Oncology News Central Peer-Spectives

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.

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 [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.

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.

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.

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.

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.

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.

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.

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.