Oncology News Central Peer-Spectives

What Does the Biggest News in Breast Cancer From ASCO 2025 Mean for Practice Right Now?

Data from the SERENA-6 trial, presented at the 2025 American Society of Clinical Oncology Annual Meeting, have the potential to dramatically change advanced estrogen receptor–positive, HER2-negative breast cancer care, says William J Gradishar, MD, the Betsy Bramsen Professor of Breast Oncology at Northwestern University Feinberg School of Medicine in Chicago. The study showed benefit in switching therapies based on circulating tumor DNA evidence of ESR1 mutation, ahead of disease progression. “If we find that the magnitude of benefit seems to be as meaningful as it’s been reported to be, then I think what we will find in practice is more and more people will be doing next-generation sequencing testing, doing it earlier, and doing it more frequently to identify these mutations and act upon them,” Dr. Gradishar told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Gradishar also discussed key drugs in development, including selective estrogen receptor degraders, and questions about the sequencing of new treatments. “There may be diminishing returns, as we’ve seen with other drugs,” he noted.

Practice-Changing “Inflection Point” Coming in ESR1-Positive Breast Cancer Care?

Editor’s Note: This interview was recorded shortly before the 2025 American Society of Clinical Oncology Annual Meeting. Big questions associated with ESR1 mutations in patients with hormone receptor–positive breast cancer may soon have answers. New data are “going to take the whole breast oncology field from one place and put it in a different place. It’s going to be an inflection point in our history of treating breast cancer,” says Jason Aboudi Mouabbi, MD, assistant professor in the Department of Breast Medical at the University of Texas MD Anderson Cancer Center in Houston. 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. Mouabbi outlined current challenges in identifying and responding to the development of ESR1 mutations. Dr. Figlin and Dr. Mouabbi also discussed how eagerly anticipated findings may transform practice and important aspects of mutational testing to consider. Dr. Mouabbi reported consulting fees from GE Healthcare, Genentech, AstraZeneca, Gilead, Novartis, Fresenius Kabi, BostonGene, and Cardinal Health. Dr. Figlin reported various financial relationships.

When ESR1 Mutations Arise in Breast Cancer Patients With PIK3CA Mutations: What Next?

The approach to ESR1 and PIK3CA mutations in patients with hormone receptor–positive metastatic breast cancer continues to evolve. What role does circulating tumor DNA (ctDNA) play in treatment decisions? How should oncologists best approach patients with PIK3CA mutations who subsequently develop ESR1 mutations? VK Gadi, MD, PhD, professor and director of medical oncology and deputy director of the University of Illinois Cancer Center in Chicago, discusses with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, how recent data are informing care for patients with comutations. “We now have at least one ESR1-targeting drug out there, and more to come,” Dr. Gadi explains. “Elacestrant is the drug I’m of course referencing, and that is used essentially like a single agent and works well for those patients. Even when they have, for example, PIK3CA mutations present.” He and Dr. Figlin consider when to act on ctDNA findings and potential future strategies. Dr. Gadi reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

How “Remarkable Change” in EGFR-Mutated NSCLC Care Is Making a Difference for Patients

The last few years have seen “a remarkable change in both our approach and management of EGFR lung cancer,” says Shirish M. Gadgeel, MD, division head for hematology/oncology and associate director of Patient Experience and Clinical Care at the Henry Ford Cancer Institute in Detroit. He discusses key considerations for managing EGFR-mutated non-small cell lung cancer with Robert A. Figlin, MD, the interim director and Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. Dr. Gadgeel describes considerations for leptomeningeal metastases, important treatment toxicities, and exciting advances on the horizon. Dr. Gadgeel reported various financial relationships. Dr. Figlin reported various financial relationships.

Oncologists Urged to Discuss Fertility With Patients, as ASCO Updates Guidelines

When it comes to tackling fertility issues associated with cancer, “oncology clinicians are often reluctant to talk about this because it is really not our wheelhouse,” says Alison Wakoff Loren, MD, MSCE, chief of the Division of Hematology Oncology, director of Blood and Bone Marrow Transplantation, and the C. Willard Robinson Professor of Hematology-Oncology at Penn Medicine in Philadelphia. Dr. Loren and colleagues recently updated American Society of Clinical Oncology guidelines for fertility preservation in people with cancer. She discusses the key changes with Robert Figlin, MD, interim director at Cedars Sinai Cancer Center in Los Angeles and the Steven Spielberg Family Chair in Hematology-Oncology. “This is a really important topic that I think sometimes gets lost in the shuffle of the hecticness of a young person’s cancer diagnosis,” Dr. Loren explains. Increased awareness among oncologists is a crucial step that can lead to faster referrals and interventions, she says. “You better be ready for the conversation,” she urges. Dr. Loren reported research funding from Equillium (Inst). Dr. Figlin reported various financial relationships.

“Second-Line ER-Positive Breast Cancer Has Just Become Very Complicated”

“Second-line [estrogen receptor (ER)]-positive breast cancer has just become very complicated,” says Erika P. Hamilton, MD, the director of breast cancer and gynecologic cancer research at Sarah Cannon Research Institute in Nashville. She discusses the role of ESR1 mutations in selecting appropriate treatments and combination regimens for patients with ER-positive breast cancer who have disease progression with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles, and Steven Spielberg Family Chair in Hematology-Oncology. From when and how best to assess for ESR1 mutations to which trials inform current treatment options in clinic, Dr. Hamilton walks through the complex decision-making process. She also shares which trial readouts she is looking forward to seeing and how social media is influencing patient choices. Dr. Hamilton reported various financial relationships. Dr. Figlin reported various financial relationships.

Will Generational Divide Among Oncologists Affect How AI Changes Cancer Care?

Burnout among oncologists is a serious concern, and artificial intelligence (AI) represents a potential solution, says Debra Patt, MD, PhD, MBA, a practicing oncologist and breast cancer specialist in Austin, Texas, who also serves as the chair of the AI task force for the American Society of Clinical Oncology. Technological advances are poised to improve cancer care while reducing the documentation burden for oncologists, she tells Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles, and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Patt describes the various practical ways in which AI is already changing oncology clinics, but acknowledges a generational divide that will need to be bridged: “I would say that the youngest generation of oncologists that is coming out, they are digital natives. They have grown up with this,” she explains. But for those who have been in practice longer, “Change management for us looks a little bit different than it does for the younger generation of oncologists that just sort of do this naturally.” Dr. Patt reported no relevant financial disclosures. Dr. Figlin reported various financial relationships.

“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.