Oncology News Central Peer-Spectives

Enfortumab vedotin plus pembrolizumab (EV/pembro) has “become the elephant in the room” when it comes to bladder cancer care, says Jonathan E. Rosenberg, MD, chief of genitourinary oncology service at Memorial Sloan Kettering Cancer Center in New York City. At the 2024 American Society of Clinical Oncology Annual Meeting, he discussed recent key advances in urothelial carcinoma treatment with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles.

Immunotherapy in “Hardest Stage” of NSCLC: Putting Recent Advances Into Practice Our host, Robert A. Figlin, MD, FACP, welcomes Melissa L. Johnson, MD, as a guest

From ASCO 2024. When it comes to the use of antibody-drug conjugates (ADCs) in breast cancer care, "we're past the inflection point," says Hope S. Rugo, MD, a breast cancer oncologist and professor of medicine in the Division of Hematology and Oncology at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center.

From ASCO 2024 The time it takes for a novel cancer therapy to go from investigational new drug application to U.S. Food and Drug Administration (FDA) approval is typically longer than a decade. “There has to be a better way,” says Bob T. Li, MD, PhD, MPH, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City and associate professor of medicine at Cornell University in Ithaca, New York.

From ASCO 2024, Dr. Robert Figlin speaks with Dr. Samer Al Hadadi from University of Arkansas. "Very Important" Myeloma Data: ASCO Highlights, Smoldering Challenges, and More.

From ASCO 2024, Dr. Robert Figlin talks with Dr. Lauren Averett Byers from MD Anderson Cancer Center. Durvalumab's Benefit in SCLC "Beyond What We Might Have Expected"

From ASCO 2024 New Standard of Care in Melanoma? Neoadjuvant Immunotherapy Offers "Fantastic" Potential, Expert Says. Dr. Robert Figlin speaks with Dr. Christian Blank from Leiden University

From ASCO 2024, Dr. Robert Figlin welcomes Dr. Aditya Bardia from UCLA Health Jonsson Comprehensive Cancer Center. Should All Breast Cancer Patients Get T-DXd? "Results of DESTINY-Breast06 Do Suggest That"

Especially in rural areas, the growing oncologist shortage has “gotten to crisis level,” says Harsha Vyas, MD, president and founding partner of Cancer Center of Middle Georgia in Dublin. “We just don’t have enough supply of medical oncologists/hematologists,” he tells Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. Dr. Vyas puts forth his ideas for potential solutions, ranging from medical school debt repayment to congressional intervention. As Dr. Figlin notes, “we need to rethink” current approaches because there’s a “storm” on the horizon and “we’re all seeing it coming.” Dr. Vyas reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

The development of noncovalent Bruton tyrosine kinase (BTK) inhibitors and other advances in chronic lymphocytic leukemia treatment signify that the “future is really exciting,” says Jennifer A. Woyach, MD, professor in the Division of Hematology at The Ohio State University in Columbus. Dr. Woyach speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles, about the potential of moving these new drugs into the frontline setting and other questions related to BTK inhibitor resistance. Dr. Woyach reported various financial relationships. Dr. Figlin reported various financial relationships.

Given recent data, how should oncologists choose a tyrosine kinase inhibitor (TKI) in patients with EGFR-mutated non-small cell lung cancer (NSCLC), and when should chemotherapy be introduced? “It’s better to have choices than not,” explains Paul Bunn, MD, the Dudley Chair in Cancer Research at the University of Colorado in Aurora. Dr. Bunn discusses how recent trials influence treatment decisions in NSCLC with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. Dr. Bunn stresses why molecular testing is so crucial and previews what additional findings are likely to further change practice in patients with EGFR-mutated NSCLC.

The treatment of biochemical recurrence in prostate cancer “is set for rapid development over the next few years,” says Edwin M. Posadas, MD, medical director of the Center for Uro-Oncology Research Excellence at the Samuel Oschin Comprehensive Cancer Center at Cedars-Sinai Medical Center. Data from the recent EMBARK trial have changed practice for the treatment of men with high-risk features. Dr. Posadas discusses these findings and related advances with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. They also consider how the growing role of prostate-specific membrane antigen (PMSA) positron emission tomography (PET)-CT is “really impacting” care for patients with prostate cancer who have biochemical recurrence. Dr. Posadas explains why the best approach for patients with negative PSMA PET-CT results who have high-risk features remains “a point of great discussion.”

The U.S. Food and Drug Administration’s recent accelerated approval of a tumor-infiltrating lymphocyte therapy in metastatic melanoma “is a real milestone,” after the approach was “pending for decades,” explains Jeffrey S. Weber, MD, PhD, deputy director at the NYU Langone Perlmutter Cancer Center. Dr. Weber, who was part of the team to first work with the treatment in the late 1980s, discusses the breakthrough with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. They examine what this accelerated approval means for practice and consider the "incredibly expensive cost” associated with the treatment. They also consider the evolving role of high-dose interleukin-2 in this patient population.

Recent advances in metastatic urothelial carcinoma have meant that optimistic outcomes are “not as much of a fairytale,” says Robert Dreicer, MD, deputy director of the UVA Cancer Center and professor of medicine and urology at the University of Virginia School of Medicine in Charlottesville. From the recent approval of enfortumab vedotin plus pembrolizumab to other key findings recently presented at the American Society of Clinical Oncology Genitourinary Cancers Symposium, Dr. Dreicer discusses “paradigm-shifting” advances with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. Dr. Dreicer explains the “deal-breaker” that renders one treatment strategy “a relative no-brainer” for certain patients, as well as what upcoming data are likely to change practice even more.

Recent approvals by the U.S. Food and Drug Administration (FDA) and findings from pivotal clinical trials have changed care for patients with breast cancer that has progressed after frontline hormone therapy. Ruth M. O’Regan, MD, chair of medicine and Charles H. Dewey Professor at the University of Rochester in New York, highlights which recent developments regarding second- and third-line treatments are most essential. She and Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, discuss which newly approved drugs are making a difference in patients with actionable mutations, as well as those without. Dr. O’Regan also details which soon-to-be reported studies she is awaiting in 2024.

Recent data on the use of immunotherapy and targeted treatments in patients with advanced non-small cell lung cancer (NSCLC) have introduced a myriad of questions. These include controversial topics and difficult decisions, like when to incorporate CTLA-4 inhibition and what patients can expect from immuno-oncology monotherapy in the metastatic setting. Edward B. Garon, MD, MS, professor in the department of medicine in hematology/oncology and director of the thoracic oncology program at the Jonsson Comprehensive Cancer Center at the University of California Los Angeles, discusses key challenges in NSCLC care with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. From optimal strategies in second-line settings to promising clinical trials, Dr. Garon shares how he applies emerging information in practice.

Belzutifan was recently approved by the U.S. Food and Drug Administration (FDA) for use in previously treated adults with advanced renal cell carcinoma. How should this drug best be incorporated into practice? Eric Jonasch, MD, professor in the Department of Genitourinary Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston, and Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, discuss how the medication might be used in clinic. Dr. Jonasch also provides insight into the LITESPARK-005 study, which led to the FDA approval, as well as other ongoing trials that may further change the landscape of kidney cancer care.

CDK4/6 inhibitors “have really been a game changer” in metastatic breast cancer, according to Komal Jhaveri, MD, clinical director for early drug development and section head for endocrine therapy research at Memorial Sloan Kettering in New York City. However, optimal treatment strategies have been complicated by a lack of head-to-head trials. Dr. Jhaveri speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, about how “practice patterns have slightly shifted” despite challenges in assessing efficacy across regimens and approaches. Dr. Jhaveri also discusses her work on the INAVO120 study, which found a benefit in adding a PI3K inhibitor to the combination of CDK4/6 inhibitors and hormone therapy. The trial reported a “monstrously important clinical hazard ratio,” according to Dr. Figlin, and may help clarify best practices moving forward.

From compelling data presented at the San Antonio Breast Cancer Symposium to the recent U.S. Food and Drug Administration approval of capivasertib, 2023 saw numerous key advances in breast cancer care. Aditya Bardia, MD, MPH, director of the breast cancer research program at Massachusetts General Hospital and associate professor at Harvard Medical School in Boston, and Robert A. Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, discuss how several notable developments are already impacting practice. Dr. Bardia explains why genotyping is essential, provided it is available and affordable, and what recent changes have meant for the “roadmap” he presents to patients with metastatic disease. He also considers what 2024 may have on tap for this rapidly changing field.

From the use of prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) to advancements in targeted treatments, prostate cancer care is quickly evolving. Edwin M. Posadas, MD, director of the Experimental Therapeutics Program and director of the Center for Urologic Oncology Research Excellence at Cedars-Sinai in Los Angeles, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai, about how he is already implementing promising new data into practice. Although Dr. Posadas notes that although immunotherapy approaches in prostate cancer have been “a bit of a disappointment” so far, he sees “a lot of exciting research going on.” He explains why he doesn’t “like to wait” when expanding his therapeutic armamentarium and why he prefers to be “proactive rather than reactive” when it comes to molecular profiling and other approaches.

Results of the recent EMBARK study show that both enzalutamide plus leuprolide and enzalutamide monotherapy significantly improved metastasis-free survival compared with leuprolide alone in patients with prostate cancer who have high-risk biochemical recurrence. Lead author Stephen Freedland, MD, associate director for education and training and director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Cancer Center in Los Angeles, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai, about how these findings should be applied in practice. Although the data represent a significant advance, Dr. Freedland suggests even more progress ahead, asking "This is the new standard, but for those [who] are really high-risk, how can we do even better?”

Studies involving high-risk, early-stage ER-positive breast cancer are among the most eagerly anticipated at this year’s San Antonio Breast Cancer Symposium (SABCS), to be held Dec. 5-9. Virginia Kaklamani, MD, professor of medicine in the division of hematology and medical oncology at the University of Texas Health Sciences Center San Antonio and leader of the breast cancer program at the Mays Cancer Center, discusses which data she thinks has the best chance of changing practice soon. She also speaks with Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about key research into HER2-positive disease, brain metastases, and local therapy to watch for at this year’s conference.

Last month, a U.S. Food and Drug Administration (FDA) Oncologic Drugs Advisory Committee (ODAC) determined that progression-free survival (PFS) could not be reliably interpreted in a confirmatory clinical trial for sotorasib (Lumakras) used to treat KRAS G12C–mutated locally advanced or metastatic non-small cell lung cancer (NSCLC). Ravi A. Madan, MD, senior clinician at the National Cancer Institute’s Center for Cancer Research and chair of the ODAC, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, about broader implications from the 2-10 vote against the sotorasib data. They discuss the specific rationale behind the decision, as well as what this means for clinical practice in the short term and big picture solutions to help improve future trials.

How should results of the FLAURA2 clinical trial be applied in practice? The study examined the use of osimertinib plus chemotherapy in the first-line treatment of EGFR-mutated advanced non-small cell lung cancer (NSCLC) compared with osimertinib alone and found that progression-free survival was significantly improved with the combination treatment. Pasi A. Jänne, MD, PhD, director of three cancer centers at the Dana-Farber Cancer Institute in Boston, including the Lowe Center for Thoracic Oncology, shares his team’s findings with Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles. They discuss toxicity concerns, best practices for treatment assessment, and how to identify patients for whom the new strategy may yield the best results.

“Therapies are improving dramatically” in mantle cell lymphoma (MCL), according to Michael Wang, MD, professor in the department of lymphoma/myeloma, division of cancer medicine at the University of Texas MD Anderson Cancer Center in Houston. Dr. Wang presented updates on major advances in MCL at the recent Society of Hematologic Oncology (SOHO) annual meeting. Here, he speaks with Bob Figlin, MD, the Steven Spielberg family chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about which promising regimens from recent studies are most appropriate for certain age groups. Dr. Wang and Dr. Figlin also discuss common challenges when approaching newly diagnosed patients, as well as how to process the “explosion” of new information in MCL.

Recent advances have provided new options for when and how best to treat patients with chronic lymphocytic leukemia (CLL). Trials of combination strategies have shown promise in providing patients the potential for unmaintained remissions. Marco Ruella, MD, an assistant professor of medicine in hematology-oncology at the Perlman School of Medicine at the University of Pennsylvania and scientific director of the lymphoma program, speaks with Robert Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about the current state of CLL care and what changes are likely in the near future. Although satisfied in many ways with recent progress, Dr. Ruella argues in favor of moving past simply “maintaining the disease at long-term” and, instead, pushing for a cure. Dr. Ruella reports relationships with AbClon, BMS, Bayer, NanoString, and UPenn/Novartis. Dr. Figlin has reported relationships with numerous companies.

The World Conference on Lung Cancer (World Lung) will be held in Singapore, September 9–12. The current president of International Association for the Study of Lung Cancer (IASLC), Heather A. Wakelee, MD, division chief of medical oncology at the Stanford Cancer Institute in California, shares which presentations and findings she is most looking forward to at this year’s event. She speaks with Robert Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about steps being taken to ensure that key information from the conference is communicated quickly, clearly, and effectively to community oncologists around the world. They also discuss specific issues that will be addressed in Singapore, including a focus on lung cancer screening and why overcoming obstacles to more widespread uptake is crucial.

Updates to the American Society for Clinical Oncology’s (ASCO’s) living guidelines for therapy in patients with stage IV non-small cell lung cancer (NSCLC) with driver alterations were recently released. Dwight H. Owen, MD, MS, from The Ohio State University Comprehensive Cancer Center – James, examines the new recommendations that he and his team introduced with Bob Figlin, MD, the Steven Spielberg family chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles. They discuss how the living guidelines are updated and the rationale for what gets included, a process Dr. Figlin notes is “critical to the practicing oncologist.” Dr. Owen describes three new additions that are “really impactful” and his hopes for how these will directly improve patient care.

In early July, beloved surgeon and breast cancer advocate Susan Love, MD, MBA, died at age 75 years, after a recurrence of leukemia. Dr. Love’s legacy extends beyond the lives of her patients and into the approaches and attitudes of her fellow physicians. Stephanie Graff, MD, medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research and director of breast oncology at the Legorreta Cancer Center at Brown University in Providence, Rhode Island, shares memories and insights about Dr. Love with Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer in Los Angeles. They discuss why talking less, listening more, and “rattling” the right cages are key lessons oncologists can take away from “a giant in cancer care” and mentor, who is already sorely missed.

HER2 inhibitors dramatically changed care for many breast cancers; however, less is known about HER3, which acts in concert with HER2. Does HER3 have the same potential to reshape treatment strategies? Erika Hamilton, MD, director of breast cancer and gynecologic cancer research at Sarah Cannon Research Institute in Nashville, talks with Bob Figlin, MD, the Steven Spielberg family chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about HER3, how it works, and how new antibody-drug conjugates (ADCs) that target HER3 are already showing activity in hard-to-treat disease. She also explains how sequencing ADC therapies may work and what other changes could be next.

Although findings have suggested that adjuvant osimertinib is beneficial in early-stage non-smallcell lung cancer (NSCLC), some concerns have persisted. Balazs Halmos, MD, MS, associate director of clinical science, and director of both thoracic oncology and clinical cancer genomics at Montefiore Einstein Cancer Center in New York, says that “all these doubts have been shifted away,” given recent data presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting. Dr. Halmos speaks with Bob Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer in Los Angeles, about data from the ADAURA trial and other studies. Dr. Halmos says that the new evidence is “not just practice-affirming” butcan be considered “practice-expanding,” resulting in complicated questions that necessitate morethorough collaborations among oncologists, surgeons, pathologists, and radiologists.

How should community oncologists best approach ESR1 mutations in breast cancer, given the latest findings? Recent data presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting and elsewhere have shed light on issues related to ESR1 testing and treatment selection. Bob Figlin, MD, the Steven Spielberg Family Chair in hematology oncology at Cedars-Sinai Cancer in Los Angeles, speaks with Hope Rugo, MD, professor of medicine in the division of hematology and oncology, department of medicine, and director of breast oncology and clinical trials education at the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, about how to put new findings into practice. Dr. Rugo provides key recommendations, as she explains that “It’s really important that we don’t just throw drugs together in clinical practice.”

Recent results demonstrated that mRNA vaccination improved recurrence-free survival among patients with melanoma. This has led to questions about what’s next for this promising intervention. Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars Sinai Cancer in Los Angeles, welcomes Jeffrey Weber, MD, PhD, deputy director, professor, and co-director of the melanoma research program at NYU Langone’s Perlmutter Cancer Center, todiscuss potential timing for FDA approval and additional cancers that may see benefit from a vaccine strategy.

Within the last few years, an “explosion of data” regarding adjuvant and neoadjuvant treatment for resectable lung cancer has contained “major wins” for patient care. Although exciting, the rapid advancement has led to questions about when chemotherapy and chemoimmunotherapy should be adopted or avoided. Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars Sinai Cancer in Los Angeles, and Charu Aggarwal, MD, MPH, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania’s Abramson Cancer Center in Philadelphia, discuss how to apply key recent findings. They also share “the special sauce” that allows Dr. Aggarwal’s team to make the best determination for surgical timing.

As treatment options increase for patients with CLL, so do questions about which interventions, if any, are right for which patients and when. Bob Figlin, MD, and Nicole Lamanna, MD, discuss key considerations, ranging from cardiac toxicity to why Dr. Lamanna “won't just treat for a symptom.”

The newly opened Pragmatica-Lung trial compares ramucirumab plus pembrolizumab versus usual care for treatment of stage IV or recurrent non-small cell lung cancer. The trial is designed to ease enrollment requirements and data collection needs, focusing on the key endpoint of overall survival. Listen as study lead Karen Reckamp, MD, professor and division director for Cedar Sinai Cancer and Medical Oncology, and Bob Figlin, MD, the Steven Spielberg Family Chair in hematology oncology at Cedar Sinai Cancer, talk about how the trial came about and why it could change how future studies are done across cancer types

With more than 10 known driver mutations in non-small cell lung cancer (NSCLC), testing is ever more critical, says Heather Wakelee, MD, division chief of medical oncology at Stanford University and president of the International Association for the Study of Lung Cancer. Listen as she and Peer-Spectives host Bob Figlin, MD, the Steven Spielberg Family Chair in Hematology Oncology at Cedars-Sinai Cancer, talk about how she manages patients with metastatic disease or those who need adjuvant treatment, when she starts targeted therapy or immunotherapy, and more. “We can drastically change the course of disease for a patient by giving them the appropriate targeted treatment. So that testing is so critical,” Dr. Wakelee said.

Treatment options are expanding quickly in early non-small cell lung cancer. Listen as Heather Wakelee, MD, division chief of Medical Oncology at Stanford University and president of the International Association for the Study of Lung Cancer, describes how she’s using new agents and incorporating trial findings into practice. She and host Bob Figlin, MD, the Steven Spielberg Family Chair in Hematology Oncology at Cedars-Sinai Cancer, explore the growing roles for neo- and adjuvant therapy and how to select patients for each therapeutic approach.

After a decade of limited gains in metastatic pancreatic cancer, Zev Wainberg, MD, professor of medicine and co-director of the GI oncology program at the University of California, Los Angeles, presented the results of the NAPOLI-3 trial at the ASCO Gastrointestinal Cancers Symposium last month. The data showed an improvement in overall survival and usher in a new standard for the hard-to-treat disease. Listen as Dr. Wainberg talks with Bob Figlin, MD,Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer, and host of OBR’s Peer-Spectives podcast, about those data and which patients should receive the regimen. They also talk about what advances might be coming next in the metastatic setting and in earlier disease, and what factors influence Dr. Wainberg’s treatment choices.

The landscape for breast cancer treatment is shifting quickly, with an ever-increasingemphasis on targeted and hormonal therapies. Listen as Virginia Kaklamani,MD, professor of medicine in the division of hematology oncology at UT Health San Antonio, and medical directorof the breast oncologyprogram at UT Health San Antonio, MD Anderson Cancer Center,talks with Bob Figlin, MD, Steven Spielberg Family Chair in Hematology-OncologyatCedars-Sinai Cancer,about key findings coming out of the 2022 San Antonio Breast Cancer Symposium. She shares how she’ll use elacestrant following updated results from the EMERALD trial, how to select patients for ovarian suppression, and the expanding role of CDK4/6 inhibitors. “[T]here's no role for combination chemotherapy in first-line [estrogen receptor]-positive metastatic breast cancer anymore –even in patients that are deemed to have visceral crisis,”she said.

Listen as Gabriela Hobbs, MD, clinical director of the leukemia atMass General, talks with Bob Figlin, MD, the Steven Spielberg Family Chair in Hematology Oncology at Cedars-Sinai Cancer in Los Angeles, about the latest progress in the treatment of myelofibrosisand how she both assesses new patients and plans their treatment. New agents, including JAK2 inhibitors,are not curative but can have substantial effects on patients and open up further treatment options. Dr. Hobbs also talks about new drug classes on the horizon and what to expect at the upcoming ASH meeting.

Melissa Johnson, MD,a medical oncologist with Tennessee Oncology and Director of Lung Cancer Research at Sarah Cannon Research Institute in Nashville,joins host Robert Figlin, MD, Steven Spielberg Family Chair in HematologyOncologyat Cedars-Sinai Cancer, to talk about KRAS G12C inhibition in non-small cell lung cancer (NSCLC)treatment. She talks about how she uses sotorasib (Lumakras), which is U.S. Food and Drug Administration (FDA)approved for second-line treatment, why plasma-based genetic testing is so important, and how she explains to patients that even though she can’t start them off with this drug in the first-line, having it in reserve is a good plan.

The key steps to launching a successful and professionally fulfilling hematology/oncology fellowship is to “reflect, project, and adapt,” according to Gerald Hsu, MD, PhD, associate clinical professor of medicine and director of the Hematology/Oncology Fellowship Program at UCSF. Dr. Hsu spoke with Robert Figlin, MD, to discuss how new fellows can best navigate the opportunities they’re presented with. Dr. Hsu recommends reflecting on your areas of passion and interest, projecting what you’ll need 10 years down the road, and adapting your goals as your priorities and interests evolve.

Tejas Patil, MD, assistant professor of medical oncology at the University of Colorado Cancer Center, talks with Robert A. Figlin, MD, about new targeted therapies for non-small cell lung cancer (NSCLC), particularly tepotinib (Tepmetko) for MET exon 14 and sotorasib (Lumakras) for KRAS G12C. The MET exon 14 skip mutation has attracted renewed attention because tepotinib and capmatinib (Tabrecta), which both target this mutation, recently received FDA approvals. But MET can be disrupted in other ways, as well. Listen as Dr. Patil discusses the different types of MET alterations, how to identify MET activation in patients, and best practices for using tepotinib to treat MET activation that arises as a resistance mechanism to the EGFR inhibitor osimertinib (Tagrisso).

Jonathan Cohen, MD, MS, Associate Professor, Hematology and Medical Oncology, Emory University School of Medicine, , joins OBR Editor-in-Chief Robert Figlin, MD, to talk about mantle cell lymphoma. Dr. Cohen describes the key to making a correct diagnosis and what the best frontline treatment approaches are for different patient groups. He also talks about how BTK inhibitors and CAR T-cell therapy are shifting the treatment landscape and what he’s anticipating will be presented at upcoming conferences. “One of the things I know I've learned about mantle cell lymphoma is that if you wait six months, something new will come down the come down the pipeline,” Dr Cohen said.

Bob Figlin, MD, and Toni Choueiri, MD, the director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute, discuss the early results from the COSMIC-313 trial, which Dr. Choueiri presented at ESMO 2022. The trial enrolled previously untreated patients with metastatic clear cell renal cell cancer who were classified as intermediate- to poor-risk. Standard of care doublet therapy, nivolumab (nivo) plus ipilimumab (ipi), was compared with triplet therapy, consisting of nivo-ipi plus cabozantinib. Triplet therapy improved progression-free survival compared with doublet therapy, specifically in the intermediate-risk group. Dr. Choueiri also discussed the complicated landscape in RCC and how practicing oncologists can evaluate patients for appropriate treatments as well as how to communicate effectively with patients about the factors that contribute to that decision.

Bob Figlin, MD, and Jamie Von Roenn, MD, discuss strategies for learning about the oncology specialty earlier in the training pipeline, particularly for under-represented groups. They also look at opportunities for oncology fellows to build skills in different career areas.

Gerald Hsu, MD, PhD, UCSF’s hematology/oncology fellowship program director, joins Robert Figlin, MD, to talk about what fellowship programs are looking for in applicants, how trainees can find programs that are a good fit, and why preparing for an interview improves the odds you land at the right spot for you.

Michael B. Atkins, MD, and Robert Figlin, MD, discuss results from the EVEREST clinical trial as well as new data on TKIs, immunotherapy, and HIF-2 inhibitors. They also discuss adjuvant therapy and how depth of response differs between immunotherapy and TKIs, and look ahead to what the future holds.

Danielle Brander, MD, talks with Robert Figlin, MD, about selecting frontline treatments for CLL and how she talks with patients about their treatment options. “What I think is unique about the last few years is we’ve seen multiple randomized trials in the frontline setting that have shown not only superior progression-free survival … but several of those randomized studies also showing improvement in overall survival versus chemoimmunotherapy,” Dr. Brander said. “I think it’s really important for us to be considering these novel treatment options.”