Oncology News Central Peer-Spectives

“Not a Straightforward Decision”: What to Do While Waiting on a Practice Change in Breast Cancer Care

In the wake of recent key data about ESR1-mutated metastatic breast cancer, treatment decisions have become more complicated. “In current clinical practice, this is not a straightforward decision,”Marla Lipsyc-Sharf, MD, explains to Robert A. Figlin, MD.
 

New Targeted Therapies Make Breast Cancer Treatment Decisions “a Bit of a Moving Target”

“In breast cancer now, all of our treatment for hormone receptor–positive metastaticdisease is a bit of a moving target because of new therapies that are available,”explains Hope S. Rugo, MD, division chief of breast medical oncology and the Women’sCancers Program director at the City of Hope Comprehensive Cancer Center in Duarte,California. She discusses the “ever-changing” landscape involving the PI3kinase/AKT/mTOR pathway with Robert A. Figlin, MD, the Steven Spielberg FamilyChair in Hematology-Oncology at Cedars-Sinai Cancer in Los Angeles. Dr. Rugo detailskey considerations that she uses for decision making in practice. “And I think we justwant to be cautious about toxicity for these patients and really know that we’rebenefiting them, rather than using up treatments,” she explains.
 

Advances in ESR1-Mutated Breast Cancer Care Lead to “Complex Situation” in Clinic

As the management of patients with ESR1-mutated metastatic breast cancer evolves,various questions have emerged in clinical practice. “It's a complex situation,” explainsHope S. Rugo, MD, division chief of breast medical oncology and the Women's CancersProgram director at the City of Hope Comprehensive Cancer Center in Duarte,California. She discusses how recent advances have changed treatment decisions withRobert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology atCedars-Sinai Cancer in Los Angeles. “I think it's important to keep in mind that today wejust have single-agent oral SERDs, and people like to give combinations,” Dr. Rugonotes. But what combinations to give and when remains unclear. “I think how we'regoing to decide is that we're going to wait and see what's approved and then look atpatients to try and figure out what to do,” she offers.
 

Tackling “the Biggest Question That Everyone Is Asking” in Breast Cancer Care

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.

Shared Decision Making and Toxicity Management in EGFR- Mutated Advanced NSCLC

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. Hedescribes the options available for prophylaxis and how he treats the toxicities that do arise.

“Where the Real Answer Lies”: How CNS Disease Influences EGFR-Mutated NSCLC Treatment Decisions

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.

“Is the Juice Worth the Squeeze?”: Treatment Intensification for Advanced EGFRm NSCLC

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 questionshouldn’t be about who needs more efficacy, but rather understanding a patient’s personality and goals.

As Terminal Patients Live Longer, How Can Oncologists Help Them Cope With Uncertainty?

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.

Should Patients With Cancer Receive mRNA Vaccines Alongside Immunotherapy?

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.

Big News From ESMO 2025 Changes Practice in Bladder Cancer

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.