Perspectives
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...
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...
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...
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...
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 ...
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...
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...
Pembrolizumab in First-Line Treatment of Metastatic Clear Cell and Non–Clear Cell Renal Cell Carcinoma
Matthew R. Zibelman, MD
The treatment paradigm for patients with metastatic renal cell carcinoma has undergone a dramatic shift over the past few years, improving outcomes for many patients but leaving many unanswered questions as to how to optimally choose the best treatment for an individual patient. The changes are mo...
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...
Breast Cancer Susceptibility Genes: Putting the Pieces Together
Nadine M. Tung, MD
With the widespread use of multigene panels for germline genetic testing, understanding the cancer risks associated with pathogenic or likely pathogenic variants (ie, mutations) has become increasingly necessary. To identify which genes are breast cancer susceptibility genes, population studies that...
Physician-Patient Relationship: Sacred and Sacrosanct
Chandrakanth Are, MBBS, MBA, FRCS, FACS
There are many relationships we build at work in our entire lifetime. Some are good, a few are not, and many are somewhere in between. But of all the relationships we are fortunate enough to build, there is no relationship more valuable and gratifying than the one between a physician and a patient. ...
The Impact of a Pandemic on Mentorship in Medicine
John L. Marshall, MD
When advising the younger members of our medical community on career decisions, I always list “access to the best mentorship” as the most important priority. By the time we hit residency, we have all proven ourselves able to extract from a book or a journal the facts essential to the practice of m...
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 fr...
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...
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...
