Oncology News Central Peer-Spectives

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.