Oncology News Central Peer-Spectives

“Time to Move On”: How Targeted Therapies Are Transforming AML Care

The standard approach of “7 + 3” chemotherapy in acute myeloid leukemia (AML) treatment has been in place for 50 years. But that may soon change, says Maximilian Stahl, MD, a member of the Adult Leukemia Group at the Dana-Farber Cancer Institute in Boston and a member of the faculty at Harvard University. “My prediction is that in 10 years, you will not see much 7 + 3 anymore. Maybe not even 10 years, maybe five years,” he tells Robert A. Figlin, MD, the interim director and Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. Dr. Stahl describes how targeted therapies such as menin inhibitor revumenib (Revuforj), which was recently approved by the U.S. Food and Drug Administration, are transforming AML care. Although currently indicated for relapsed/refractory disease, trials are exploring frontline use. “Pretty much, if you can think of any combination treatment in your head, that is already an ongoing clinical trial,” Dr. Stahl explains. He outlines how targeted therapies have already changed practice and looks to what advances are likely in the near future. Dr. Stahl reported a consulting or advisory role with the Boston Consulting Group, Clinical Care Options, Curis Oncology, GlaxoSmithKline, Haymarket, Kymera, Novartis, and Sierra Oncology. Dr. Figlin reported various financial relationships.

ASCO President Speaks Out on “Huge Problem” of Oncologist Burnout

Oncologist burnout and career dissatisfaction are a “huge problem,” says Robin T. Zon, MD, president of the American Society of Clinical Oncology (ASCO). Dr. Zon sits down with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles, to discuss revelations from a recent ASCO report. “ASCO recognizes that if, in fact, we are going to accomplish our mission, we have to pay very close attention to what is happening to the workforce and the burnout that is associated with that,” Dr. Zon explains. She shares insights into common underlying causes and lays out a plan of attack for improvement. With an emphasis primarily on organizational, and not individual, reforms, Dr. Zon pledges that ASCO will remain focused on burnout and job dissatisfaction. “We are going to continue to have interventions. And we will continue to give voice to our members at all levels.” Dr. Zon reported various financial relationships. Dr. Figlin reported various financial relationships.

Oncologists Overtreat Patients at End of Life

When it comes to end-of-life care for patients with cancer, “I think that there is a real deficit in our training,” says Nathan I. Cherny, MD, director of the Cancer Pain and Palliative Medicine Service at Shaare Zedek Medical Center in Jerusalem, Israel. Dr. Cherney and colleagues recently examined factors contributing to oncologists overtreating patients at the end of life. He discusses key findings and ways to address this continued problem with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. “When one reads practice guidelines, they never include a section of when further treatment is more likely to be harmful than helpful,” Dr. Cherny notes. “Unless it appears in every illness guideline, the message does not necessarily get through that this is something that is really important.” Dr. Cherny reported serving as a consultant for and owning stock in Canopy Care. Dr. Figlin reported various financial relationships.

FDA Approvals Change Practice for Metastatic Breast Cancer With PIK3CA Mutations

Recent advances in hormone receptor–positive, HER2-negative metastatic breast cancer have led to questions about the timing of genetic testing and the optimal treatment choices for patients. “I, like many others, have changed my personal practice,” says Azka Ali, MD, a medical oncologist at the Cleveland Clinic Taussig Cancer Institute in Ohio. She and Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles, discuss what newly approved medications for patients with PIK3CA mutations mean for oncologists. “I think the breast cancer landscape is changing faster than we can all keep up with it,” Dr. Ali explains. She breaks down current genetic testing concerns and how she approaches treatment decisions that sometimes take place in a “data-free zone.” Dr. Ali reported no relevant financial disclosures. Dr. Figlin reported various financial relationships.

To Help Oncologists’ Burnout, Should Primary Care Take on More Burden?

The European Society for Medical Oncology (ESMO) Resilience Task Force recently released recommendations intended to reduce burnout in oncology worldwide. One of the task force’s members, Konstantinos Kamposioras, MD, PhD, a consultant in medical oncology at the Christie NHS Foundation Trust in Manchester in the United Kingdom, explains to Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, how those recommendations came to be and what institutions should do to help care for cancer care providers. They discuss differences between young oncologists and late-career specialists and consider solutions beyond those laid out in the ESMO guidance. “I’m wondering whether we have not done a good enough job having our primary care colleagues help us manage our cancer cases,” Dr. Figlin speculates. Dr. Kamposioras reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

Choosing Between an “Old Friend” and New Ones in EGFR-Mutated Metastatic NSCLC

When it comes to the treatment of EGFR-mutated metastatic non-small cell lung cancer (NSCLC), osimertinib (Tagrisso) is an “old friend,” says Kamya Sankar, MD, assistant professor and co–medical director of the Thoracic Disease Research Group at Cedars-Sinai Cancer Center in Los Angeles. Recent approvals by the U.S. Food and Drug Administration have introduced several “new friends,” in the form of amivantamab (Rybrevant) and lazertinib (Lazcluze). Dr. Sankar talks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology also at Cedars-Sinai Cancer Center, about how to choose among osimertinib monotherapy, osimertinib plus chemotherapy, or amivantamab plus lazertinib. Without overall survival data available for all choices, Dr. Sankar explains how she and her patients decide which treatment is best, as well as how to consider sequential therapy after disease progression. Dr. Sankar reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

Privatization of Cancer Clinical Research Raises Concerns for Practice

“Cancer clinical research has been largely privatized,” explains Joseph Unger, PhD, MS, associate professor in the cancer prevention program at the Fred Hutchinson Cancer Center in Seattle. Dr. Unger and colleagues recently assessed patient enrollment in industry-sponsored and federally sponsored clinical trials. They found an 8:1 ratio favoring participation in research backed by industry. This raises significant concerns, he tells Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. Dr. Unger explains what he sees as the root causes for the current imbalance, potential negative effects, and possible solutions for how to “rebalance the portfolio.” “I’m doing whatever I can to help illustrate what the issues are through my research,” he notes. Dr. Unger reported a consulting/advisory role with AstraZeneca and Loxo/Lilly. Dr. Figlin reported various financial relationships.

What 3 Big Trials Mean for Breast Cancer Practice

Treatment approaches for patients with hormone receptor (HR)-positive, HER2-negative breast cancer have rapidly evolved, thanks in part to data from three key studies. Erin Frances Cobain, MD, associate professor at the University of Michigan Rogel Cancer Center in Ann Arbor, explains how findings from the KEYNOTE-756, monarchE, and NATALEE clinical trials are influencing decision-making for these patients. She and Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles, discuss the evolving role of immunotherapy and how to choose between CDK4/6 inhibitors, given the recent U.S. Food and Drug Administration approval of adjuvant ribociclib for patients with early breast cancer who are at high risk for recurrence. Dr. Cobain acknowledges that these and other findings have led to “challenging discussions,” even if those conversations are ultimately beneficial. Dr. Cobain reported various financial relationships. Dr. Figlin reported various financial relationships.

“Confusing for All of Us”: Questions Arise Over ADCs, HER2 in Metastatic Breast Cancer

Approvals of antibody-drug conjugates (ADCs) for metastatic breast cancer have introduced complex questions about HER2 expression. “It’s certainly been a changing landscape, which has been confusing for all of us,” explains Ian Krop, MD, PhD, director of the clinical trials office, chief clinical research officer, and associate director for clinical sciences at Yale Cancer Center in New Haven, Connecticut. He and Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles, discuss how oncologists should best approach HER2 testing, ADC sequencing, and toxicity concerns. When it comes to answering key questions, “We're a little data-poor in some ways because this is such a rapidly evolving field,” Dr. Krop explains. He also considers what’s next for ADCs in breast cancer, including the potential for those treatments to move into the curative early-disease setting. Dr. Krop reported various financial relationships.  Dr. Figlin reported various financial relationships.

”Where Do We Go From Here?” Targeted Therapies Lead to Challenging Choices in Breast Cancer

Newly approved targeted therapies for patients with advanced hormone receptor (HR)-positive, HER2-negative breast cancer are changing care. “We have an abundance of opportunities, but challenges with having to choose the right opportunity at the right time,” says Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. Dr. Figlin discusses how to navigate new options with Manali Bhave, MD, a breast medical oncologist and assistant professor at the Emory University School of Medicine in Atlanta. Dr. Bhave stresses that disease progression in breast cancer can’t be addressed with a one-size-fits- all option. “Where do we go from here? I think it is largely dependent on clinical factors, patient comorbidities, and even biomarker status,” she explains. Dr. Bhave and Dr. Figlin discuss recent developments in targeted therapies and important challenges. “We’ve come a long way in treating metastatic HR-positive, HER2-negative breast cancer as more of a chronic disease,” she says. Dr. Bhave reported consulting fees from Lilly, Novartis, and AstraZeneca. Dr. Figlin reported various financial relationships.