Perspectives
Novel Selective Estrogen Receptor Degraders in Advanced Breast Cancer: Use of Elacestrant in the Phase III EMERALD Trial
Melissa McShane, MD, and Lori J. Goldstein, MD, FASCO
Endocrine therapy is the foundation of first-line therapy in most patients with hormone receptor–positive, HER2-negative metastatic breast cancer. Many of these patients respond to endocrine therapy but eventually become resistant to it through both intrinsic and acquired resistance mechanisms. This...
How ASCO Is Helping Members Navigate the Cancer Care Terrain for Pregnant Patients Since the Reversal of Roe v Wade
Jo Cavallo
In response to the U.S. Supreme Court decision in Dobbs v Jackson Women’s Health Organization overturning Roe v Wade, eliminating the constitutional right to an abortion and returning the power to regulate reproductive health for women to the states, ASCO, the American Cancer Society Action Network,...
The NordICC Trial: The Devil Is in the Details
Rishi Surana, MD, PhD, and Kimmie Ng, MD, MPH
Colorectal cancer ranks third among cancer deaths in both men and women in the United States, with an estimated 150,000 new cases and 52,000 deaths anticipated in 2022.1 Colorectal cancer rates have declined by approximately 2% per year from 2014 to 2018 in people older than age 50, which is thoug...
My White Coat Doesn’t Fit
Narjust Florez (Duma), MD
There I was, crying once again all the way from the hospital’s parking lot to my apartment, into the shower, and while trying to fall asleep. This had become the norm during my internal medicine residency. For years, I tried hard every day to be someone else to fit in. It started with off-hand comme...
‘TRANSFORMING’ Our Thinking About Second-Line Therapy for High-Risk Large B-Cell Lymphoma: Bring in the CARs
Leo I. Gordon, MD, FACP
As reported in The Lancet by Kamdar et al,1 and summarized in this issue of The ASCO Post, the international phase III TRANSFORM trial was completed in 184 patients with primary refractory or early (≤ 12 months) relapsed large B-cell lymphoma (LBCL). Patients were randomly assigned to receive second...
A Call for Creativity: The Shades of Gray in Delivery of Goal-Concordant Care
S. MONICA SONI, MD
I continue to be struck by the creativity of medical oncologists. The reimagining of dosing, duration, or regimen composition to respond to patient symptoms or preferences is like a master chef in the kitchen. Although standardization has, with good reason, become the paragon, delivering goal-concor...
Changing the Algorithm for Relapsed or Refractory Large B-Cell Lymphomas
Sonali M. Smith, MD, FASCO
Despite a significant potential for cure, relapsed and refractory large B-cell lymphomas (LBCL) comprise the most common cause of lymphoma-related mortality. Sequential relapses reflect the limits of repeated exposure to chemotherapy, even when delivered at high doses. More than 30 years ago, rando...
What Is the Best Induction Regimen for Newly Diagnosed PCNSL?
Syed Ali Abutalib, MD; Arjun Patel, PharmD, BCOP; and James Rubenstein, MD, PhD
Primary central nervous system lymphoma (PCNSL) accounts for less than 1% of all non-Hodgkin lymphomas and between 3% and 4% of all brain tumors, with an age-adjusted incidence rate of four cases per million persons per year. Approximately 1,500 new cases are diagnosed each year in the United States...
What the Supreme Court’s Abortion Decision Means for Patients With Cancer and Their Clinicians
Govind Persad, JD, PhD
On June 24, 2022, the Supreme Court ruled in Dobbs v Jackson Women’s Health Organization (Dobbs)1 and overturned Roe v Wade and Planned Parenthood v Casey, which recognized a federal constitutional right to end a pregnancy up to the point of viability. This decision opened the door for states to enf...
EQRx Pricing Strategy: Not a Win for Everyone but a Key First Step to Expand Access to Cancer Care
Lee N. Newcomer, MD, MHA
EQRx is an economics professor’s dream company. It is the perfect example of the principle of substitution. EQRx provides quality, lower-cost drugs in high-cost categories that may substitute for the higher-priced options. Although the profit margin for each drug unit is smaller than the competiti...
Wall Street Doesn’t Believe in This Target
Dario C. Altieri, MD
March 2, 2009. Just published in the Journal of Clinical Investigation.1 And we even got the cover. Twists and turns of heat shock protein-90 (Hsp90), the chaperone, the evolutionary capacitor. Great name and important cancer target. People smiled when I talked about this at the Hsp90 conference. ...
Impact of the Dobbs v Jackson Women’s Health Organization Ruling on Patients With Cancer
Karen E. Knudsen, MBA, PhD
As a nonpartisan organization, the American Cancer Society has an overarching goal to improve the lives of patients with cancer and their families. We believe all individuals should have an equitable opportunity to prevent, find, detect, and survive cancer, irrespective of geography. The June 24 de...
Cancer Knows No Borders
Marc Lawler, PhD, FRCPath and Satish Gopal, MD, MPH
This is a critical time for cancer research and cancer care across the world, and the cancer community has clearly highlighted the need for greater and more equitable international collaboration. Addressing the global cancer challenge is a significant undertaking, and it has become more urgent a...
Medical Costs and Clinical Value: Playing the Long Game
M. Gregg Bloche, MD, JD; Neel U. Sukhatme, PhD, JD; And John L. Marshall, MD
Even as soaring medical costs strain public and private budgets around the world, patients yearn for therapeutic breakthroughs. Game-changing cancer treatments, emerging antiviral agents, and mRNA vaccines are powerful reminders of medical technology’s potential. But insurance premiums and out-of-po...
Changing the Natural History of ER-Positive, HER2-Negative Breast Cancer With the Introduction of CDK4/6 Inhibition
Richard S. Finn, MD
It has been 14 years since a collaboration between the University of California, Los Angeles (UCLA) and Pfizer identified a unique role for cyclin-dependent kinase 4/6 (CDK4/6) inhibitors in estrogen receptor (ER)-positive human cell line models and demonstrated that these agents act synergistically...
Two Early-Career Cancer Researchers From Africa Aim to Make a Difference and Never Give Up
Safa El Kefi, PhD Candidate, and Khalid El Bairi, MD
In countries with a high income, research in oncology is sponsored by funding agencies and industry, which has meaningfully improved survival outcomes of patients with cancer. In contrast, the African continent is disadvantaged in all aspects of human development, particularly in the fields of innov...
Death and Clinical Trials in the Plague Years
Bruce D. Cheson, MD, FACP, FAAAS, FASCO
“Everybody knows that pestilences have a way of recurring in the world; yet somehow, we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise.” —Albert Camus, The ...
Cautious Optimism About Mining for Patient-Centric Data
Robert Peter Gale, MD, PhD, DSc (hc), FACP, FRCPI (hon), FRSM
“If we have data, let’s look at it. If all we have are opinions, let’s go with mine.” —James Barksdale In this issue of The ASCO Post, Daniel Vorobiof, MD, and Irad Deutsch, principles at Belong.Life, a patient-oriented website whose self-described mission is to improve patient quality of life an...
Shaping the Future of Cancer Care: The Value of Managing Aggregated Data From Patients’ Online Communities
Daniel Vorobiof, MD, and Irad Deutsch
In 2021, more than 1.9 million people in the United States were estimated to be diagnosed with cancer, and that number continues to increase yearly. Medical research is critical in prolonging survival and improving the quantity and quality of life of patients. Cancer research is one of the most heav...
ARIEL4 Confirms Rucaparib’s Efficacy in Recurrent, BRCA-Mutated Ovarian Cancer: Does It Tell Us Anything New?
Kathleen Moore, MD, MS
In March 2022, Kristeleit et al reported the results of the ARIEL4 trial1 of rucaparib in relapsed BRCA-mutant ovarian cancer in The Lancet Oncology (summarized in this issue of The ASCO Post) and are to be congratulated on this accomplishment. This report, along with the almost simultaneous release...
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...
Invest in the Unexpected: Basic Research Enterprise Needs Adequate Funding to Foster Treatment Innovation
Ronald DePinho, MD
The National Institutes of Health (NIH) now stands as the largest single public funder of biomedical research in the world.1 The FY2022 Consolidated Appropriations Act (H.R. 2471), signed into law in March, increases biomedical research funding by nearly 5%, and it provides a total of $45 billion fo...
PD-1 Inhibition in First-Line Treatment of Advanced Esophageal Squamous Cell Carcinoma: More to Come on New Paradigm
Jill Lacy, MD, and Michael Cecchini, MD
Esophageal cancer is associated with significant morbidity and mortality worldwide, with more than 600,000 new cases and 540,000 deaths in 2020. The squamous cell histology comprises nearly 90% of cases globally, despite its steady decline in the United States over the past 40 years. Historically, t...
Annual Meeting of the Moroccan Cancer Society: An Opportunity for Young Cancer Researchers to Evolve
Khalid El Bairi, MD; Dounia Filali, MD; Nabil Ismaili, MD; Zouhour Bourhaleb, MD; Ali Sbai, MD; Mohamed Marjani, MD; Zineb Benbrahim, MD; Meriem Iraqi Houssaini, MD; and Mohamed Mesmoudi, MD; On Behalf Of The Moroccan Cancer Society
The Moroccan Cancer Society (MCS; Société Marocaine de Cancérologie/https://smc.ma) was created in 1992 by a group of Moroccan medical and radiation oncologists, surgeons, and pathologists who had led the field in the 1980s. To date, this scientific society has more than 350 members practicing in bo...
Cemiplimab-rwlc Following Platinum-Based Chemotherapy in Recurrent or Metastatic Cervical Cancer: Clinical Implications
Renata R. Urban, MD
It is estimated that globally, more than 600,000 women per year are diagnosed with cervical cancer, and more than 300,000 die annually of the disease.1 Many women continue to be diagnosed with cervical cancer at an advanced stage, with a high risk of recurrence. To date, the most effective combinat...
DESTINY-Breast03: Should Trastuzumab Deruxtecan Be the Preferred Second-Line Regimen in HER2-Positive Metastatic Breast Cancer?
Nancy U. Lin, MD
Since the introduction of trastuzumab in the late 1990s, overall survival for patients with HER2-positive metastatic breast cancer has substantially improved. Median overall survival in the pivotal first-line trial was only 20.3 months in the chemotherapy arm, and 25.1 months in the trastuzumab/chem...
No Good Treatment Options, So I’ll Eat Ice Cream
Mary Evelyn Burman, PhD, MS, BSN
On a warm summer afternoon, I stood in front of tables at the local farmers market loaded with my favorite fruits and vegetables: peaches, tomatoes, corn, peppers, melons, kale. I practically drooled thinking about what I could make that week: corn and tomato salad, kale and mushroom quesadillas, ch...
Missed Opportunities in Geriatric Oncology Research
Stuart M. Lichtman, MD, FACP, FASCO
The underrepresentation of older patients (≥ 65 years) in clinical trials has been well documented for more than 20 years. This has been an issue at all phases of drug development, including pivotal trials for drug approvals,1 despite the fact that many of these new therapeutics will primarily be us...
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...
Incidental Respiratory Disease Found in Low-Dose CT Screens: Challenges and Opportunities
Ryan Nguyen, DO, Lawrence E. Feldman, MD, and Mary M. Pasquinelli, DNP, FNP-BC
A retrospective analysis of the National Lung Screening Trial (NLST) by Pinsky et al, summarized in the April 25, 2022, issue of The ASCO Post, found high rates of incidental respiratory abnormalities on low-dose computed tomography (CT) examinations.1 Specifically, the findings of emphysema and ret...
Innovation Can Advance Equitable Cancer Care
Everett Vokes, MD, FASCO
The North Star of an organization is its mission statement. At ASCO, no initiative gets the green light unless it can fulfill the Society’s mission. ASCO updated its mission statement in 2020 specifically to reinforce our goal of reducing disparities, changing it to read: “Conquering cancer through ...
Long-Term Overall Survival in Unresectable Stage III NSCLC With Consolidation Durvalumab in the PACIFIC Trial: Translation to Real-World Outcomes?
Manali I. Patel, MD, MPH, MS
Lung cancer mortality rates have declined by more than 50% in men since 1990 and more than 30% in women since 2002. These declines in mortality are largely due to increases in smoking cessation. However, in recent years, clinical treatment advances, such as targeted therapies and immunotherapy, have...
The Impact of War on Patients With Cancer
Just days after Russia invaded Ukraine on February 24, ASCO, together with its partners the American Cancer Society (ACS) and the Sidney Kimmel Cancer Center–Jefferson Health, began assembling resources to establish a network of oncology professionals to help Ukrainian patients with cancer find clin...
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...
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...
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...
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...
