Oncology News Central Peer-Spectives

How are oncologists currently approaching the care of patients with ESR1-mutated advanced breast cancer in practice? Erin Frances Cobain, MD, associate professor at the University of Michigan Rogel Cancer Center in Ann Arbor, speaks with Wassim Mchayleh, MD, MBA, the clinical program director of the breast cancer program at AdventHealth Cancer Institute and associate professor of medicine at the University of Central Florida in Orlando, about how to best use oral selective estrogen receptor degraders. “And the big question is ‘Can we use SERDs in combination, or are SERDs effective in patients without an ESR1 mutation?’ Can we go outside the current approved guidelines? And I think that’s the biggest question that everyone is asking today,” notes Dr. Mchayleh.

Combination regimens improve survival in advanced EGFR-mutated NSCLC, but they also increase toxicity. Jorge Nieva, MD, shares how he talks with patients about potential adverse events. He describes the options available for prophylaxis and how he treats the toxicities that do arise.

Tackling central nervous system (CNS) disease in EGFR-mutated non-small cell lung cancer “is a huge problem, both from a quality-of-life perspective for patients and also from a longevity perspective,” explains Sid Devarakonda, MD, director of thoracic medical oncology at Swedish Cancer Institute in Seattle and clinical associate professor at Washington State University. He speaks with Aakash Desai, MD, MPH, associate director of the Phase 1 and Precision Oncology program at the University of Alabama at Birmingham, about how CNS metastases inform choices between regimens. Dr. Devarakonda also discusses how the recent U.S. Food and Drug Administration approval of subcutaneous amivantamab (Rybrevant Faspro) may change his approach. “[Y]ou still need to be comfortable managing some of the toxicities that still persist, even with the subcutaneous formulation, but it's terribly convenient from a practical perspective,” he notes. Dr. Desai and Dr. Devarakonda reported various financial relationships.

With multiple regimens available for advanced EGFRm NSCLC, selecting the best regimen for an individual patient is key. Jorge Nieva, MD, tells host Aakash Desai, MD, MPH, that the question shouldn’t be about who needs more efficacy, but rather understanding a patient’s personality and goals.

Progress in cancer care means that millions of patients are living longer lives, albeit without hope of a cure. What role can oncologists and other physicians play in helping to navigate these uncertain futures? “What is our obligation to them? How do we understand them and their needs and respond to them?” asks Sunita Puri, MD, author of That Good Night: Life and Medicine in the Eleventh Hour and associate professor of medicine and director of the inpatient palliative care service at the University of California Irvine School of Medicine. She discusses how she uses “radical honesty” with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer Center in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Puri explains how she admits her own limitations when helping patients who are grappling with questions about what treatments mean for quality vs quantity of life. “I want to be a resource to you, but I also want you to know I share in your uncertainty because I’m not sure what’s going to happen next.” Dr. Puri reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

A recent study found a link between mRNA vaccination and improved cancer immunotherapy response. The preclinical data demonstrated impressive results, leading to big questions. “We believe that [vaccination] actually does generate and even converts the cold tumors to hot tumors,” Steven H. Lin, MD, PhD, a physician-scientist and radiation oncologist at the University of Texas MD Anderson Cancer Center in Houston, tells Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer Center in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology.

Survival data from the KEYNOTE-905 trial and insights into the use of circulating tumor DNA to guide treatment decisions from IMvigor011 made big waves in bladder cancer care at the European Society of Medical Oncology Annual Congress. “Overall, this is going to change the standard of care for muscle-invasive bladder cancer,” says Amanda Nizam, MD, a genitourinary medical oncologist at the Cleveland Clinic Taussig Cancer Institute. She and Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, discuss how the findings are being incorporated into clinic and what questions remain. “I am continually surprised by the changes taking place in bladder cancer management,” notes Dr. Figlin. Dr. Nizam reported various financial relationships. Dr. Figlin reported various financial relationships.

Options for the treatment of acute myeloid leukemia (AML) are rapidly expanding, says Amir Fathi, MD, associate professor of medicine at Harvard Medical School in Boston and program director of the Center for Leukemia at Massachusetts General Hospital. “Over the course of the last 10 to 12 years, there have been a series of approvals, predominantly for targeted therapies,” he explains. Speaking with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, Dr. Fathi outlines how and when to look for mutations in AML and key considerations for various targeted therapies. He also shares what developments he is anticipating. “I’m most excited about where we’re moving in the upfront setting.” Dr. Fathi reported various financial relationships. Dr. Figlin reported various financial relationships.

The artificial sweetener sucralose may impair the efficacy of cancer immunotherapy, according to a recent study published in Science. Although further research is needed before these findings can be translated into actionable information for patients, the investigation highlights that “the science of nutrition in cancer is actually quite poor,” says senior author Diwakar Davar, MD, associate professor and clinical director of the melanoma and skin cancer program at the University of Pittsburgh School of Medicine Hillman Cancer Center in Pennsylvania. Dr. Daver shared why he and his colleagues chose to explore the potential effects of sucralose on cancer treatment, and what research is next, with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair. “What I think we are hoping to try to do is actually just kickstart a movement to get people to focus on nutrition,” Dr. Daver explained. “We spend $1 billion to try to get a hazard ratio of 0.8, and here it appears that if you eat just a little less of this, you can maybe double your likelihoods of success.” Dr. Davar reported various financial relationships. Dr. Figlin reported various financial relationships.

New survival data from the FLAURA2 and MARIPOSA trials represent “a massive advance for our patients” in terms of frontline treatment for EGFR-mutated non-small cell lung cancer says Sandip P. Patel, MD, professor of medicine at the University of California San Diego. However, the findings have led to new questions about sequencing. “Just like in chess, when you make a move, you’re restricted in the moves that you can make afterward,” he explains to Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair. Discussions have become “much more nuanced,” and “thinking about the patient holistically becomes even more important in the setting of all these excellent treatment options for our patients,” Dr. Patel shares. Dr. Patel reported scientific advisory income from Amgen, AstraZeneca, BeiGene, Bristol Myers Squibb, Certis, Eli Lilly, Jazz, Genentech, Illumina, Merck, Pfizer, Natera, and Tempus. Dr. Figlin reported various financial relationships.

The development of oral selective estrogen receptor degraders (SERDs) represents substantial progress for patients with metastatic breast cancer who have ESR1 mutations. “I’m extremely excited because they’re the most effective form of endocrine therapy today,” says Wassim Mchayleh, MD, MBA, the clinical program director of the breast cancer program at AdventHealth Cancer Institute and associate professor of medicine at the University of Central Florida in Orlando. He spoke with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology about SERDs that are currently available and those in development. When it comes to weighing toxicity, “across the board, they are very well-tolerated endocrine therapies with a very low discontinuation rate,” Dr. Mchayleh noted. In addition to recent key clinical trial results, he also looked ahead to what data may help establish the drug class as a replacement for the current standard of care. Dr. Mchayleh reported various financial relationships. Dr. Figlin reported various financial relationships.

From a “game-changer” in triple-negative disease to broader paradigm shifts and practice changes, the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting was pivotal for breast cancer care, says Sara M. Tolaney, MD, MPH, chief of the Division of Breast Medical Oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts. Dr. Tolaney broke down some of the top data at ASCO 2025 with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles, California, and Steven Spielberg Family Chair in Hematology-Oncology. She singled out findings from the ASCENT-04 trial, the plenary session on SERENA-6, and the DESTINY-Breast09 trial. “I think it’s been a very exciting ASCO for breast cancer overall, with just so much exciting data,” Dr. Tolaney concluded.

Results from the phase 3 ATOMIC trial are practice changing for colorectal cancer care and raise broader questions about immunotherapy use in patients with mismatch repair deficiencies across tumor types. Frank A. Sinicrope, MD, a professor of oncology and medicine at the Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, presented the findings at the 2025 American Society of Clinical Oncology Annual Meeting. He discussed the significance of the ATOMIC results and next steps with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. “I think that microsatellite instability is a terrific predictive biomarker for immunotherapy, and all of these patients should get immunotherapy in some form or another,” Dr. Sinicrope noted.

“An increasingly unrealistic set of performance expectations” is putting a strain on oncologist faculty members, says Clifford Hudis, MD, CEO of the American Society of Clinical Oncology (ASCO). He discussed the mounting challenges for academic cancer physicians and how ASCO is working to address them with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Hudis explained that academic oncologists are expected to be clinicians, researchers, teachers, and administrators. “And in most cases, there just isn’t a pay line and salary support for all four of those jobs, nor are there enough hours in the week for somebody to do all four of those jobs in a superb way,” he said. When it comes to ASCO’s ability to enable proactive change, Dr. Hudis explains that “we don’t have an enforcement mechanism. All we can do is shine a very bright light on reality and then ask for collective action to identify best approaches.” Dr. Hudis reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

“For the first 15 years of my career, we had nothing new” in bladder cancer care, said Jonathan E. Rosenberg, MD, chief of the genitourinary oncology service at Memorial Sloan Kettering Cancer Center in New York City. Now, “the pace of change has been dizzying,” he told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Speaking at the 2025 American Society of Clinical Oncology Annual Meeting, Dr. Rosenberg discussed key studies that have recently changed practice and what questions still remain. For certain laboratory testing and other concerns, “it’s a bit of the Wild West right now,” he noted.

Findings from the SERENA-6 trial, which examined switching therapies in patients with breast cancer ahead of disease progression, made headlines during the 2025 American Society of Clinical Oncology Annual Meeting. However, big questions remain. “I don’t know for sure if the approach is practice changing yet. I think the approach is practice confounding,” said Stephanie Graff, MD, director of breast oncology at Brown University Health Cancer Center in Providence, Rhode Island. Dr. Graff discussed the high-profile data with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. The trial showed a progression-free survival benefit when patients switched from an aromatase inhibitor to camizestrant, based on circulating tumor DNA information. And yet, issues with the study’s design may make taking the results into clinic challenging. “We don’t have clear evidence on how changing based on molecular therapy changes overall survival,” said Dr. Graff. “I think we’re going to get there, but I don’t know that the point we are at with SERENA-6 has us there.”

From digitizing its guidelines to potential embedding them in EMRs, the National Comprehensive Cancer Network (NCCN) is working to “make the workflow easier and better” for oncologists, Crystal S. Denlinger, MD, FACP, CEO of the NCCN, told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting. Dr. Denlinger broke down the organization’s current priorities and key initiatives, including how the network is tackling preauthorization challenges and helping to educate clinicians about changes to best practices. She notes that initiatives to ensure NCCN guidelines are available, useful, and up to date are crucial because “I truly believe that guideline-concordant care is one of the ways in which we can cure cancer.”