Perspectives
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 ...
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...
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 ...
How Telemedicine Can Transform Clinical Research and Practice
Anne Chiang, MD, PhD, and Roy S. Herbst, MD, PhD, FACP, FASCO
The COVID-19 pandemic transformed the world, and nowhere more so than in the health-care arena. Significant changes happened almost overnight in the delivery of medical care to focus on the safety and convenience of patients, staff, and providers. Although pilot efforts to integrate telemedicine had...
Cancer Drugs and Price Controls: Is It Time?
JOYCE KURISKO, MBA; TIM BARTHOLOW, MD; and SCOTT LITOW, ASA
According to a recent article published in Cancer Epidemiology, Biomarkers & Prevention, cancer care in the United States exceeded $208 billion in 2020 and is expected to surpass $240 billion by 2030.1 These estimates are driven largely by a growing and aging population. The expenditures a...
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 tho...
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. ...
