that there have been reports of squamous cell carcinomas (SCC) and various lymphomas of the breast in the capsule or scar of breast implants. These lymphomas a...
Cardiotoxicity: How Far Have We Come?
LORCAN RUANE, BSc, MBBS; SANDHIR PRASAD, MBBS, PhD; and JOHN ATHERTON, MBBS, PhD
A little more than 12 months ago, the first major cardio-oncology guidelines were published by the European Society of Cardiology (ESC).1 The extensive document embodied the immense progress of this subspecialty over its short existence. In reaching this milestone, it is worth considering what adva...
Accelerating Progress in Melanoma and Cancer Research
Marc Hurlbert, PhD
The Melanoma Research Alliance is on a mission to cure and prevent melanoma, a skin cancer that is diagnosed in more than 100,000 people each year and is expected to take the lives of more than 8,000 individuals in 2024.1 We invite stakeholders across all fields, including medicine, science, and ind...
Be Prepared: A Patient Perspective
I’m not prepared. It could be a few months, a few years, maybe longer. I don’t know how bad the verdict will be, but whatever it is, I’m not prepared. They always told us to be prepared. That was our motto. At age 7, I joined the Brownies, the beginning of 12 years of being molded by Girl Scout phi...
From a Small Town in Lebanon, a Young Doctor Follows His Passion to an International Career in Cancer Research
Ronald Piana
Philip A. Salem, MD, Director Emeritus of Cancer Research at St. Luke’s Episcopal Hospital, Houston, was born and reared in Bterram, a village that overlooks the Mediterranean Sea. “I had the most beautiful and blessed childhood, as I lived in a household dominated by a father who believed in the po...
AI in Cancer Care: Embrace the Change
ANANT MADABHUSHI, PhD, AND JAME ABRAHAM, MD, FACP
According to Google Chief Executive Officer Sunder Pichai, artificial intelligence (AI) is “the most profound technology humanity is working on—more profound than fire or electricity or anything that we’ve done in the past.” The impact of AI on health care and especially cancer care will not be ...
Reframing DCIS as an Opportunity for Cancer Prevention
KELLY HEWITT, MD, and LAURA J. ESSERMAN, MD, MBA, FASCO
We have been taught that early cancer detection and treatment save lives. The way to cure cancer is to find it early and treat it aggressively. The public has subscribed to this approach in our struggle to “eradicate cancer.” In certain disease types, there is merit to this philosophy. The ability t...
Treating DCIS: To Escalate or De-escalate?
Steven A. Narod, MD
There is much debate about the necessity of treating women with ductal carcinoma in situ (DCIS) with surgery or radiotherapy.1,2 It is disconcerting to many that patients with DCIS are treated in the same way as are women with early-stage invasive breast cancer. Many patients with DCIS have bilatera...
Cardio-Oncology Is a Growing Subspecialty, but Where Are the Oncologists?
Susan Faye Dent, MD, FRCPC, FIC-OS
It has been almost 20 years since the approval of trastuzumab for the treatment of early-stage, HER2-positive breast cancer. I remember returning from the 2005 ASCO Annual Meeting excited to offer patients a treatment that led to significant improvement in clinical outcomes. However, within a short ...
Sotorasib, the Poster Child for Project Optimus: Truths and Fantasies
GARTH STROHBEHN, MD, MPhil; ALLEN LICHTER, MD, FASCO; AND MARK RATAIN, MD, FASCO
In January 2021, two of us wrote in these pages about our field’s pressing need to pivot away from identifying and deploying the maximum tolerated dose (MTD) when it comes to targeted oncology therapies.1 We argued that, instead, one should be looking for the “optimal dose”—the dose that best balanc...
Generic Drug Shortages and Essential Cancer Medicines
Kevin B. Knopf, MD, MPH, and Charles L. Bennett, MD, PhD, MPP
Decisions regarding the rationing of chemotherapy are commonplace in many countries around the world—including those where patients must pay for chemotherapy out of pocket—and increasingly so in cancer settings that treat both well-off and socioeconomically disadvantaged patients. However, these lim...
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...
All Adult Oncologists Are Geriatric Oncologists
STUART M. LICHTMAN, MD, FACP, FASCO
The data developed over the past few years have overwhelmingly favored geriatric assessment as part of the routine care for older patients with cancer. It has become the standard of care. ASCO has recently published a Practical Geriatric Assessment to aid in the implementation of this vital evaluati...
Value of Some Established Treatment Practices in Chronic Myeloid Leukemia
FADI G. HADDAD, MD, AND HAGOP M. KANTARJIAN, MD, FASCO
The introduction of imatinib mesylate, the first BCR::ABL1 tyrosine kinase inhibitor, as a treatment of Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML) changed the course of the disease from invariably fatal (without allogeneic stem cell transplantation [SCT]) to indolent, where...
On Mark Cuban and the Chemotherapy Crisis
Nithya Krishnan, MD; Kimberly Boldig, DO; Kathryn Desimone, PharmD; and Ryan Rodriguez, MD
Although significant progress has been made to reduce the gap in health outcomes of minority or underserved patients, meaningful steps forward still need to be made to improve health disparities. Countless studies have shown, in general, that affluent White individuals have better health outcomes th...
Screening for Lung Cancer: Much Work Remains to Be Done
Suresh S. Ramalingam, MD, FASCO
Remarkable progress has been made in the treatment of lung cancer in the past 10 to 15 years; it is therefore not surprising that lung cancer mortality in the United States is declining consistently, at the rate of 2% to 4% annually in recent years. Long-term survival is possible even for patients w...
Gender Equity in Academic Hematology: Where There’s a ‘WiL,’ There’s a Way
ELIZA A. HAWKES, MBBS Hons, FRACP, DMedSc, AND CARLA CASULO, MD
Gender diversity, equity, and inclusion (DEI) in medicine has long been acknowledged as more than “the right thing to do,” with clear evidence of benefits in innovation, collaboration, and workplace culture.1 Yet the data continue to showcase challenges in achieving these goals despite women com...
Decentralized Care Models Empower Equitable Pediatric Cancer Treatment
NORMAN J. LACAYO, MD
Childhood Cancer Awareness Month is recognized every September to help shine a light on the realities of pediatric cancer and raise awareness of the important work being done to make a difference for the children who are diagnosed with cancer. September 15 also marked the start of Hispanic Heritage ...
The Future Priorities of the National Cancer Institute
RICHARD J. BOXER, MD, FACS
Fifty-two years ago, President Richard Nixon signed the National Cancer Act of 1971 into law, which established the National Cancer Institute (NCI) in its current form. At the time, the budget was $1.6 billion. Today, it is $7.8 billion, $4.5 billion less than the amount needed to keep up with inf...
Catalyzing Change: Young Moroccan Oncologists Spearhead the Fight Against Sarcoma
Saoussane Kharmoum, MD, PhD; Jinane Kharmoum, MD; Mariame Chraibi, MD; Mohammed Shimi, MD; and Hassan Errihani, MD, PhD
The management of sarcoma presents several challenges because of its rarity and diverse subtypes, making accurate diagnosis and specialized treatment crucial. A multidisciplinary approach involving various experts from different cancer specialties is the optimal strategy to improve survival and redu...
Perspectives on Cancer Therapy Development
William J.M. Hrushesky, MD, FACP, ABIM IM & MO
Long ago, as an ethical alternative to military service, I joined the National Cancer Institute’s Yellow Beret Program, and was assigned to its Division of Cancer Treatment (Dr. Vince DeVita) Cancer Therapy Development Branch (Dr. Steve Carter). This program reviewed and rejected or approved all exp...
Rising After Struggle: Surviving My First ASCO Breakthrough in Japan
KHALID EL BAIRI, MD
After a year of hard work preparing a strong abstract for the prestigious 2023 ASCO Annual Meeting, I finally received an acceptance letter from the scientific committee. I was overjoyed to see the efforts of our multinational team being rewarded. A few moments later, I received the decision regardi...
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...
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...
Cancer and War in Ukraine: How the World Can Help Win This Battle
Sergey Kozhukhov, MD, PhD; Nataliia Dovganych, MD, PhD; Ivan Smolanka, MD, PhD; Iryna Kriachok, MD, PhD; and Olexiy Kovalyov, MD, PhD
In Ukraine, with a population of about 44 million, there are more than 1.3 million patients with cancer. Approximately 160,000 new cases of cancer are diagnosed each year.1 In almost every region, there are local cancer centers; specialized oncologic centers are located in large cities. In Kyiv, hi...
On the Art of Organizing Best of ASCO Meetings
NAGI S. EL SAGHIR, MD, FACP, FASCO
Preparing and running a medical conference is usually a complex but rewarding mission. It is a demanding job that is typically done voluntarily by physicians and educators who are dedicated to professional and community service; advancement of research and education; as well as the dissemination of ...
‘I Want to Kill You’
Noelle K. LoConte, MD
My patient threatened to kill me. I was in the middle of a busy medical oncology clinic. I was seeing her to discuss test results 1 week after I told her I was concerned that her cancer had returned. As I suspected, the test confirmed recurrent cancer, and this time, it was incurable. I walked into...
Prostate Cancer Disparities and the ‘Last Mile’ Problem
WILLIAM K. OH, MD, and CHARLES J. RYAN, MD
Prostate cancer is the most commonly diagnosed cancer in men in the United States and the second-leading cause of cancer death.1 It also offers a sobering example in the national conversation on racial disparities in cancer care. Despite a deeper scientific understanding of the disease—as well ...
A Call for Tailored Medical Services in Oncology Care for Older Deaf Patients
CAROLINA TANNENBAUM-BARUCHI, PhD
My father is deaf. Born deaf, he is now 75 years old. He uses his voice, but he sounds strange to a hearing person when he speaks. He uses lip-reading techniques to communicate. A year ago, he was diagnosed with Hodgkin lymphoma. We did his oncology itinerary together. My father cannot go alone to m...
Rethinking Prior Authorization
S. MONICA SONI, MD, AND ANDREW A. HERTLER, MD, FACP
Prior authorization of medical procedures, services, and medications has been a standard requirement of health-care providers for decades. Rising health-care costs, specifically the escalating prices of cancer drug therapies, have led to a new focus by payers, providers, and policymakers on prior au...
Lung Cancer Screening and Possible Unappreciated Benefits
Ernest Hawk, MD, MPH
Screening that reduces cancer mortality serves as a foundational element of impactful care for certain cancers. That said, harms related to screening deserve our attention—overdiagnoses; diagnostic odysseys that may be invasive, expensive, or even unintentionally harmful; overtreatment of diagnosed ...
Highlighting Progress in Myeloma Treatment: POLLUX Trial Final Overall Survival Results With Daratumumab-Based Therapy
Shaji Kumar, MD
The updated results of the POLLUX trial, reported in the Journal of Clinical Oncology by Dimopoulos and colleagues and in this issue of The ASCO Post, showed significantly improved overall survival with daratumumab plus lenalidomide/dexamethasone (DRd) vs Rd in patients with previously treated multi...
Partnering With Patients: The Cornerstone of Cancer Care and Research
ERIC P. WINER, MD, FASCO
The health and well-being of our clinicians, our communities, and our care systems need vigilance now more than ever to ensure we keep pace with the effects of change that is also advancing our medicine. When clinicians or patients talk about health care, they might mention frustrations with forms...
The Role of Salpingectomy in Ovarian Cancer: Standard of Care or Targeted Therapy?
COLLEEN M. FELTMATE, MD
No one doubts the deadly nature of high-grade serous ovarian cancer. This histologic subtype is responsible for most ovarian cancer deaths, representing the eighth leading cause of cancer deaths in women worldwide and the fifth in the United States. Although there has been some progress in improving...
Social Drivers of Health: Grabbing the Steering Wheel
S. MONICA SONI, MD
Study after study has demonstrated race-based differences in survival and other clinical outcomes for patients with cancer. But as health professionals, we are learning that these differences are less about a patient’s skin color and more about the legacy of racial inequality.1 This knowledge change...
Yes, You Should Attend the 2023 ASCO Annual Meeting
ROBERT PETER GALE, MD, PhD, DSc (hc), FACP, FRCPI (hon), FRSM
The questions I am challenged to answer are twofold: (1) Should you attend the 2023 ASCO Annual Meeting? (2) If you attend, how is your time best spent? Most people agree scientific conferences are important venues for cancer researchers and clinicians to share and discuss research findings, exchan...
It Is Time to Close the Gap in Cancer Care
Jeff Dunn, PhD, AO
Cancer is a leading cause of death in every country worldwide.1 In 2020, almost 10 million people died of cancer, a number that is expected to rise to 16.3 million by 2040.2 In addition, cancer incidence continues to grow, driven by an aging and growing population and changes in the prevalence and d...
Working Together to Close the Global Care Gap
KAREN E. KNUDSEN, MBA, PhD; LAWRENCE N. SHULMAN, MD, FASCO; CLIFFORD A. HUDIS, MD, FACP, FASCO, FOR THE GLOBAL CANCER COLLABORATIVE
The COVID-19 pandemic has underscored that public health is the product of one global, integrated ecosystem. Although it is tempting to focus on specific aspects of local health-care systems, or the political or physical environment, health and health care in other countries also impacts the United...
Have We Reached the Limits of Chemotherapy for Burkitt Lymphoma?
Mark Roschewski, MD
Burkitt lymphoma (BL) is a fascinating disease from which many groundbreaking medical and oncologic lessons have been learned. Since the Irish surgeon Denis P. Burkitt, MD, FRCS, FRS, first described rapidly enlarging jaw and facial tumors in Ugandan children in 1958,1 the study of BL has led to num...
KRYSTAL-1 Confirms Activity of Adagrasib in KRAS G12C–Mutated Metastatic Colorectal Cancer and Highlights Need for Randomized Controlled Trials
Marwan Fakih, MD
KRAS G12C–mutated colorectal cancer represents 3% to 4% of metastatic colorectal cancers. Like other KRAS-mutated metastatic colorectal cancers, this group of patients represents a patient population with an unmet need, with limited options beyond two lines of therapy. In contrast to other KRAS muta...
Influence of the ‘Mark Cuban Effect’ on Cancer Drug Prices in the United States: Focus on CML
Hagop Kantarjian, MD, and Mary Alma Welch, MMSc
The advent of the BCR::ABL1 tyrosine kinase inhibitors for the treatment of Philadelphia chromosome (Ph)-positive chronic myeloid leukemia (CML) was a therapeutic miracle that changed the management paradigm of CML. The first of them, imatinib, was developed in the late 1990s.1,2 Within a few years,...
Communicating Prognosis: A Core Competency of Patient-Centered Oncology Care
S. Monica Soni, MD, and Lowell Kleinman, MD
Most of us have felt our stomachs sink as we opened a patient’s radiology or laboratory report and realized the patient faced a grave situation. If we’re lucky, we have a couple of days before a scheduled patient appointment to prepare ourselves to deliver that bad news. Other times, we may have jus...
Addressing the Continued Existence of Racial Inequities in Cancer Care
John H. Stewart IV, MD, MBA, FACS
The opportunity to write this commentary on cancer disparities comes at a sorrowful time for me. Despite practicing as a surgical oncologist for more than 20 years and understanding the unequal burden that cancer visits on the Black community, I was woefully unprepared for the premature death of my ...
