Cancer.Net Podcasts: Recent Episodes

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ASCO recently published a clinical practice guideline on cannabis and cannabinoids for adults with cancer. This podcast covers what patients should know about cannabis, cannabinoids, and cancer.

Treatments, Tests, and Procedures

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In this Meaningful Conversations podcast, Dr. Karan Jatwani talks to Dr. Amy Case about what people with cancer should know about hospice care, including the difference between palliative and supportive care and hospice care, who is eligible to enroll in hospice care, and the types of support available for people receiving hospice care and their family and caregivers.

Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations.

Cancer Basics

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In this podcast, the Reverend Jane Jeuland discusses what people with cancer should know about the role of chaplains in cancer care, including how chaplains are trained, the type of support they can provide for people with cancer and their family members and caregivers, and how someone with cancer can ask for spiritual support from their health care team.

Quality of Life

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In this podcast, Dr. Fay Hlubocky and Shelly Rosenfeld discuss what people should know about returning to work after cancer treatment. This podcast is intended for informational purposes only and does not constitute legal or medical advice.

After Treatment and Survivorship

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In this podcast, members of the Cancer.Net Editorial Board discuss the latest research, innovations, and discussions taking place across the field of genitourinary cancers, including prostate cancer, bladder cancer, kidney cancer, and testicular cancer.

This podcast is led by Cancer.Net Associate Editor for Genitourinary Cancers, Dr. Petros Grivas. He is joined by Dr. Neeraj Agarwal, Dr. Shilpa Gupta, Dr. Tian Zhang, and Dr. Timothy Gilligan.

Cancer Research News

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In this Meaningful Conversations podcast, Dr. Richard Lee talks to Dr. Tara Sanft and Dr. Biren Saraiya about what people with advanced cancer should know, including the value of palliative and supportive care and ways to talk with their families and healthcare teams about their health care wishes.

Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations.

Cancer Basics

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ASCO’s first clinical trial is the Targeted Agent and Profiling Utilization Registry, or TAPUR Study. This clinical trial is intended for people with advanced cancer without other treatment options available, and whose cancer has at least one genomic variation that can be targeted with specific drugs.

In this podcast, Dr. Richard Schilsky discusses the TAPUR study and explains why it is significant. He also discusses what participants can expect. Dr. Schilsky is the Principal Investigator for the TAPUR study. He is also the former Chief Medical Officer for ASCO and Professor Emeritus at University of Chicago.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor for Lung Cancer, Dr. Charu Aggarwal, and Cancer.Net Specialty Editor for Thymoma, Dr. Ryan Gentzler, discuss what people with early-stage non-small cell lung cancer should know about their treatment options before and after surgery, called neoadjuvant therapy and adjuvant therapy, respectively.

Treatments, Tests, and Procedures

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In this podcast, Dr. Allison Kurian and genetic counselor Kristen Mahoney Shannon talk about what people should know about genetic testing and hereditary breast cancer, including what to expect when meeting with a genetic counselor, ways to reduce your risk of developing cancer, and talking about genetic test results with family.

Cancer Basics

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In this Meaningful Conversations podcast, Dr. Lalan Wilfong talks with social worker Lydia Mills about what people with cancer should know when discussing their goals of care with their health care team, including the ways it can help inform their treatment plan and tips for navigating the conversation.

Meaningful Conversations is a Cancer.Net blog and podcast series that describes the important discussions people may need to have with their providers, caregivers, and loved ones during cancer and offers ways to help navigate these conversations.

Cancer Basics

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In this podcast, Dr. Abby Rosenberg discusses what parents and family members of children with cancer should know about palliative and supportive care. She addresses the way palliative and supportive care is different from hospice or end-of-life care, what to expect when meeting with the palliative and supportive care team, and the ways this type of care can support children with cancer and their families.

Dr. Rosenberg is the chief of pediatric palliative care at the Dana-Farber Cancer Institute and Boston Children's Hospital in Boston, Massachusetts.

Quality of Life

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The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today’s episode, our guests will discuss new research advances in treating non-small cell lung cancer, small cell lung cancer, and mesothelioma.

Cancer Research News

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The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in symptom tracking and improving health equity in childhood cancer.

Cancer Research News

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The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in melanoma and health equity.

Cancer Research News

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The theme of the 2023 ASCO Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in gynecologic cancers [2:06], multiple myeloma [9:15], and head and neck cancer [16:03].

Cancer Research News

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The theme of the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting was “Partnering With Patients: The Cornerstone of Cancer Care and Research.” From June 2 to 6 in Chicago, Illinois, and online, cancer researchers and clinicians from around the world gathered to discuss the latest cancer research and how to ensure that all people receive the cancer care they need.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field presented at the meeting, and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in breast cancer, lymphoma, multiple myeloma, and brain tumors.

Cancer Research News

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In September 2022, ASCO and the Society for Integrative Oncology, or SIO, published a joint guideline on using integrative therapies to manage pain in people with cancer. Integrative therapies are treatments and techniques used in addition to standard cancer treatment to help people cope with the side effects of cancer, including cancer-related pain.

In this podcast, Dr. Richard Lee talks to the guideline panel co-chair, Dr. Jun Mao, about these guideline recommendations. They discuss why the guideline was created and the different types of integrative therapies included in these recommendations, including acupuncture, reflexology and acupressure, hypnosis, massage, yoga, guided imagery and progressive muscle relaxation, and music therapy.

Side Effects

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Fatigue is a common symptom of cancer and its treatment, and it can be very difficult to treat. However, exercise is one simple method that’s been shown to help people with cancer manage and cope with cancer-related fatigue.

In this podcast, Dr. Anna Roshal talks with Dr. Tarah Ballinger and exercise physiologist Danielle Halsey about what people with cancer should know about cancer-related fatigue and the ways that exercise can help.

Side Effects

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June 15th to June 21st, 2023, marks the third annual National Black Family Cancer Awareness Week, an initiative led by the U.S. Food and Drug Administration's, or FDA's, Oncology Center of Excellence to increase cancer awareness within the Black community. Today we're going to be talking about cancer disparities in the Black community, the importance of cancer screening and prevention for Black families, and resources available to Black families for support. Our guests today are Dr. Luckson Mathieu and Rea Blakey. 

Cancer Screening and Prevention

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In this podcast, Cancer.Net Associate Editor Dr. Christopher Flowers covers new research in non-Hodgkin lymphoma presented at the 2022 American Society of Hematology Annual Meeting, held December 10-13 in New Orleans, Louisiana.

Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interimof Cancer Medicine in August 2020.

View Dr. Flowers’ disclosures at Cancer.Net.

Dr. Flowers: Hello and welcome to this Cancer.Net podcast. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma at the University of Texas MD Anderson Cancer Center. And it's my great pleasure to talk to you today about updates in lymphoma from this year's American Society of Hematology meeting in December of 2022. I have a number of disclosures related to my work as a consultant for companies in the development of therapies for lymphoma. I will not talk about agents specifically related to those companies, but 2 companies that overlap with some of the areas that I'll talk about in bispecific antibodies includes Genentech, Roche, and Genmab, as well as research support from those companies for research that is performed at MD Anderson. So this year's American Society of Hematology meeting had a number of highlights. I was very fortunate to be the introducer for one of those key highlights, and that was the abstract presented at this year's plenary session. This was actually the first abstract presented in the plenary session where I introduced the abstract and set the context, and Dr. Martin Dreyling from the German group described the TRIANGLE study. So the TRIANGLE study was a randomized controlled clinical trial, meaning that the trial was performed in a randomized fashion to be able to test 3 particular strategies for patients with mantle cell lymphoma.

Mantle cell lymphoma, as many of you may know, is a relatively uncommon form of non-Hodgkin lymphoma. It's a kind of lymphoma that can be quite aggressive, and particularly for younger patients who are suitable for aggressive therapy, the role of autologous stem cell transplantation has been something that's been important for the first-line therapy for mantle cell lymphoma. This study evaluated the use of a standard regimen of giving R-CHOP chemotherapy alternating with R-DHAP chemotherapy. So a chemotherapy regimen that includes Ara-C as their component followed by autologous stem cell transplantation. And it compared using that same regimen to giving it with ibrutinib added to the R-CHOP portion of the chemotherapy, followed by ibrutinib maintenance after the stem cell transplant or another experimental arm that added ibrutinib to the R-CHOP portion of the chemotherapy and gave 2 years of ibrutinib maintenance without stem cell transplantation. I think, importantly, this arm compared to each of those 2 experimental arms versus the standard of care and showed graphically that both of the arms that contained ibrutinib, the BTK inhibitor, looked to have improved failure-free survival compared to the standard stem cell transplant arm. Formal statistical tests were performed to compare the arm that included transplant plus ibrutinib showing that that was superior to transplant alone. And it remains to be seen whether that arm is superior to the arm that used ibrutinib alone.

But those 2 arms look fairly similar in terms of their outcomes, and also the toxicity associated with the transplant obviously was substantially more than performing the therapy without transplant. This suggested perhaps autologous stem cell transplantation can be removed from frontline therapy for patients with aggressive mantle cell lymphoma and provides provocative data that may help to change practice, both in Europe and in the United States, as well as the rest of the world.

A few other abstracts that were presented at this year's ASH meeting presented provocative data about ways to be able to improve the ways that we predict outcomes for patients. Matt Maurer presented the results of the Follicular Lymphoma International Prognostic Index 24, or the FLIPI24, as a risk factor to try and predict patients who might have early progression of disease with follicular lymphoma. One of the things that we know is that when you look at patients with follicular lymphoma, those patients who have progression of their disease within 24 months of the start of chemoimmunotherapy are patients that have markedly worse outcomes. And Dr. Maurer and our colleagues led an international study showing that a new prognostic factor model that included age, hemoglobin, white blood cell count, normalized lactate dehydrogenase, and beta-2-microglobulin, so all laboratory values that are connected within routine clinical practice, along with age, were a better predictor of this early progression of disease. This may serve as a useful model moving forward to help patients and their providers to understand who are the patients who are at higher risk of having aggressive behaving follicular lymphoma, and eventually, we can make strategies that help to address that for those patients.

A second provocative model for using integrated genomics helps to identify patients who also have early progression of disease, and those are for patients with diffuse large B-cell lymphoma. This was presented by Kirsten Wenzel from the Mayo group, where Anne Novak was the senior author for this publication. What they did was they integrated the genomics into the clinical prognostic factors and found that there was a particular RNA-seq profile that helped to identify those patients who had early progression of disease with diffuse large B-cell lymphoma. They compared this approach to other prognostic models and suggested that these approaches may be able to improve upon the prediction of outcomes and be incorporated into the ways that we predict treatment strategies for patients with diffuse large B-cell lymphoma in the future. While these are still early on in their development, I think this holds promise for the future management of patients.

And then the other class of agents that I'll mention from this year's ASH meeting are the bispecific antibodies. There were several abstracts that addressed this, both in patients with relapsing, refractory, diffuse large B-cell lymphoma, and in patient populations with relapsing refractory follicular lymphoma. One of those highlighted came from Nancy Bartlett, who discussed the role of a specific bispecific antibody for patients with relapsed follicular lymphoma. And I think these agents hold broad promise. So I appreciate your time and attention and hope you enjoyed this podcast and look forward to talking to you in the future about new developments in lymphomas broadly.

ASCO: Thank you, Dr. Flowers. You can find more research from recent scientific meetings at www.cancer.net.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.

Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In this podcast, esophageal cancer survivor Rachael Kearney shares her story with Dr. Frank Penedo, Associate Director of Cancer Survivorship & Behavioral Translational Sciences and the Director of the Cancer Survivorship Program at the University of Miami Sylvester Comprehensive Cancer Center, and an Advisory Panelist on the Cancer.Net Editorial Board.

They discuss her podcast, Call On Courage, which features conversations connected to courage, starting over, and overcoming. They also discuss the value in sharing your story, and tips for people with cancer and survivors.

You can view disclosures for Dr. Penedo and Ms. Kearney at Cancer.Net.

Dr. Frank Penedo: Hello, I am Frank Penedo. I am the associate director of cancer survivorship and behavioral translational sciences and also the director of cancer survivorship and supportive care programs at the University of Miami Sylvester Comprehensive Cancer Center. I'm also an advisory panelist on the Cancer.Net Editorial Board. Today, it is my pleasure to welcome and talk with Rachael Kearney. Rachael is an esophageal cancer survivor who lives in Manchester, England. After she received her cancer diagnosis, Rachael started a podcast called Call On Courage, which features conversations connected to courage, starting over, and overcoming in general. Rachael, thank you so much for talking with us today.

Rachael Kearney: Thanks for having me, Frank. I'm excited to get into this conversation.

Dr. Frank Penedo: Before we begin, Rachael, I should mention that we have no relationship to disclose related to this podcast today. Rachael, can you please tell us a little bit about your experience being diagnosed with cancer and your journey thereafter and what was it like?

Rachael Kearney: Yeah, so this is kind of coming into about 15 months ago. Out of nowhere, I had sort of severe acid reflux. And I was due to meet up with some girlfriends in Manchester, and I was just really struggling to eat my breakfast. It was just bizarre because I've not had those type of symptoms before. And essentially, what happened very quickly, within a 3-week period, this acid reflux increased, and it got worse. And it got to the point where I couldn't tolerate water. So I knew something was seriously up. But there was a waiting period before I got admitted to hospital, before I could have an endoscopy, which is obviously what I knew was going to get to the bottom of things to find out what was going on. And, yeah, it was just very scary in terms of not being able to tolerate normal food. But essentially, when I did get admitted, the endoscopy appointment came a lot quicker within a matter of 2 days, and then the actual diagnosis of esophagus cancer was within 24 hours after that. Obviously, it was just a massive shock because there wasn't a history of this in my family. And at the time, I was only 42. I'm 43 now. And it just felt very bizarre because I hadn't heard of anyone else that had esophagus cancer in my age group or friendship circles or whatever.

Dr. Frank Penedo: Yeah, you mentioned, Rachael, a couple of words in there that stand out. It's just a shock of that diagnosis and, of course, the fear that comes along with that. It sounds like you were able to get proper attention pretty quickly, which is obviously very important when dealing with a cancer diagnosis. But can you tell us a little bit about how you dealt with that initial shock and fear?

Rachael Kearney: So the weird thing was I was in shock, but I wasn't scared. And I don't know why, logically. I don't know why I wasn't struggling with a lot of anxiety. I don't know. There was just this inner sense, that things were going to get treated quite quickly. And, I mean, I had 2 surgeons because-- I don't know what the procedure is like in other countries, but in the UK, the treatment plan was a sandwich of chemotherapy and esophagectomy, and then chemotherapy at the end of that. The esophagectomy is the critical bit because the surgery essentially-- mine was actually an advanced tumor, so it had been there a while. So I knew surgery was the best course of action because this thing had been growing inside of me. And it was like-- it's a drastic surgery, the esophagectomy, because they're obviously removing a chunk of your esophagus, and you're also having essentially a gastric band. I was massively into fitness before I had cancer, so it almost sounds slightly annoying now, but the challenge now is more to focus on getting the calories in. And maintaining good weight is the focus. But that said, I think it was just a lot of-- I was having to process a lot of information because the treatment was coming at me quite quickly. And there was things about it lifestyle-wise that-- because prior to chemotherapy, I was on a feeding tube to get my nutrition. And at the time, I was more concerned that I wouldn't be able to eat in the normal way, that I'd maybe end up long-term on a feeding tube, which was something that was-- you've got all these questions about what your future and your lifestyle looks like post-esophagus cancer, and that was kind of in the mix.

But I think one of the things that was amazing was I had a lot of community, I had a lot of support around me in Manchester. So I was really fortunate, even though there were some wards within the local hospital I was in that were COVID-restricted still in terms of visitors, they made allowance for me to be able to have visitors and stuff like that. So I was really fortunate and even had a friend that worked in the hospital that would come and see me at the end of her shifts and stuff like that. So I had a lot of people checking in when I was in hospital, so I felt very supported through that process. But the thing that's complicated is you're very unwell and you're having to take in lots of information in terms of your treatment plan. And then they can't give you guaranteed scenarios of what your lifestyle is going to look like at the end of surgery. So that's the grey area, really. Yeah.

Dr. Frank Penedo: Sure, Rachael. And cancer in itself, it can be very challenging, let alone during a pandemic, when we have to adjust so many other aspects of our life. But it sounds like you had a pretty good support system, which, as we know, helps our cancer patients and survivors really manage the experience and get through. You touched a little bit upon your treatment. You mentioned it included surgery and reshaping of your esophagus and the stomach. And you touch upon the effects of surgery, which can be persistent. It can really persist well beyond that active treatment period. Can you talk a little bit more about how you've been able to cope with these side effects and changes that you've experienced?

Rachael Kearney: Yeah, so I was a massive foodie before all of this, very food-orientated. Food was almost, in family and friendship circles, a love language. And Manchester's got a thriving food scene out in the city and stuff, so a lot of socializing revolved around food. And I think the great thing about the upper GI ward that I was on at the time is there's no secrets and there's no sugar coating everything. They give you probably sometimes worst-case scenarios in terms of what things might look like after surgery. But the one thing they did say is I would need to have a puree diet moving forward and that would, to all intents and purposes, be permanent as a lifestyle change. They did say I could have these particular-- they're a bit invasive, but dilatation procedures where there's a physical stretching of the esophagus-- what actually happens is if-- once you come out of the surgery and you try to eat food, what's actually happening is things sometimes get caught. So I've got to be really careful about what I eat. I'm now on basically a liquid diet. And for texture, there's certain types of crisps, or, obviously, you guys say chips, that are melty or crackers that are melty in texture. So at least I get some kind of crunch just in terms of what I'm putting into my mouth and stuff. But I'm pretty much living on blended food or soups and ice cream and yogurt and things like that and smoothies. So the diet is massively limited now in terms of what I eat. The dilatations were offered to me as a way to kind of stretch my esophagus to encourage-- it's the swallow that's the challenge.

So if I had something bread-based and tried to eat that, it just gets caught and it just comes straight back up. So I live alone. So I don't try and test the boundaries of what I can eat and what I can't eat because I don't want to risk choking and things like that when I'm at home on my own. And then obviously, in public, there's so little warning if something needs to come back up. Socially, it's just a no-no. So what I have found, 2 things, are, I guess, really making my needs known. So there's a food market in Manchester I went to at the weekend. And there's this amazing Mexican vendor there. And they make things that are not on the menu for me that pureed, amazing, delicious Mexican food that-- they just know what my condition is. And I'm really clear I've had esophagus cancer, and this is the situation.

And then I think the other thing that's really key for me, because when I tell people I'm never going to be able to have pizza again in my life, people look at you and feel really sad because food is such a thing that brings joy. And I was so food-orientated before all of this. But I think I have to keep remembering I was on a feeding tube for 3 and a half months and I wasn't sure if that was going to be my new normal moving forwards. And there's obviously people, even young people, with other medical conditions-- I found these people on social media who live permanently on a feeding tube. Lifestyle-wise, that is so limiting. And I just thought, "Actually, my lifestyle-- it's changed. But I'm still out, I'm still active." I used to throw around kettlebells a lot, but now I'm just doing a lot of walking. So I'm still walking a lot and getting my exercise in. It's just that my diet has gone more simplified, this liquid diet, and I'm grateful that I can taste things and still occasionally have a cocktail. And obviously, the volume of what I can tolerate because of the gastric band side of things is just less in terms of volume. So I just get fuller quickly, as well, just being mindful of that.

Dr. Frank Penedo: Rachael, thank you for sharing that experience. I think we tend to undermine or underestimate what happens after treatment. We're so focused on curing the cancer and having the right level of treatment and getting the best care possible. But you have so eloquently described what experiences one can face after treatment. And these can be very challenging for anyone. Was there anything that surprised you? Were you expecting these changes or anything that popped up that said, "Oh, I wasn't thinking this was going to be my experience after being treated?"

Rachael Kearney: I did surprise myself at how well, relatively speaking, I coped with the puree diet. I think I thought that was going to affect my mood. The weird thing about my journey that I've shared with Call On Courage and just my story in general is I had 3 difficult years all truncated together. So before I got my esophagus cancer diagnosis, I've had burnout because I've been part of a startup that was a bit bonkers and been working excessive hours and stuff like that. So because I've gone from burnout to then going into this physical illness, from mental health to physical illness, and then coming out the other side of that, I was thinking, "Is this going to really be a setback in terms of mental health journey?" And amazingly, it wasn't. And I think there was things that had been put in place in my life from the burnout that was like support networks and things-- I'm very creative, so things creatively speaking that I put into my lifestyle that I thought just really bolstered my mental health and kind of allowed me to recognize there was a purpose in this quite messy journey. Obviously, the surprise was, "Oh my gosh, I'm living off soup a lot and blended curries and things like that and everything." My blender gets used all the time, but I've also been quite determined to try and not hibernate or not massively change my social life. I've had to adapt my social life. And in the past, it would be a 3-course meal and a bottle of wine. Wouldn't think anything of it. But these days, it's just literally 1 course. It's either pudding or something savory that someone's blended if I can go out and get that, and then 1 glass of alcohol, and then I'm full.

And I'm having to get in the habit of eating little and often. And I don't experience hunger. That's another sort of side effect. There's weird things about it because I don't experience hunger. It has become quite liberating because I've not got food on the brain. I'm not thinking about my next meal or-- I recognize the old version of Rachael was having to work a busy job, and then there was a lot of preparation around food and cooking from scratch and going to the shops and all of that kind of stuff. And everything's so much more simplified now in terms of what I purchase, whether it's ingredients or premade stuff. And it's quicker, and I'm literally just getting the nutrition in. There's still a pleasure to eating certain types of food, but that emotional connection to food has totally gone. And just the hunger isn't there. I've probably got to be a little bit more careful because I get a lot of steps in in a day because I'm active, that I should take snacks with me just because, even not having hunger, suddenly, I can be a bit-- not dizzy but light-headed. And that's when I recognize my blood sugar's low, and I need to kind of get something in to kind of give me energy. But yeah, the surprise would be, I guess, how liberating not having hunger is. And it's one less thing to think about, even though people listening to this, if you love food, that will be hard to wrap your head around because I understand that because I think it's such a big part of our social life and how we express ourselves.

Dr. Frank Penedo: Rachael, I mean, it sounds like you've been coping remarkably well. And I think it's not-- shouldn't be very surprising to all of us that most cancer patients actually do very well. It's a normal fear, concern, anxiety surrounding the diagnosis and treatment. But most of them adjust really well, making these changes and adaptations as needed so that they can manage treatment-related challenges, limitations that are going to persist over time. Anything that you would advise for cancer survivors and patients on coping with cancer?

Rachael Kearney: My 2 big things, I would say, that change stuff is community and purpose. And I think it's an obvious thing to say, but it's not going into that sort of tunnel mental health-wise around like, "Why me?" Because cancer is so indiscriminate, and the statistics we see on TV in the UK is 1 in 2 of us will have cancer at some point in our lifetime. It's obviously just more of a surprise when it happens when you're younger. But I'm massively grateful because there's a very special treatment center in the UK called the Christie, so that's where you go and have chemotherapy. And I was sat in the waiting room one time in the Christie, and there was just a very smartly dressed gentleman probably in his 70s. And I was asking which doctor he was waiting to see, and it was the same one as mine. And it turned out that he had exactly the same cancer as me. But when we spoke about what his treatment was, he was told he had about 6 weeks to live. Esophagus cancer is an aggressive cancer and I'm just-- honestly, there's not a day that goes by that I don't give thanks because the gratitude side of things is it was actually treatable even though it was advanced, and they were able to remove it. So I'm hugely thankful for that. And I know there's going to be people listening to this at all different stages of their cancer journey and different outcomes, but I think the community side of things for me was actually having friends that were like family that kind of swept in in Manchester that would come and visit me. I mean, come and visit me when my hair was falling out, when I was looking a mess. It was sort of important that people saw me at all different stages when I had the feeding tube in and post-surgery and stuff like that. But, yeah, I was massively grateful for that community.

So I think being part of some kind of community or being open with friends around where you are and what you need-- and sometimes, you need privacy as well as that. But yeah, I think connecting with people and seeing people when you're unwell is important to process stuff with people.

Dr. Frank Penedo: Absolutely. You touch on so many words that resonate with me as a behavioral scientist. We know social support and community is just critical to helping individuals navigate through a cancer diagnosis and survivorship. Social support is one of the strongest predictors of quality of life, for example. So having that sense of community support is really critical, and it sounds like you had that available for you. Also, having faith in the treatment you're getting and your treatment team is critically important because that's going to empower you to understand and believe that you're going to be able to challenge this and fight it and get better. You talked also about sense of purpose and sense of purpose and gratitude. And sense of purpose is really important. And I want to talk a little bit about this website and podcast, Call On Courage, which I love the name. So we know that cancer can be a devastating experience to many, and having courage is really a word that I use to describe many of the cancer patients and survivors that I work with, that I interact with. Can you tell us a little bit about this Call On Courage project and what your goals were?

Rachael Kearney: Yeah. Oh, absolutely. It's been something-- I actually started it prior to having cancer. So I started Call On Courage and the website CallOnCourage.com that started when I had burnout because I was really-- I've been basically part of something, a business venture that was faith-based. And I kind of thought that was something I was going to be part of for years and kind of do it with excellence and really go for it. And so when I did have burnout, it was just devastating to really let go of that because, yeah, I thought that was part of kind of what my future career would be attached to. So Call On Courage started initially just as a blog. I was just writing to kind of process some of those feelings and work through some of the sort of things that I felt. It sounds like a strong word because it was a work venture, but a sense of grief, a sense of loss to do with not being able to sustain in the business. So writing and blogging was just something that helped me navigate those feelings. And then I just recognized I ended up-- if I'm honest with you, I deleted a lot of those posts because I guess they felt like quite journal-like in their quality. And I thought, you know what? I want to create something that's a platform and a conversation starter about other people. There's so many other people out there that have got stories about having to start over or they've tried something, they failed, it's not gone in the way that they thought it would go. And so creating Call On Courage as a podcast, doing it as a podcast has definitely opened the door for just building friendships and connections across the world, basically with all different types of people that have done interesting things.

There's a woman that I'm still in regular contact with based in California. She knew at elementary school that she wanted to be a software engineer. She achieved that and then decided she hated it and then ended up having to do something totally different. There's another woman, Lu in LuLand, who's all about growing old outrageously. And she was in Portland and wore lots of fabulous outfits. And then she's moved to South London. And she's in touch with me now regularly as well. And, yeah, having a conversation with a guy, Mike Janda, who had a creative agency that serviced Hollywood and did $25 million worth of billings to creative clients. And we're having a conversation this afternoon. So I've not got a massive Instagram following or anything like that, but it's something very emotive about courage. And I think we've all got-- everyone's got some kind of story about grit and stamina and having to kind of dig deep to make harder things happen, whether that's health or career or whatever it is. But I'm particularly interested in that connection between creativity and courage together.

Dr. Frank Penedo: It is so important for other patients and survivors to hear a story from a survivor like yourself. It's relatable. It creates a sense of commonality, understanding that they're not alone and relating to experiences that you've faced, even if they have a different type of cancer, because some of these challenges are very universal across different cancers. And let me again thank you for sharing your personal story, which is very powerful. How do you think hearing your story can help someone cope with a challenge like a cancer diagnosis?

Rachael Kearney: Hearing my story?

Dr. Frank Penedo: Yeah, your personal story.

Rachael Kearney: I mean, my type of cancer is rare. So I was finding when I was googling-- I mean, it's not the best thing to do when you instantly get a diagnosis, but I was googling esophageal cancer. And the stats around it on Google aren't great. Yeah. It wasn't great when I was unwell to look at that, but it took a long time to get to actual sort of stories or testimonials around how people recovered from esophagus cancer. And so I felt a bit like one of the reasons-- and this is why I've written a piece for Cancer.Net as well. It was important to write about my story, was that at least there's a few more websites that have featured kind of what I talk about is my journey, what's been positive about recovering from esophagus cancer, because I was really struggling to find those particular stories online. And it was skewed-- well, the data around esophagus cancer is skewed way more towards much older people over 65, heavy smokers, drinkers, and more men that have this illness. But I mean, I also want to give sort of grace for the fact that every type of cancer is different, and even just speaking to people that have had breast cancer or ovarian cancer or whatever that is, or even a benign tumor that might have grown somewhere else, it's so case-by-case specific that I wouldn't be in a position kind of to dish out advice to say, "Oh, everything is going to be fine once you get your diagnosis. And it's about do these 3 steps towards gratitude and a creative project and X, and everything's going to be peachy." I really wouldn't patronize people with that information because I think you have good days and you have bad days with it. And it is definitely a journey of processing it through. I think me personally, I found my faith in my prior life really kind of bolstered things as well when I was processing things on my own that I wasn't kind of totally alone in working that stuff through. But I just think, yeah, kind of going back to the original point, I think it was just really practically important to kind of get a bit more content out there about esophagus cancer that's coming from a younger perspective and from a female perspective, because I think that was something that I found hard to research on when I was looking.

Dr. Frank Penedo: It's certainly a challenge, Rachael, for many providers, because there's a lot of resources for breast cancer, for example, prostate cancer, but the less common, more rare cancers, we still haven't done a great job of getting the word out there and creating the necessary support services. So I cannot over-emphasize how important it is to hear a personal story like yours to help these survivors. Just a few words in closing, Rachael, what advice do you-- what advice do you have for other people with cancer and survivors who are interested in sharing their story?

Rachael Kearney: Yeah, I think even just writing down what's happened for yourself is really critical. I think you don't have to necessarily get your story out on a blog. I was nowhere near that headspace as I was going through my treatment or illness or anything like that. But writing definitely kind of helped me process some of those feelings and the difficulty of it. I think if you're in a position to be able to-- I mean, I'm quite fortunate that I come from that background of building websites and creating stuff for myself, and I'm quite used to doing that. But I think if you can do it through a free platform or on social media and start to share your story when you're well, that's also a really great way of getting it out. But I've been really surprised and fortunate that I've approached places like Cancer.Net and, in the UK, Macmillan and some other cancer charities and cancer blogs and just asked, "Would you be interested in publishing my story?" And that's led to some great conversations like I'm potentially doing some press for another digestion charity in the UK that wants to talk about Christmas and the difficulties of someone like me living on a puree diet, kind of how you navigate holiday season or whatever with food.

So I've just found it's been a source of conversation starter and a sense of-- I'm in this interim phase between recovery, and I want to get back into work and stuff like that. And it's enabled me to kind of create things and pieces of work that I'm proud of. I'm in creative industries, so I can talk about that when I'm in job interviews and things like that as well. It kind of feeds into that, which has been wonderful. But I think you're in charge of your own story, and you don't have to overshare anything. So share as little or as much as you want about it. But I've definitely found there has been a response to it and, because I've shared with much bigger cancer organizations, that's also, on a very pragmatic level, that's increased a lot of traffic to CallOnCourage.com, and I'm seeing a lot more visitors from around the world. And the spread is kind of mixed a lot more. So I'm massively thankful for that because it's just wonderful that other people's stories are kind of getting out there as well through the blog.

Dr. Frank Penedo: Well, Rachael, I want to thank you for sharing your very remarkable and inspiring story with us today. Thank you for your time, and it was great having you.

Rachael Kearney: Oh, thank you so much, Frank. I've really enjoyed it.

ASCO: Thank you, Ms. Kearney and Dr. Penedo. You can find more stories from people with cancer at the Cancer.Net Blog, at www.cancer.net/blog.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

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In this podcast, Dr. Xiuning Le discusses new research on targeted therapy for non-small cell lung cancer presented at the 2022 North America Conference on Lung Cancer, held September 23-25 in Chicago, Illinois.

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In this podcast, Cancer.Net Editorial Board members discuss new research in gastrointestinal and genitourinary cancers presented at this year’s ESMO Congress, held September 9-13 in Paris, France. Dr. David Ilson discusses treatment advances in liver, colorectal, and gastric, or stomach, cancers. Dr. Sumanta (Monty) Pal and Dr. Tian Zhang discuss new research in kidney, bladder, and prostate cancers.

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At the 2022 ASCO Annual Meeting, registered nurse, breast cancer survivor, and patient advocate Stephanie Walker presented the results of the BECOME Research Project, which looked at Black patient participation in metastatic breast cancer clinical trials. In this podcast, she shares her story with Dr. Manali Patel, a medical oncologist and Assistant Professor of Medicine at Stanford University, as well as the Cancer.Net Associate Editor for Health Equity. They discuss Ms. Walker’s experience with metastatic breast cancer, how she became involved with patient advocacy and research, and the work being done within the oncology community to make cancer clinical trials more equitable and inclusive.

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In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in lung cancer, lymphoma, and childhood cancer that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois.

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in lung cancer, lymphoma, and childhood cancer that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois.

First, Dr. Charu Aggarwal will discuss 3 studies looking at treatment options for people with non-small cell lung cancer.

Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the Cancer.Net Associate Editor for Lung Cancer.

You can view Dr. Aggarwal’s disclosures at Cancer.Net.

Dr. Aggarwal: Hello and welcome to this Cancer.Net podcast. I'm bringing you updates from the Annual Meeting of the American Society of Clinical Oncology, held in Chicago in 2022. I'm Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania's Abramson Cancer Center. I will be discussing updates on 3 studies today that offer insights and new advances in the management of patients with non-small cell lung cancer. I don't have any direct relationship with any of these companies or studies, and you can view a list of my disclosures on the Cancer.Net website.

First off, I would like to talk a little bit about advances in the management of patients with EGFR exon 20 mutations. We know that a lot of advances have been made in the management of patients with non-small cell lung cancer, and much of that has been attributed to the fact that we are now able to deliver targeted therapy for a subset of patients. EGFR mutations form one such subset where we have a lot of oral drugs that are available, and we can offer these that improve survival, and patients can avoid chemotherapy, immunotherapy, and other IV infusional therapies. Within the subset of EGFR mutations lies this unique subset of EGFR exon 20 insertion mutations, which have been historically harder to target with currently available EGFR inhibitors. And over the last 5 years, we have seen tremendous growth of opportunities, targets, and new drugs for this subset of patients. The mutations in this subset forms about 2% to 5% of all non-small cell lung cancers. But now we have 2 FDA-approved drugs in this space, one being intravenously administered, amivantamab, and another that is orally available, mobocertinib. We covered this in a podcast as well as a blog, so please check those out on our Cancer.Net website.

But building upon that progress, there is now another drug that was reported at ASCO. This drug is called CLN-081. And we saw preliminary activity in a phase 1 and 2 study of this molecule or this drug in patients with EGFR exon 20 insertion mutations. It's an orally available drug. The top line data is that it is safe, it is effective, it was tested in different doses. It was tested at less than 65 milligrams, 100 milligrams, and 150 milligrams, again, as I mentioned, administered orally, and we saw responses and patients that had previously received other therapies and may have progressed on other therapies. And what we found was that this drug also tends to have activity against brain metastases, which I think is this huge unmet need in the management of such patients. So I think more to come, but again, I think offers us an insight into what may be in the future, an attractive drug for our patients with EGFR exon 20 insertion mutations. So stay tuned, more on that in the future.

Shifting gears, I would like to now talk about one of the common mutations. So we talked about EGFR exon 20, which is about only 2% to 5%, but the largest subset of mutations in non-small cell lung cancer really revolves around KRAS mutations, and these form about 30% to 35% of all mutations in non-squamous, non-small cell lung cancer. And amongst this group there is another subset which is KRAS G12C non-small cell lung cancer, that forms about 13% of all lung cancers. We have 1 approved drug already in this space by the name of sotorasib that is FDA approved for the management of patients with this particular mutation after having received 1 prior therapy, be it chemo-immunotherapy or immunotherapy. At this year's ASCO meeting, we heard data from a study called KRYSTAL-1, which looked at the activity and safety of another molecule called adagrasib, which is an orally available drug targeting KRAS G12C, again, in a similar population of patients with advanced and metastatic non-small cell lung cancer harboring a mutation.

We found that this drug is again effective, the overall response rate was about 43%, the majority of the patients had stabilization of disease, about 80%, and many patients were able to remain on treatment with stabilization of disease. We found that this drug does have side effects and adverse events and most commonly of this were diarrhea, nausea, vomiting, and fatigue. Many patients did require dose reductions, but the activity of the drug remained despite dose reductions. Now, what would be the advantage of this drug against the currently available sotorasib? In another smaller study reported at ASCO, there seemed to be activity in the brain, including intracranial penetration with the use of this molecule, adagrasib, which has not been demonstrated before with other KRAS G12C inhibitors, so I think that makes it a potentially attractive option. Again, I will say that the report of this intracranial activity was in a very small subgroup of patients, so I think needs to be further corroborated in a larger study.

Shifting gears again and talking about our last study, so I would like to highlight what do we do if, in case, patients don't have a targetable mutation. I want to highlight that we do have a lot of available options, and we are continuing to improve upon available options. The way we treat such patients is by using immunotherapy, either alone or in combination with chemotherapy. But what do we do after this treatment stops working? Researchers from the Southwestern Oncology Group, or SWOG, launched a massive national effort called Lung-MAP, which is basically a clinical trial that evaluates several different strategies all at once, either for patients with targetable mutations or for patients without a targetable alteration. And they reported results from a study that evaluated the combination of pembrolizumab with ramucirumab in patients that may have progressed after frontline immunotherapy. Now, pembrolizumab is immunotherapy, so the concept was, can we continue immunotherapy beyond progression and perhaps get some synergistic activity by using ramucirumab, which is a drug that prevents blood vessels from forming in the tumor itself. It's an anti-angiogenic agent, meaning that it is a targeted molecule that prevents blood vessel formation and promotes tumor death. What they found was that patients that received pembrolizumab and ramucirumab were more likely to live longer, so overall survival was longer for patients with this combination compared to a physician investigator discretion choice, such as chemotherapy in combination with ramucirumab or other chemotherapies that are otherwise used in the second line setting.

And interestingly, we did not find a significant improvement in shrinkage with this combination of pembrolizumab and ramucirumab or a significant reduction in the time of progression-- or, sorry, prolongation of the time of progression of disease. But the overall survival findings are interesting, and I think that's why we are including them in this podcast because that's one of the approaches that is leading to an improvement in survival and improvement in outcomes. I will point out that this is a phase 2 study. These results would need to be validated in a large prospective phase 3 trial so that we can account for certain confounding factors that may have led to these results. Having said that, I think there's a tremendous excitement, there's tremendous excitement in this field. I gave you examples of, or highlighted, 3 studies: one in patients with EGFR exon 20 insertion mutations, another in KRAS G12C mutations, and the third in patients who may have already received either immunotherapy or chemoimmunotherapy. We will continue to update our Cancer.Net website with updates as they come through, new advances, new studies, so thanks for following, thanks for listening, and more to come. Stay tuned. Thank you.

ASCO: Thank you, Dr. Aggarwal.

Next, Dr. Christopher Flowers will discuss new research in treating people with different subtypes of lymphoma, including mantle cell lymphoma and diffuse large B-cell lymphoma.

Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interimof Cancer Medicine in August 2020. He is also the 2022 Cancer.Net Associate Editor for Lymphoma.

You can view Dr. Flowers’ disclosures at Cancer.Net.

Dr. Flowers: Hello and welcome to this podcast that is a review of late breaking abstracts from the ASCO Meeting and recent updates in lymphoma. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma and Interim Division Head for Cancer Medicine at The University of Texas MD Anderson. And it's my great pleasure to discuss with you some of these late breaking abstracts. I do have some disclosures that are related to the content that I will present from this year's ASCO Meeting and recent studies in lymphomas. Those are available at Cancer.Net. Those relate to my role as a consultant for the development of clinical trials in lymphomas and research funding that MD Anderson has received from companies related to my role in clinical trials in lymphoma and clinical trials across cancers.

So, the ASCO Meeting had a host of new information that was presented. Some of that information centers around key clinical trials. One that was a pivotal clinical trial, the SHINE clinical trial, looked at patients with mantle cell lymphoma, a rarer lymphoma subtype, that looked at the combination of bendamustine and rituximab, a standard chemoimmunotherapy combination, compared to that same chemoimmunotherapy combination, bendamustine, rituximab, plus the Bruton's tyrosine kinase inhibitor ibrutinib. Ibrutinib, as some of you may know, is a kind of therapy that is typically used in the relapse setting for patients with mantle cell lymphoma when they have their disease come back. And the SHINE clinical trial was looking at adding it to frontline therapy. What this randomized, controlled trial in the phase 3 setting found was that patients who received the combination of bendamustine, rituximab, plus ibrutinib had improvement in their progression-free survival, meaning that the time that it took for their disease to come back or them to have deaths related to the lymphoma was longer for patients who received this combination. About 2.3 years longer than the group that received bendamustine, rituximab, plus placebo. And in total, that led to a median progression-free survival of 6.7 years.

That study has now been published in the New England Journal of Medicine and was led by my colleague Dr. Michael Wong from MD Anderson. Dr. Wong also led another study that was presented at the ASCO Meeting looking at CAR T-cell therapy for patients with mantle cell lymphoma. That study has now been published in the Journal of Clinical Oncology, and it looks at brexucabtagene autoleucel, a kind of CAR T-cell therapy, where that-- the CAR T-cell therapy was successfully manufactured for 71 of the 74 patients in the trial. 68 of those patients received an infusion and the median progression-free survival, so the average amount of time that it took for patients to have progression of their disease, was about 25 months. And so a marked benefit for those patients who were receiving CAR T-cell therapy when their mantle cell lymphoma came back.

There also were major breaking abstracts at the ASCO Meeting in the area of diffuse large B-cell lymphoma. As many of you may know, diffuse large B-cell lymphoma is the most common type of lymphoma that occurs in the United States. And there was a breaking trial that was presented in December at the American Society of Hematology Meeting describing polatuzumab, a CD79b antibody drug conjugate, as a new drug in the substitution of frontline therapy for patients with diffuse large B-cell lymphoma in combinations with rituximab, cyclophosphamide, adriamycin, and prednisone, or the pola-R-CHP arm, that compared favorably to rituximab and CHOP chemotherapy, which has been the standard of care for patients with diffuse large B-cell lymphoma. And that trial showed an improvement in progression-free survival.

At this year's ASCO Meeting, Franck Morschhauser presented results from looking at subsets of that patient population. Those patients who had BCL2 by immunohistochemistry that was positive or MYC expression by immunohistochemistry that was positive, or both of those, what we call double-expressor lymphomas, those who have poorer risk than standard groups. And those double-expressor lymphomas, treated with pola-R-CHP, had improvement in progression-free survival compared to R-CHOP with a hazard ratio of 0.64 in that group. We also saw in a multitude of analysis that that supported the benefit of pola-R-CHP in patients with both BCL2-positive and MYC-positive diffuse large B-cell lymphoma.

Another area that has been very hot in diffuse large B-cell lymphoma clinical trials is the role of bispecific antibodies. Bispecific antibodies are antibodies that bind both to CD20, a marker on the diffuse large B-cell or the lymphoma cells, and to the marker CD3, which is a marker on T-cells which brings the normal T-cells of the immune system in close proximity to the lymphoma cells and then leads to immune-directed killing of lymphoma cells. The agent glofitamab is an agent that was presented by Michael Dickinson at this year's ASCO Meeting in an abstract. And in this study, 107 patients who received more than 1 dose of steady treatment went on to have complete responses in about 35% of patients. And this showed that glofitamab induced durable complete responses and had a very favorable safety profile in patients with relapsed and refractory diffuse large B-cell lymphoma. And in this trial, they compared that also for patients who had prior exposure to CAR T-cells and showed that responses were also good in those patients.

Another set of studies has also looked at bispecific antibodies and a whole host of other areas with multitude of other agents. Another study that was presented at this year's ASCO Meeting explored the use of bispecific antibodies in the frontline setting in combination with the R-CHOP regimen that I just discussed. In that study, Lorenzo Falchi presented results of the subcutaneous bispecific antibody epcoritamab in combination with R-CHOP. This was a relatively small study of 33 patients that showed that the combination of epcoritamab plus R-CHOP was something that was safe and tolerable. There were no new treatment emergent adverse events that led to discontinuation of epcoritamab in the study. And there are some adverse events that are of special interest that we see with the bispecific antibodies, and those include the kind of immune-mediated adverse events that we can also see with CAR T-cells, like cytokine release syndrome, or CRS, or neurologic toxicities that we can see there that are also called ICANS. What we've seen in this trial, that about 42% of patients had some form of cytokine release syndrome, but that most severe form of cytokine release syndrome, those that were greater than grade 3 in severity, was only in 3% of patients. And likewise, the neurologic toxicities, or ICANS, that were grade 2 was in only 3% of patients. Relatively few patients completed all therapy by the time that this was presented. Only 10 patients had completed 6 cycles of therapy, but that showed an overall response rate that was quite high in that patient population.

There were a whole host of other trials that were presented at this year's ASCO Meeting, and those portend improved kinds of outcomes on the horizon for patients with lymphomas across the spectrum. And I think it's an exciting time moving forward for clinical trials in lymphoma and hopefully, to see new therapies that emerge for the management of this disease.

One of those new therapies that happened outside of the ASCO Meeting was the recent FDA approval of CAR T-cell therapy in the relapse setting for follicular lymphoma. And this was based on the ELARA clinical trial. And I think the future is quite bright for therapies and for patients with lymphomas broadly.

ASCO: Thank you, Dr. Flowers.

Finally, Dr. Daniel Mulrooney will discuss new research in childhood cancers, including a study comparing treatment options for Ewing sarcoma, and several studies on neuroblastoma.

Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children’s Research Hospital. He is also the Cancer.Net Associate Editor for Pediatric Cancers.

You can view Dr. Mulrooney’s disclosures at Cancer.Net.

Dr. Mulrooney: My name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I'm the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primary care for survivors of pediatric solid tumors. The annual ASCO Meeting is typically quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care.

Today, I'd like to highlight some of the exciting presentations in pediatric cancer. Please note, I do not have any relationships to disclose related to any of these studies. At this year's meeting, one of the highlights was a European study in patients with relapsed or refractory Ewing sarcoma. Ewing sarcoma is a rare bone cancer that typically occurs in adolescents or young adults. While challenging to treat, it is difficult to cure in patients who have relapsed, and studies are needed to improve the care of these patients. Investigators from 13 European countries and Australia and New Zealand studied the most common relapsed therapies, which include irinotecan and temozolomide, gemcitabine and docetaxel, topotecan and cyclophosphamide, or high-dose ifosfamide.

The study enrolled 451 patients between 2014 and 2021 and randomly assigned them to one of these four treatments. Based on response rates, the first 2 arms were dropped and the study was largely a comparison between topotecan cyclophosphamide and high-dose ifosfamide. The main outcome was event-free survival. Event-free survival is a common way in a clinical trial to see how well a treatment works. It measures the time from treatment that the patient remains free of complications, such as return or progression of the cancer. But investigators also looked at overall survival, toxicity, and quality of life. The 6-month event-free survival was better for high-dose ifosfamide at 47% compared to 37% for topotecan cyclophosphamide.

The median overall survival was also better for high-dose ifosfamide compared to topotecan cyclophosphamide. The results were best for children younger than 14 years old versus those 14 or greater. Toxicities included fever and neutropenia, nausea, vomiting, and diarrhea. Patients receiving high-dose ifosfamide had more neurologic and kidney toxicities, which might be expected since ifosfamide is known to affect these organ systems, while only descriptive measurements of quality of life appeared higher for those children treated with high-dose ifosfamide compared to topotecan and cyclophosphamide.

The strength of this trial is its large size, particularly for a rare cancer, and the fact that it randomized patients to the most commonly used treatment regimens for relapsed Ewing sarcoma. Importantly, data did not previously exist comparing these different treatments. While the results of this study are promising, clearly more needs to be done, and there was a lot of discussion at the ASCO Meeting about how to further improve survival in these patients. This study provides some information for doctors and patients, but importantly, provides data to advance future trials, which will concentrate on incorporating new targeted drugs with high-dose ifosfamide. This study is ongoing and is adding additional arms to continue to improve the outcomes for patients with relapsed or refractory Ewing sarcoma.

In addition to this study in Ewing sarcoma, several studies investigating neuroblastoma were presented. Neuroblastoma is the most common extracranial solid tumor in children and for children with high-risk disease requires intensive and prolonged treatment, including chemotherapy, surgery, radiation therapy, and stem cell transplantation. Treatment for these patients has improved since the introduction of immunotherapy, particularly an antibody directed at a particular antigen named GD2 on the neuroblastoma cells. One study showed improvement in outcomes using this antibody for children with relapsed or refractory neuroblastoma, and another study demonstrated feasibility of using this antibody earlier in treatment, which was not previously known to be safe and tolerable.

In what is called the BEACON study, investigators tested whether the antibody, called dinutuximab, would be effective when combined with chemotherapy for relapsed or refractory neuroblastoma. They enrolled 65 patients from 2019 to 2021 and randomized these patients to either chemotherapy alone or chemotherapy plus dinutuximab. The median age of these children was 4 years. The overall response rate, which means either a complete or partial response, was 18% for the chemotherapy-only arm but improved to nearly 35% for those treated with chemotherapy and dinutuximab. The progression-free survival was 27% for chemotherapy only and improved to 57% for those treated with chemotherapy and the antibody. There was no change in overall survival, though investigators think this may have been due to some patients who had progressive disease and crossed over to the antibody arm of the study.

This presentation was followed by a study from the Children's Oncology Group, which investigated the feasibility of adding antibody treatment earlier in the treatment regimen for neuroblastoma. Prior studies had used antibody later in treatment when the tumor burden is thought to be lower. The endpoint of this study was tolerability measured by toxic deaths or unacceptable toxicities, such as adverse reactions to the medication. For example, sustained low blood pressure requiring a ventilator or breathing machine, or severe neuropathy. 42 high-risk neuroblastoma patients were enrolled from 8 different children's hospitals between 2019 and 2021. 41 of the 42 were able to complete the induction chemotherapy plus the antibody. There were no toxic deaths or unacceptable toxicities. Importantly, 85% were able to complete the next phase of treatment, called the consolidation phase, and 79% were able to complete the following phase after consolidation, called post-consolidation. One-year event-free survival was 83%, and 1-year overall survival was 95%. Now, it's important to know these are still early results, and the trial recently closed, and some of the patients have only completed therapy within the last year. Both of these studies add to the knowledge of chemoimmunotherapy for children with high-risk neuroblastoma. These studies provide a foundation for larger randomized trials that will further advance the care of these children.

And finally, another study looked at race, ethnic, and socioeconomic disparities among children treated for high-risk neuroblastoma on Children's Oncology Group studies. There were no differences in event-free survival, but there were differences in overall survival based on ethnicity. The 5-year survival was lowest for Hispanic patients at 47%, 50% for non-Hispanic other ethnicities, which included Asian, Native American, Native Hawaiian, or Pacific Islanders, and 62% for non-Hispanic Black and non-Hispanic White children. Importantly, these investigators also studied household and neighborhood poverty. Overall, survival was lower for children living in poverty, though some of these differences went away when accounting for other factors, such as stage of disease or high-risk features. This study is important because it highlights the increasing need to collect data on clinical trials that may contribute to inequities in outcomes. While most studies collect data on the race and ethnicity of participants, other factors known as social determinants of health, such as income, neighborhood, education, access to health care, and insurance coverage, may also contribute to outcomes in pediatric cancer patients.

Overall, the studies highlighted here and presented at this year's ASCO Annual Meeting focused on difficult-to-treat cancers, such as relapse or refractory disease, and they have laid the groundwork for future investigations to continue to improve survival rates for all children diagnosed with a malignancy through improved therapies and by addressing potential social barriers. Thank you for listening to this brief summary of the new research in pediatric oncology presented at the 2022 ASCO Annual Meeting.

ASCO: Thank you, Dr. Mulrooney.

You can find more research from recent scientific meetings at www.cancer.net.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.

Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

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In this podcast, Dr. Maryam Lustbergdiscusses highlights from the Multinational Association of Supportive Care in Cancer’s 2022 Annual Meeting, held June 23-25 in Toronto.

Cancer Research News

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In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in head and neck cancer, brain tumors, and health equity that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois.

Cancer Research News

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in head and neck cancer, brain tumors, and health equity that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois.

First, Dr. Cristina Rodriguez will discuss 2 studies on new treatment options for locally advanced head and neck cancer.

Dr. Rodriguez is a medical oncologist at Seattle Cancer Care Alliance, an Associate Professor in the Division of Medical Oncology at the University of Washington, and an Associate Member for solid tumor clinical research at the Fred Hutchinson Cancer Research Center. She is also the Cancer.Net Associate Editor for Head and Neck Cancers.

You can view Dr. Rodriguez’s disclosures at Cancer.Net.

Dr. Rodriguez: Hello. My name is Christina Rodriguez. I'm a medical oncologist with a clinical and research focus on head and neck cancer. And today I'm going to discuss research on head and neck cancer that was presented at the most recent 2022 ASCO Annual Meeting. I don't have any relationship to disclose that pertains to the research that I will talk about today. I'd like to discuss 2 abstracts that I thought were practice changing or practice affirming that really addresses some of the key questions that patients and doctors like me have about the treatment of patients with head and neck cancer. So, as you know, most patients with head and neck cancer present with typically locally advanced disease, and most head and neck cancer patients are treated with the intent of curing them most of the time with the use of radiation either as the main treatment or after surgery. And many clinical trials have shown that when we add a chemotherapy called cisplatin to radiation, we improve curative outcomes for patients.

But the first abstract that I will talk about, abstract 6003, asks the question "What do we do for patients who are not candidates for cisplatin chemotherapy?" And we know that a significant proportion of our patients will have other medical problems that could make it difficult for us to give chemotherapy and often will result in complications or more toxicity or in side effects for patients. This clinical trial was carried out in India, and it compared radiation alone for patients with head and neck cancer versus radiation given with a non-cisplatin chemotherapy called docetaxel. What's unique about this clinical trial is that it's specifically focused on patients who were not candidates for cisplatin chemotherapy, something that really hasn't been done for this population. Interestingly enough, they found that when we give docetaxel with radiation in these patients, we find that they do better, they live longer, and they feel better based on quality-of-life questionnaires.

So I will say that this study, abstract 6003, tells us that even in patients who are not candidates for cisplatin to be given with radiation, there is an alternative treatment that we can use, such as docetaxel given with radiation, that might still improve patient's cure rates for their head and neck cancer.

The second study that I think was another interesting study was a clinical trial that asked the question, "Can we give cisplatin in an alternative manner for patients who are undergoing definitive radiation treatment as their main treatment for head and neck cancer?" Like I mentioned, the clinical trials that led to the use of chemoradiation as a standard use cisplatin given in larger doses every 3 weeks, but there's been concern about how well that approach is tolerated by patients. So this particular clinical trial compared patients receiving radiation as curative intense therapy for head and neck cancer with either the cisplatin given every 3 weeks or the cisplatin given at a lower dose once a week.

It's important to know that this trial was done in India, where the population is pretty different from what we see in the United States. These are mostly patients who have HPV-negative cancers, mostly cancers acquired through exposures like tobacco and alcohol. And what they found was that these 2 groups of patients had very similar outcomes. In other words, there didn't seem to be a reduction in the rates of cure when we give chemotherapy every week versus every 3 weeks. And interestingly enough, it looked like from a toxicity or side effect standpoint, the every week seems to be a little bit better tolerated. Patients who got the treatment every 3 weeks also had less need for hospitalization or IV fluids and less utilization of health care resources.

I think this is a very interesting finding because it really provides us with what we call high-level data that the weekly administration can work. I think it's important to recognize that the population that it studied for this particular clinical trial really was more an HPV-negative population. That's important to know because the standards for HPV-positive head and neck cancer are generated from larger trials that use cisplatin every 3 weeks. But we are continuing to study this question, and there's actually a large NRG study, HN009, that is asking that question both for the HPV- positive and HPV- negative population. So we are, I think, making strides in terms of asking the questions that allow our patients not only to receive treatment that is highly efficacious but also that limits side effects and toxicity. I will also mention that these trials were completed during the COVID-19 pandemic, which tells you that the dedication of these researchers to complete something like this in such a challenging time is to be commended. That's all I have to say, and thank you for listening to this brief summary of new research in head and neck cancer from the ASCO 2022 Annual Meeting.

ASCO: Thank you, Dr. Rodriguez.

Next, Dr. Glenn Lesser will discuss 3 studies that looked at new treatments for different types of brain tumors.

Dr. Lesser is the inaugural Louise McMichael Miracle Professor and Associate Chief in the section on Hematology and Oncology in the Department of Internal Medicine at Wake Forest Health. He is also the Cancer.Net Associate Editor for Central Nervous System Tumors.

You can view Dr. Lesser’s disclosures at Cancer.Net.

Dr. Lesser: Hello. My name is Glenn Lesser, and I'm a professor of medical oncology and the director of medical neuro-oncology at the Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem, North Carolina. I'm also the editor of the brain tumor section for ASCO's Cancer.Net. And today, I would like to briefly discuss several clinically relevant research studies involving patients with brain tumors that were presented at this year's ASCO Scientific Program. Of note, I have no disclosures or relationships relevant to the abstracts I'll be discussing today.

The first presentation to talk about is a late-breaking abstract presented by Dr. Eric Bouffet, who described the results of a phase II trial of 2 targeted anticancer agents, dabrafenib and trametinib, in pediatric patients with a kind of brain tumor called a low-grade glioma, which harbored something called a BRAF V600E mutation in their tumor DNA. By way of background, gliomas account for about 45% of all pediatric brain tumors, and the majority of these gliomas are low-grade, which include World Health Organization grade 1 and 2 tumors. Common types of pediatric low-grade gliomas include pilocytic astrocytomas, gangliogliomas, and low-grade gliomas that are not otherwise specified. Now, mutations in the BRAF gene are common in certain kinds of cancers, particularly melanoma, and novel oral targeted therapies have been developed to effectively treat these tumors by targeting this mutant BRAF gene. A particular mutation in this gene called a V600E mutation occurs in about 15% to 20% of pediatric low-grade gliomas. The presence of this mutation is thought to lead to an increased risk of progression to a higher grade or a more malignant glioma in these patients, and these mutations in their tumors also predict a less favorable response to chemotherapy.

In adults, recent studies in patients with malignant gliomas, papillary craniopharyngiomas, and melanomas containing V600E mutations have shown excellent results, with 1one of several similar 2-drug combinations that target both the V600E mutation and a second pathway that cells use to escape from this BRAF blockade. Now, early pediatric data suggested that one of these pairs of drugs, the combination of dabrafenib and trametinib, was safe and tolerable and had the ability to effectively treat patients whose tumors had the V600E mutation. So with that as background, this study was started and enrolled patients from 12 months to 18 years of age who had a low-grade glioma that contained a BRAF V600E mutation. And it randomized them to receive either the combination of dabrafenib and trametinib, or an older, standard cytotoxic chemotherapy regimen consisting of carboplatin and vincristine. Importantly, these patients were newly diagnosed, and this was the first systemic treatment they got, following their surgery or biopsy. 110 patients were enrolled, with 73 given the new targeted therapy combination and 37 receiving the standard combination. The most common types of tumors that the patients enrolled on this study had included pilocytic astrocytoma, ganglioglioma, and low-grade glioma.

The results of this trial were that the patients who received the newer combination, targeted treatment of dabrafenib and trametinib, did substantially better than those who received standard, older cytotoxic chemotherapy. Their overall response rate - that's defined as a complete or partial disappearance of the tumor on MRI scan - was 47% versus 11% in the control arm. When patients who had stable disease by MRI were included, 86% of those on the new combination versus 46% of those patients treated with the older chemotherapy had the so-called best clinical response. Now, a large number of patients responding to dabrafenib and trametinib, remain on treatment and are receiving these drugs with an ongoing imaging and clinical response at the time of this report. Patients receiving the new combination had a median or average progression-free survival of 20 months versus about 7.4 months with the older, standard chemotherapy.

The investigators conducting this study also had patients fill out a variety of questionnaires to assess their quality of life while on treatment. Once again, the patients who received dabrafenib and trametinib, on average, experienced an improved quality of life in contrast to those on standard chemo who, on average, had a worse quality of life. The new treatment was also well-tolerated with fewer serious adverse events or side effects when compared with standard chemotherapy. And these side effects were no different than what has been seen in patients without brain tumors who have been treated with this combination, including fevers, headaches, fatigue, skin changes, and lower blood counts. The authors appropriately suggested that these findings demonstrate the importance of molecular testing of these pediatric low-grade glioma tumors at the time of diagnosis and that this combination of dabrafenib and trametinib is a new potential standard of care in those patients who have the BRAF V600E mutant, low-grade tumors. Of note, liquid formulations of these drugs have been developed for those pediatric patients who are unable to swallow capsules or tablets.

The second presentation at ASCO highlighted the continued importance of prospective randomized clinical trials in patients with malignant brain tumors. Dr. Jann Sarkaria from the Mayo Clinic presented the long-awaited results of the Alliance for Clinical Trials in Oncology cooperative group phase II/III study of a PARP inhibitor or placebo added to standard temozolomide and radiation in adult patients with newly- diagnosed glioblastoma, and in addition, glioblastomas that had specific molecular finding called MGMT promoter methylation. This change to the DNA of the tumors prevents the MGMT DNA repair enzyme from being made in the tumors and leads to a better outcome with temozolomide treatment. Some very elegant laboratory science had suggested that adding a type of drug called a PARP inhibitor, which also causes defects in DNA repair, could lead to improved killing of glioblastoma tumor cells. So patients with newly- diagnosed glioblastomas, which had MGMT promoter methylation on genomic analysis, were enrolled on this study between December of 2014 and October of 2018. The study was conducted in 2 phases separated by a pre-planned pause after the first group of patients were enrolled, which was the phase II part of the study. This was done in order to allow a preliminary analysis of the outcomes of the treatment arms to make sure that there was a signal of activity that justified moving on to test this treatment in a larger number of patients, the so-called phase III part of the trial. This trial design hopes to minimize the number of patients treated with an inactive drug and save years of drug development time by avoiding large trials that go on for a long time with what turns out to be ineffective drugs.

For this trial, 447 patients were eventually treated on this trial. Despite the convincing laboratory evidence and early, promising clinical results that led to the trial moving to the second or phase III portion, the final results showed no statistically significant difference in progression-free or overall survival between the 2 arms, that is, those treated with a PARP inhibitor, and those treated with placebo. I personally was very excited about this study and had hoped that the long wait to hear the results indicated that something good was happening. In addition, several of my patients who were treated on the study did exceedingly well, so I, incorrectly, it turns out, expected positive results from the trial. These negative results are a stark reminder of why we spend lots of time and money and energy performing well-designed clinical trials to determine appropriate treatment strategies for our patients, rather than relying on expert opinion or 1 institution's published experience. This approach turns out to be the best way to fairly test treatment strategies and establish new therapeutic approaches which are truly effective.

A final, interesting abstract that was presented at a poster discussion session at ASCO was from the group with the University of Pennsylvania in Philadelphia, and it dealt with the risk of bleeding in patients with brain tumors who had blood clots and were then treated with a newer class of blood thinners or anticoagulants called direct oral anticoagulants, or DOACs for short. It's been known for over 100 years that a variety of types of cancer cause patients to be hypercoagulable, that is, to be predisposed to developing blood clots throughout the venous system. Patients with malignant brain tumors have the highest incidence of all tumors of developing blood clots, which typically occur in the legs, called deep venous thrombosis or DVTs, or in the lungs, called pulmonary emboli or PEs. These clots can lead to a variety of severe and debilitating symptoms, including leg pain, swelling, shortness of breath, heart strain, and even death. For the past 2 to 3 decades, affected patients have typically been treated with a class of medications called low-molecular-weight heparins, which need to be injected under the skin once or twice daily. Over the past decade, a new class of oral anticoagulants called DOACs have generally replaced low-molecular-weight heparins as the primary method of treatment for patients with and without cancer who develop venous blood clots because of their safety, ease of administration, and a lack of requirement for regular blood tests or monitoring. However, little, if any, data has been available to determine the safety of these agents in patients with brain tumors and blood clots, a situation where bleeding into the brain or the brain tumor as a side effect of the anticoagulant could be catastrophic.

In fact, this potential risk led to the exclusion of patients with brain tumors from several of the large trials which established the safety of the DOACs. Despite the absence of evidence, the DOACs are now pretty broadly used in brain tumor patients for the reasons described above. So this abstract described a cohort of patients with glioblastoma who developed venous blood clots between 2014 and 2021 while under treatment at Penn. The authors reviewed the medical record to determine the relative efficacy or effectiveness and the toxicity or side effects experienced by patients treated with the low-molecular-weight heparins and with the DOACs, including the rates of bleeding into the brain or the brain tumor. 121 patients were identified who fit these criteria, and the cumulative incidence of clinically significant intracranial hemorrhage, that is, bleeding into the brain or the brain tumor, by 30 days after starting the drugs, was minimal and similar in the 2 groups. When measured at 6 months, 24% of the patients in the low-molecular-weight heparin group had developed intracranial bleeding, and 4 of those patients had died from this bleeding, while none of the 32 patients in the DOAC group experienced this complication. Thus, these investigators felt that their data suggested that there was a lower incidence of clinically important intracranial hemorrhage or bleeding in patients with glioblastoma and venous blood clots who were treated with DOACs as compared to low-molecular-weight heparin. They went on to suggest that the use of DOACs was a safe alternative in patients with glioblastoma. Now clearly, either a prospective trial, a larger trial, or additional retrospective evaluations with a larger number of patients are needed to prove the safety of this approach. But this data is pretty comforting, as the use of these agents is now widespread in patients with high-grade gliomas.

The ease of administration of a pill once or twice a day, as compared with potentially lifelong injections once or twice a day, is a major quality of life advantage for our patients. Thank you for listening to this brief summary of new research in neuro-oncology from the 2022 ASCO Annual Meeting.

ASCO: Thank you, Dr. Lesser.

Finally, Dr. Manali Patel discusses new research focused on reducing disparities in cancer care.

Dr. Patel is a medical oncologist and Assistant Professor of Medicine at Stanford University. She is also the Cancer.Net Associate Editor for Health Equity.

You can view Dr. Patel’s disclosures at Cancer.Net.

Dr. Patel: Today I have the privilege of discussing several really exciting research abstracts that were presented at the 2022 ASCO Annual Meeting. My name is Manali Patel. I'm a thoracic oncologist, meaning I take care of patients and try to provide good care delivery for patients with lung cancer. And I also am a researcher focused on health equity. I have no relevant disclosures for any of the studies that I will be presenting today with the exception of one that I was leading.

And there were several wonderful abstracts that were presented on describing disparities and the ongoing state of disparities continuing within cancer care delivery. What I was particularly struck by were many of the abstracts that I'm presenting this morning and this podcast that really focus on what we can do as a nation and what we can do individually in our clinics to try to move towards action to overcoming these inequities. The first abstract I want to present was looking at how the Affordable Care Act and changes in the Affordable Care Act led to differences in mortality or deaths by race and ethnicity following the enactment in California. And this particular study looked at greater than 150,000 people who were diagnosed with breast cancer, colorectal cancer, and cervical cancer. And they evaluated death rates from these cancers both before and after the implementation of the Affordable Care Act. And what they found was that the cancer death rates for everyone was much lower after the Affordable Care Act was passed, but specifically for individuals who had self-identified as Hispanic ethnicity, who also identified as Black and who identified as White. And so what this abstract showed me was that at a larger level and a macro level, our policies that are enforced at the national level really do play a role in terms of how we can overcome disparities in cancer.

Our group, as I mentioned before, has worked on really trying to integrate community health workers into care. So this abstract paired with local union organizations in Chicago and in Atlantic City to try to help individuals who self-identified as having been from families that were from low-income households and racial and ethnic minorities to communicate their goals and their preferences for care and to also better their relationships with their clinicians as well as to describe their symptoms. And what we found in this randomized trial was that for individuals who received this community health advocate who helped them to better engage with their clinician and who also helped them to describe the symptoms that they were experiencing as well as receive community resources such as food boxes if they were food insecure or be connected to household agencies if they were having difficulties with housing, we found a significant improvement in quality of life, but we also found reductions in the use of the hospital unnecessarily. We also found that this translated into reductions in total cost of care, thereby reducing the amount of out-of-pocket costs these individuals were spending on their cancer care.

One of the other abstracts that I thought really was reflective of the many different ways that we can move towards action was an abstract which looked at during the pandemic, trying to reduce the number of times people need to come in for mammograms, their biopsies, and then any further testing that they needed after their biopsy. And this particular study evaluated what was called a same-day biopsy service, which layered on a same-day mammogram reading program. So at this particular institution, they had already implemented when you came in to get your mammogram as a woman or a man, you would have a read on the same day. So you did not have to wait to find out what your results were. And what they did further to push better care was that they layered on on that same day you could get your biopsy. So almost a one-stop shop. And what they found was that for everyone, regardless of race and ethnicity, the time to biopsies decreased by almost half. And the median days, for example, from an abnormal mammogram to obtaining a biopsy, meaning a sample of that tissue, that it decreased from 10 days median to 5 days. And particular patient populations did much better. And so they were able to show that when you do interventions that move the care to provide better care for everyone, everyone benefits, but particularly our patient populations who identify as racial and ethnic minorities who were more likely to experience delays in care, they also received some benefit from this intervention.

The last study I want to highlight is work which looked at how to improve specialized services for people who would otherwise not receive those. And this particular study looked at stem cell transplantation for people with blood cancers. And what they found was that these services are often only offered in very tertiary centers, so places that may not be as accessible, large institutions that a lot of people may not have access to receiving care. So what they did was they partnered with this large academic institution so that they could build a pathway for individuals who would otherwise not get stem cell transplantation so that they could have access to those services. And it was really a multipronged approach where they not only educated the clinicians in the community practice about the effort, but they also educated the institution-level clinicians about the effort. They also provided shared medical records, which oftentimes in practice, we don't share our medical records with other clinics. And what they were able to do was to convince these clinics and the institution, let's share the medical records so that then you can have access to seeing what's happening for patients that are diagnosed in the community. And then that way we can both document, we can both have access in the community as well as in the institution where they're receiving the specialized service so that there's better communication. They also provided a navigator for each patient that would help each patient to identify any sort of barriers that they may experience to receiving stem cell transplantation. And then they offered telemedicine, which allowed for individuals to receive specialized services in the comforts of their own home without having to travel after the stem cell transplantation had occurred. And what they found was that usually in the institution, most individuals were more affluent. So they had higher levels of socioeconomic status. But after the intervention, individuals that were referred from this community clinic made it such that the affluence really decreased so that it was showing that people who wouldn't otherwise have access, who had identified as having low income, were now able to receive those services and had been receiving transplantation.

I think that these studies really do move us towards a new paradigm of taking action on the many disparities that we know continue to happen. I really appreciate you all for listening to this brief summary of the new research on health equity from the 2022 ASCO Annual Meeting, and I hope to see you next year.

ASCO: Thank you, Dr. Patel.

You can find more research from recent scientific meetings at www.cancer.net.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.

Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

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Today we're going to be talking about coping with the mental and emotional challenges of cancer through exercise. Our guests today are Dr. Sheila Lahijani and Sami Mansfield.

Quality of Life

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

Brielle Gregory Collins: Hi, everyone. I'm Brielle Gregory Collins, a member of the Cancer.Net content team, and I'll be your host for today's Cancer.Net podcast. Cancer.Net is the patient information website of ASCO, the American Society of Clinical Oncology. Today we're going to be talking about coping with the mental and emotional challenges of cancer through exercise. Our guests today are Dr. Sheila Lahijani and Sami Mansfield. Dr. Lahijani is an associate clinical professor of psychiatry and behavioral sciences at the Stanford University School of Medicine and the medical director of the Stanford Cancer Center Psychosocial Oncology Program. Dr. Lahijani is also an advisory panelist on the Cancer.Net Editorial Board. Thanks for joining us today, Dr. Lahijani.

Dr. Sheila Lahijani: It's truly my pleasure to be here today, Brielle, with all of you.

Brielle Gregory Collins: Thank you. Ms. Mansfield is the founder of Cancer Wellness for Life and the director of Oncology Wellness for the Sarah Cannon Cancer Institute at HCA Midwest Health. Thanks for joining us today, Ms. Mansfield.

Sami Mansfield: Thanks, everybody, for having me. Excited to be here as well.

Brielle Gregory Collins: Before we begin, we should mention that Dr. Lahijani and Ms. Mansfield do not have any relationships to disclose related to this podcast, but you can find their full disclosure statements on Cancer.Net. Now to start, Dr. Lahijani, how can a cancer diagnosis impact a person's mental and emotional well-being?

Dr. Sheila Lahijani: Thanks for asking this question, Brielle. Usually, when people want to know the answer to this, what I preface it by saying is that there is a spectrum of responses. Many people find themselves to be quite distressed because cancer continues to have quite a lot of stigma, both in this country and as well as internationally. People oftentimes associate it with feelings of despair, anxiety, and helplessness. Having said that, many of these responses and reactions are normal. Some people can progress to have many more significant emotional responses and reactions that can become more disruptive to their lives and to the roles that they play a part in. We really try to meet patients where they're at to better understand how they've previously coped with past life challenges and/or traumas and to identify what strengths they have, what coping mechanisms they have to help them manage the distress associated with cancer. There are patients who also have a history of past psychiatric diagnoses and problems, in which case getting diagnosed with cancer and undergoing cancer treatment can cause a lot more difficulty. So each person is different. There are a lot of, quote-unquote, "normal" reactions, responses and reactions, that we as providers do validate and reflect back to the patients. And then there are those that can cause many more problems, and those are the ones we really need to address.

Brielle Gregory Collins: Okay. And getting into some of those problems, what are some of the most common mental and emotional challenges that people face during cancer?

Dr. Sheila Lahijani: The majority of people feel very anxious. And I've shared this with others and share this with my patients: being anxious means something. It means that you care about something. You care about yourself. You care about your life. You care about people in your life. And so it's a sign. It's something that needs to be tended to. People suffer from mood symptoms such as depression as well, difficulty coping, feelings of loss and despair. Those are the most common reactions. Some people can develop other difficulties related to side effects of cancer treatments as well. And also, there are people, as I mentioned, who previously have suffered from psychiatric symptoms, where things can become much more difficult and challenging, affecting their way of thinking: problems with cognition, memory, recall, things like that. So to summarize, largely mood disturbances and mood symptoms in the forms of anxiety and depression. Panic is also a part of that, as well as post-traumatic stress. And there are others who have previous symptoms that can become more problematic. So we really try to evaluate both mood and thinking in our patient population.

Brielle Gregory Collins: Thank you so much for walking through those. And I want to talk a little bit now about exercise and how that can play a role in coping with some of these challenges. Ms. Mansfield, what is considered exercise, and what are some of the benefits of exercising during cancer?

Sami Mansfield: Great question because there are so many different terminologies around exercise and physical activity and fitness. So I think we should start there. The terminology of physical activity is probably the most broad thing that we talk about. Physical activity is anything that we do to move the body, anything from rolling over in bed, getting up, brushing your teeth, etc. Exercise is a physical activity that is more defined or maybe has a purpose. And so it might be a goal to get stronger or a goal of rehab or prehab in this particular patient population. Or some people just want to be able to walk a 5k or run a 5k. So exercise is more intentional. And that's really how we try to define it in the literature.

From a cancer patient perspective, probably the most broadly impactful side effect management tool for exercise is actually fatigue because that is where we have a depth of evidence both in physical activity and inactivity differences. And related to fatigue from the mental health side, we see a strong benefit of both exercise and physical activity in anxiety, depression, stress management, sleep quality. So I think it's important for our audience to know that anything that you do for movement is good. Having a planned and structured movement program known as exercise is going to be ideal because the bottom line is we want you to reach your goal the quickest and without kind of feeling like you're not getting a lot of benefit to movement. And so that's why exercise really does have a significant role and why I think a lot of people really strive for, "What should I do? What does that specific exercise plan look like?"

Brielle Gregory Collins: Got it. And I want to circle back to some of the challenges, Dr. Lahijani, that you outlined earlier. So how does exercise help address some of these challenges of cancer specifically?

Dr. Sheila Lahijani: Well, I love this question. And I'm very informed by what my colleague, Ms. Mansfield, just described. Exercise and physical activity, in my opinion, are so beneficial to patients who are already diagnosed with cancer, as well as those patients who may be at risk for developing cancer-- any of us, really, to reduce our risk for certain kinds of cancer. There have been many studies that have been done that have demonstrated that intentional physical activity, as my colleague termed it, in the form of exercise can ramp up certain biological processes that contribute to improvements in cognition as well as memory function. There's a factor called a “brain-derived neurotrophic factor” which can get increased with physical activity and exercise. At the very molecular level, muscle cells can play a part in reducing the progression of disease and even potentially metastases. So there's a lot to be said biologically. As well as psychologically, it really can offer quite a lot of benefit to help people manage their distress through focusing on momentary breathing, momentary muscle relaxation. And there is also a social component to it. Even if someone is participating in an activity like this by himself, herself, or themself, there is something to be said about the communal experience of being up on your feet, moving yourself, and not being so isolated and alone, which is very much a problem for patients who undergo cancer care.

Brielle Gregory Collins: That's a really good point. And Ms. Mansfield, I want to get a little bit into the specific things that people can do. So what kinds of exercise can help people with cancer cope with these challenges?

Sami Mansfield: Now, it's a great question because that's what everybody wants. What should I do, right? And I tell everybody let's just start, number 1, with avoiding as much true sedentary behavior as possible. And I say true sedentary behavior because when you are just sitting and doing perhaps mindless activities, watching TV, there's a lot of exercises that can be done when you're seated, which is great for patients that have high amounts of fatigue or balance challenges. And I tell everyone, "Lift an arm. Lift a leg. Flex your toes and feet a couple of times, roll your shoulders, and you've just moved." It doesn't have to be vigorous or difficult. It just needs to be movement. So I think just thinking about these 1-minute, we call it “exercise snacks,” make a much more significant impact throughout the day than feeling like, "Oh, I've got to go to the gym and exercise for 30 minutes," or you might even have physical therapy. And the volume might be too high for people. So I want people to think first in small 1-minute movements.

But the next piece of this is, we've studied the different modalities of exercise between aerobic exercise, thinking about things like walking, or chair-based, like marching in the chair, swimming, biking, whatever that may be. And resistance training exercises that use muscles. You could do something with weights, soup cans. You could do bodyweight exercises that build muscle. We've studied them separately and together. And what we've learned is that for the emotional side effects, specifically anxiety, depression, having a combination of these movements is going to give you the most significant benefit. So my advice is do a minute of marching, whether that's in your chair or standing, then maybe do a chair sit-to-stand 10 times and a couple of countertop pushups, and you've now hit a full-body routine exercise regimen in under 5 minutes. I do think that people need to remember although there are recommendations of how much you should strive for, there's no reason you have to do the whole recommendation of 150 minutes of moderate activity per week to see benefit. Start with just 1 minute at a time, 1 movement at a time, and try to mix it up. Make it fun. Add music. Make it a challenge. Make it something that you feel that you can attain because you will feel better and also accomplished. And that does improve your well-being, to feel like, "I did that. I did my 1 thing a day." And that's really phenomenal and goes a long way to how people feel mentally.

Brielle Gregory Collins: Absolutely. And I love that term you use of “exercise snacks.” I think that's a really helpful way of looking at it. So for someone who's maybe just getting started with exercise, what is your advice for them as they manage their cancer diagnosis and are trying to look toward exercise as something that they want to incorporate into their lives?

Sami Mansfield: That's definitely the question I love to answer. Because if somebody's motivated, we want to get them there quickly or get them to find a resource that helps them feel successful. I kind of go back to the whole “exercise snack” piece. I think it's more important that people realize it's better to do a little something every day than to think, "Oh my gosh, I need to hit 30 minutes today, and then for the next 3 to 5 days, I don't do anything." I really advise start small, start manageable, and look for something that you can do without having to add extra barriers to your life. As an example, if getting somewhere logistically on time doesn't work for you, start with 5 minutes of things that you can do from your home. I do think there is a really important resource within most of our cancer spaces. We have oncology rehab programs. We have trained exercise professionals that can guide you. But I think people don't realize that just moving around their house, maybe 1 flight of stairs if you can do that, is a really great way to get started. There's a lot of great YouTube videos you can try. There is definitely—talk to your physicians. They might have some great ideas. But starting daily, consistency really is going to make the biggest difference than just going, "Hey, Saturday is my day to exercise." I think we can all do a little bit in that snack fashion. And I don't know. I think we can all agree snacks are good. We all like a few snacks now and again. Definitely.

And I also kind of have this thought about-- people say, "Well, if they have cancer, should they do yoga?" And my answer is, "Well, do you like yoga?" I mean because yoga has a lot of really great resources for mental health and breath to movement and mindfulness and that grounding effect. But for someone who doesn't like yoga, which I will admit yoga is a little bit of my challenge so I push myself to do it, someone telling me to do yoga every day versus maybe exercises that I enjoy, I would be a little bit more down in the dumps about it, that you're taking away maybe what I love. So I think 1 thing, really thinking about what's the type of exercise you like to do, is it reasonable for you to continue that? If you used to run and maybe you have a lot of neuropathy in your feet, it might not be the most reasonable now. But what is the exercise that you enjoy? And that should also be part of that first thing that you do every day, not your, "Well, someone told me I should do yoga because they enjoy doing yoga," piece. And I think that's something that we need to think about in exercise. It still should be enjoyable and have good music. I think music is key as well.

Dr. Sheila Lahijani: I think it's really important to highlight as well that cancer causes so many life disruptions: disruptions to different roles, activities, functions, whatever it may be. And in speaking about intentional physical activity and exercise, it's an opportunity to create a routine and to try to lessen the impact that's caused by the disruptions.

Sami Mansfield: The pandemic certainly accelerated that for those of us who don’t even have cancer. I don't know if anybody here also experienced this. But I remember I was working out in a gym setting-- and we actually had our own-- we ran a gym space at the time in Kansas City for cancer survivors. So we took that virtual. But I struggled with my routine. I was like, "Wait a minute." And I could go to my own gym that was private, right? But I really struggled with the mentality of like, "It wasn't my routine." And when your routine slips, you just feel very out of control. I think 1 recommendation we should make for all of our listeners, physicians, or those of us that are working in the field is I recommend starting every day with a minute of movement. I don't care if you're doing a few arm circles where you're waiting for your coffee or whatever, but there is something about getting your blood flow moving quickly that makes a really big difference. So whether that's, "Before I brush my teeth, I'm going to just do a couple of leg swings or a couple of countertop pushups or something simple every single day." Or if you're in bed, you do something in bed, even if it's just your foot flexion or drawing the alphabet where you're doing something to stimulate movement." You bring up a really good point, that we need to make that ritualization or routine, but make it also very accessible for people.

Brielle Gregory Collins: Absolutely. Thank you, Ms. Mansfield. That's really helpful. And Dr. Lahijani, in addition to exercise, what else can people with cancer do to cope with some of the mental and emotional impacts of their diagnosis?

Dr. Sheila Lahijani: Thanks for asking this question. And I want to also preface this by saying so much of what we're talking about is essentially what is now a field of exercise oncology, right? And so there's more and more literature available and resources that emphasize the benefits of exercise in this patient population and how the effects of other treatment modalities, such as antidepressants and psychotherapy, can be further enhanced when someone is also being physically active or having an exercise snack. So to answer your question, what I'm saying is there are many ways we can support our patients and many ways we can encourage them to have better management and control over their distress-- why there is anxiety, depression, sleep disturbances. It's really meeting people where they're at-- which Ms. Mansfield also mentioned, starting somewhere.

So when we see patients in our clinic-- and I've been known to do this, and I've done this back in the day where we would really write a lot more paper prescriptions. But even as part of my discussion points and patient instructions, I always make a point of writing, "Do some physical activity, even minimum opportunity to get yourself moving." Because what we're trying to really do is help with the circulation-- help with the circulation in the body, in the brain, really ramp up those neurotransmitters that help people feel better, remove the unhealthy oxygen, introduce the healthier oxygen. And that, in conjunction with medications, in conjunction with different psychotherapy modalities, in conjunction with progressive muscle relaxation, mindfulness, grounding techniques, can really help people feel less helpless, less stuck, less tired-- again, as I mentioned earlier, less alone, and find opportunities where they have more of a sense of control because that's part of what we're talking about here. There's a strong feeling of helplessness and lack of control when someone is diagnosed with cancer and undergoes cancer care. And this is an opportunity to help them find ways to manage their health physically, mentally, cognitively, spiritually, and feel less a sense of helplessness.

It’s really encouraging me to say that there are many patients who are physically really suffering, whether it's from neuropathic pain, cancer-related fatigue, any kinds of deconditioning related to surgical interventions, other effects of chemotherapies, from depression. And it is much, much harder. And people sometimes cannot physically move. And it requires a lot more activation energy to take those steps. So part of what we do in my clinic and how we partner with our colleagues in palliative medicine as well is how can we manage people's symptoms? How can we manage their depressive symptoms, their physical symptoms? How can we help them be more cognitively stable and intact to be able to safely take those steps or to have more of that motivation or that energy or that pain relief to be able to participate in the things that we're talking about? I'm cognizant of the fact that when we have our patients and family members and caregivers listen to this, there may be some folks who are like, "But I just can't." And I have patients who tell me, "I get it, Dr. Lahijani. I understand. And I appreciate this guidance that you've offered me and the recommendations to use this medication or to consider this, but I just can't." So that problem with motivation and lack of optimal symptom management really has to be addressed in parallel, in my opinion, to really help support patients in actually participating in what we're suggesting here.

Sami Mansfield: I think that's not only an excellent point, I think you really reiterate the partnership that needs to happen with the clinicians and the exercise oncology field or oncology rehab field because the only way to really do this effectively again, and especially a more complex patient, is in conjunction with one another. And I think that we need to be mindful and remind the patients, and like you said, the family members listening, that the conversation should be had, but the clinicians really can help manage the clinical symptoms so that the exercise or rehab professionals can really get in with that, the more implementation piece, when reasonable. But I think we need to take the guilt off our patients that it's not going to be every day, even though they want to. And that's the reality, and that is okay. And some days, it is a rest day or a rest week. And that is part of the healing process of the body and a really important way to recover. And that's okay, too. I think recommendations are nice as an example. But at the end of the day, if they're not reasonable for people, we need to also take that next layer of guilt away. And they just need to be able to feel comfortable and pain-free and symptoms-managed. And that's quality of life as well.

Brielle Gregory Collins: Wow, what a great discussion. And I think the main takeaway here for anyone listening is your health care team is there to help you, and they'll work with you to figure out what's best for you, whatever that might be. So thank you so much. That was wonderful to hear both of your perspectives. And I want to talk a little bit about resources that people listening can turn to to learn a little bit more about this. So I'd like to direct this to both of you. Ms. Mansfield, we'll start with you, but where can people go to learn more about exercise and managing the mental and emotional effects of cancer?

Sami Mansfield: Absolutely. That is the key question is, what next? Really, Cancer.Net is a wonderful and evolving resource and is continuing to progress its information. So no matter when you're listening to this podcast, check out Cancer.Net. I know that the information is online. There's a ton of resources right there. There are some other really great programs and resources. I would talk to your clinicians about things like cancer-specific rehab programs that you may have access to, which many have insurance coverage. And I tell people you don't have to feel broken to get cancer rehab. There are a lot of ways that cancer rehab can help you even just manage general fatigue or cognition. Referral to a speech-language pathologist can be helpful with some of those techniques about memory and chemobrain. So those are resources. In addition, there are qualified exercise professionals through the American College of Sports Medicine that have training and certifications and have experience. That can be another resource that can help you. I would also advise people to think, "You don't always have to have a cancer professional." There are great fitness professionals that may fit-- yoga professionals or other types of exercise modalities. So don't always feel like you have to find the “cancer person.” But depending on your symptoms or side effects, having a professional that understands what it means when you say neuropathy can be very helpful. So I would definitely start with those resources first and then branch out as you feel comfortable.

Dr. Sheila Lahijani: She responded to that question beautifully. And to add to what she just shared, looking at what your own cancer center, your place of health care where you receive it, what's available. There are many websites through the different cancer centers and medical centers that have wonderful patient-facing and family-facing educational resources. The American Cancer Society also has a lot of helpful information. As Ms. Mansfield mentioned, Cancer.Net is a wonderful resource. And also to emphasize that there are programs that can be done virtually, especially in this era of this pandemic. While we encourage in-person interactions, however it's safe and feasible because there's so much benefit to feeling less alone and isolated and maybe having that direct 1-on-1 attention, we recognize that many patients because of their immune compromise or because of whatever challenges they may have with respect to support or transportation or finances, whatever it may be, it might be harder to access care or services where someone lives. And so there are programs and services that are available online. And that shouldn't be limiting. That should be something to really think about and consider.

Actually, I was in a meeting recently where I learned about an organization called the Maple Tree Cancer Alliance, which has programs available through different cancer centers as well, among which is my center, Stanford. And so there are plenty of resources available. And with that, I will also say pick something. Choose something. You don't need to look at everything and try to do everything. Take a look at what's available to you, what's accessible to you, what makes sense, and just try it out, and see if it helps. And if it doesn't help or if it's not providing you any kind of immediate benefit, look to see what other options there are. We have so many patients tell us that they're trying to follow through on our recommendations, and people want to be, quote-unquote, "good patients." And that can get very overwhelming. People in large part want to feel better. They want to get better. That doesn't mean you have to take advantage of every single resource or recommendation that's being offered to you. Take a look at what's close to you, what you can access, and how you can make it work, and start somewhere.

Brielle Gregory Collins: Absolutely.

Sami Mansfield: And on that start somewhere, the other thing to really think about too - and Dr. Lahijani really said this - is you don't have to do-- everything at once can be so overwhelming. This is the long game. And so this exercise piece should be a lifestyle behavioral change piece that works for you in the long-term. It isn't about just, "Here I am. I want to get through just this 1 specific piece in my life." Look for something that you enjoy because you're going to be much more likely to continue. And then thinking about that support circle, it may be someone that has a similar diagnosis or understands what you're going through or have gone through. And it may be somebody that you have met or a family member that has never experienced this but is that person that you can vent to or is your accountability partner or your meet-for-a-walk or a virtual walk partner. I think we need to be really mindful, be creative about this. It should be enjoyable. It should be something that fits you. And at the end of the day, there's no right way to exercise. I think we'd all do something different here today if we all could choose. And that's okay too. Cancer is very individual, and so is this piece of that. So I think that's really empowering for all of our listeners to remember.

Brielle Gregory Collins: Definitely. And that's so nice to hear, as far as there's no right way to exercise, I think that's a really helpful way of looking at it. Well, thank you both so much for your time today and for sharing your expertise, Dr. Lahijani and Ms. Mansfield. It was so great having you both.

Sami Mansfield: Thank you so much for having us.

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In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in multiple myeloma, breast cancer, and cancer in adults 60 and over that was presented at the 2022 ASCO Annual Meeting, held June 3-7.

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, our guests will discuss new research in multiple myeloma, breast cancer, and cancer in adults 60 and over that was presented at the 2022 ASCO Annual Meeting, held June 3-7.

First, Dr. Sagar Lonial discusses a study on treatment for newly-diagnosed multiple myeloma in people under 65.

Dr. Lonial is a professor of Hematology and Medical Oncology at Winship Cancer Institute at Emory University, where he also serves as Department Chair. He is also the Cancer.Net Associate Editor for Myeloma.

View Dr. Lonial’s disclosures at Cancer.Net.

Dr. Lonial: Hello, I'm Dr. Sagar Lonial from the Winship Cancer Institute of Emory University in Atlanta, Georgia. And today I'm going to discuss one of the Plenary abstracts at ASCO 2022, which was the DETERMINATION study, again, presented at the ASCO Annual Meeting. For the sake of disclosure, I just want to make sure I list that I was an investigator on this study. I also have consulting relationships with Takeda, Celgene, BMS, Janssen, and other companies that have agents in the context of multiple myeloma.

So the reason I want to talk about this study today is I think it's a really important study that was designed over a decade ago to really ask the question, with a really powerful induction regimen that uses what we now call the RVd regimen, lenalidomide with bortezomib and dexamethasone, do you really still need to have high-dose therapy and autologous transplant as part of the treatment approach?

And so the trial was a very simple randomized trial that everybody received RVd induction. And then there was a randomization between early transplant and then going on to consolidation and continuous lenalidomide maintenance versus no transplant going on to consolidation and lenalidomide maintenance. So both arms actually received continuous lenalidomide maintenance, which is really one of the important endpoints of this study overall. And the reason I say that is there was a smaller study done in France a few years previous to this where patients only received 1 to 2 years of lenalidomide maintenance. And in that trial, clearly the use of transplant was better. And the remission duration for the group that received the transplant was about 48 months. So the question was, with continuous lenalidomide maintenance, can you make that longer?

So randomized trial, over 600 patients were randomized between these 2 arms. And the follow-up now is somewhere around 7 years in total. And what was demonstrated both in the ASCO Annual Meeting as well as in the paper that came out at the same time in the New England Journal of Medicine was that the remission duration was clearly longer in the group that had the transplant than the group that did not, even with both arms receiving continuous lenalidomide maintenance. And it was almost 66 months in the group that received the transplant, 21 months longer, almost 2 years longer than the group that did not receive the transplant. And so I think this is really important because what it says is that even in an era of really good induction therapy, transplant continues to offer significant benefit in terms of progression-free survival.

Now, the reason progression-free survival is so important in this study is that we know that no time is more sensitive for treatment of myeloma than that first time we treat the patient. And so prolonging that first remission is really important because the disease is at its most sensitive at that time point. Now, there were questions about overall survival. Should we see an overall survival benefit? And I'll tell you, A, this trial was never designed to measure an overall survival benefit. And, B, the median survival for myeloma patients is now between 10 and 15 years on average. And so with only 7 year follow-up, it seems to me unrealistic to expect this to have a survival benefit at this early time point. So rather than saying there's no difference in overall survival, I think it's a fair statement to say at the short follow-up we have, there is no difference in survival. But I actually don't think survival is the right endpoint for newly diagnosed myeloma trials in fit patients because we do have so many important treatments to discuss.

Now, there was also discussion about adverse events. Obviously, the quality of life during the transplant dropped a little bit. Not a big surprise. That lasted about 2 to 3 weeks, and then quickly, by 3 months out, returned back to baseline for almost every patient in the study. Additionally, there was a concern about second primary malignancies. If you look at this data, it's really no different than what we saw in the French study. There was a slightly higher risk of second primary malignancy, but we know that this is the case not only in myeloma, but in patients who receive alkylate-based therapy. And despite that, the progression-free survival was 2 years longer in the group that received the transplant than the group that did not.

So I think, in summary, this is really an important trial because there are many groups that are making the case that perhaps we don't need transplant in this modern era of myeloma therapy. And I think that it's important to recognize that what we're looking at are not short-term endpoints. We're not looking at early MRD (minimal residual disease) negativity. What we're looking at is really ultimate measurement of clinical benefit, which to me is prolonging that first remission as long as you can. And so this trial clearly demonstrates that for young, fit patients, transplant continues to offer significant benefit, almost 2 years of benefit with continuous lenalidomide maintenance. And while there's a push to say perhaps we can think about which patients may or may not need a transplant, honestly, as clinicians, we're not good enough to make that prediction. And what I think is really important is that we not lose sight of trying to prolong that first remission with the best tools that we have. And I think even in this modern era of 2022, high-dose therapy and autologous transplant continues to be one of those tools, and we want to use it to maximize the duration of that first remission. So thank you again for listening to this brief summary of the DETERMINATION trial presented at the 2022 ASCO Annual Meeting and published in the New England Journal of Medicine.

ASCO: Next, Dr. Norah Lynn Henry discusses new treatment advances for people with metastatic breast cancer, as well as 2 studies in early-stage breast cancer.

Dr. Henry is an Associate Professor in the University of Michigan's Division of Hematology/Oncology in the Department of Internal Medicine and is the Breast Oncology Disease Lead at the Rogel Cancer Center. She is also the Cancer.Net Associate Editor for Breast Cancer.

View Dr. Henry’s disclosures at Cancer.Net.

Dr. Henry: Hi. I'm Dr. Lynn Henry, a breast cancer oncologist from the University of Michigan Rogel Cancer Center. Welcome to this quick summary of updates in breast cancer from the 2022 ASCO Annual Meeting. I have no conflicts of interest for any of the trials that I will talk about. First, I'm going to give a very brief overview of the types of breast cancer, then talk about some research that was presented on both metastatic and early-stage breast cancer. As a reminder, there are multiple kinds of breast cancer. Some breast cancers are called hormone receptor-positive or estrogen receptor-positive and are stimulated to grow by the hormone estrogen. We typically treat those cancers first with antiestrogen treatments, which block estrogen or lower estrogen levels. Other breast cancers are called “HER2 positive.” These are often more aggressive cancers, but because they have extra copies of HER2, they often respond to treatments that block HER2. Finally, there are breast cancers that don't have hormone receptors or very much HER2. These are called triple-negative breast cancer and are also often aggressive cancers.

One of the biggest stories from the ASCO Annual Meeting was the results of the DESTINY-Breast04 trial. In this trial, researchers studied a type of medication called trastuzumab deruxtecan, which is also called Enhertu. This drug is a combination of the anti-HER2 antibody, trastuzumab, plus a chemotherapy drug, and the antibody targets the drug to the cancer sort of like a guided missile. Trastuzumab deruxtecan is currently routinely used to treat patients with metastatic HER2-positive breast cancer. Now, the interesting thing is there was already data from studies that suggested that this drug might also work against breast cancers that have some HER2 receptors on the surface of their cells, but not so many that they meet the true definition of being HER2 positive.

For the DESTINY-04 study, patients' tumors had to have either 1+ or 2+ HER2, which some people called “HER2 low,” and could be either estrogen receptor positive or negative. Two thirds of the patients were treated with trastuzumab deruxtecan, and the other one-third were treated with 1 of 4 different standard chemo regimens that their physician thought was the best treatment option for them. Treatment with trastuzumab deruxtecan was shown to lengthen the time people were able to remain on treatment. Importantly, it was also shown to increase the overall survival of patients compared to standard chemotherapy by more than 6 months for patients with estrogen receptor-positive cancer and by more than 10 months for patients with estrogen receptor-negative cancer. Since this is a drug that we currently use to treat patients with other types of cancer, we actually know a lot about its side effects. One key toxicity is it can cause a very severe inflammation of the lungs in a very small subset of patients. So this is something that we have to watch for very carefully. Otherwise, it is a relatively well-tolerated drug, especially compared to standard chemotherapy. The main side effects are nausea and fatigue.

Another clinical trial presented at ASCO called TROPiCS-02 also studied a drug that is currently used to treat a different type of breast cancer. In this case, the drug is sacituzumab govitecan, also called Trodelvy. It is also a combination of an antibody that is targeted against cancer cells plus a chemotherapy drug. Sacituzumab govitecan is currently approved to treat metastatic triple-negative breast cancer.

In the TROPiCS-02 trial, however, it was tested to see how effective it is for treating hormone receptor-positive, HER2-negative metastatic breast cancer. All of the patients enrolled in this trial had already been treated with antihormone therapy medications as well as at least 2 chemotherapy regimens. Half of the patients were randomized to treatment with sacituzumab govitecan, and the other half were treated with 1 of 4 standard chemotherapy drugs that their physician thought was the best for them. Those patients who were treated with sacituzumab govitecan had a longer time on average that the treatment worked compared to those who received standard chemo. They also had improved quality of life based on responses that the participants themselves provided on questionnaires. Although the overall benefit was rather modest, this drug may represent a new treatment option for patients with hormone receptor-positive, HER2-negative metastatic breast cancer, although at this time it isn't yet approved for treatment of this type of breast cancer. Both of these are examples of being able to take drugs that have been shown to treat 1 type of cancer and potentially expand it so that they can be used to benefit more patients with breast cancer. These drugs are also being tested to see if they are beneficial for treating early-stage breast cancer. So we await more hopefully very exciting results in the future.

To switch gears a little bit, I'll now talk about another study I found interesting. This one is in the setting of early-stage breast cancer. So typically, radiation therapy is recommended after lumpectomy since it reduces the likelihood of cancer returning in the breast. However, questions have arisen about how much benefit radiation is actually providing for some patients whose risk of having cancer return in the breast is really low to start with. Therefore, these patients may be at risk of the side effects of radiation as well as other risks, such as financial problems, without actually getting much benefit from the treatment.

Therefore, this trial, called LUMINA, evaluated whether radiation therapy was beneficial after lumpectomy for patients who have small, low-risk breast cancers and no lymph node involvement. The trial included 500 women who were at least 55 years of age with invasive ductal cancers that were no more than 2 centimeters in size. They had to be estrogen receptor-positive, HER2-negative, either grade 1 or 2, and Ki-67 low. Everyone had to be planning to take antihormone therapy for at least 5 years. During the 5-year follow-up period, a total of 10 patients out of 500, about 2.3% of all patients, had their cancer return in the breast. The researchers therefore concluded that for patients with this type of very low-risk breast cancer, it is reasonable to omit radiation therapy and just take endocrine therapy. Similar results have previously been shown for patients over the age of 70 with small lymph node-negative low-risk cancers, but this trial expands that option to patients who are as young as 55.

Finally, I will touch briefly on the updated results from the ABCSG-18 clinical trial. So this trial enrolled postmenopausal women with early-stage estrogen receptor-positive breast cancer who are being treated with aromatase inhibitor therapy. Aromatase inhibitors are known to cause reductions in bone density. This trial therefore evaluated a medication called denosumab, also called Prolia, which is used to treat osteoporosis. Participants were randomized to treatment every 6 months with either denosumab or a placebo. They found that the patients who were treated with denosumab were half as likely to have a bone fracture. Importantly, patients treated with denosumab also had an improvement in bone density despite taking the aromatase inhibitor medicine, whereas those who received placebo had a decrease in their bone density over time.

The other very interesting thing from this study is that patients who received treatment with denosumab were less likely to have their breast cancer return or to develop a new cancer during the 8-year follow-up period. So it's actually already recommended that postmenopausal patients with all types of early-stage breast cancer consider treatment with a different type of bone strengthening medicine called a bisphosphonate as part of their breast cancer treatment. The goal is to further reduce their risk of cancer returning. These new results will now lead experts to debate whether to also include denosumab as a potential additional breast cancer treatment option, not just to help protect people's bone density.

There were a lot of other research findings presented that were related to treatment for both early-stage and metastatic breast cancer at the meeting. Importantly, we got glimpses of the many new drugs on the horizon for treatment of breast cancer, and we eagerly await the results of large, randomized trials so that the drugs that work can be used to care for patients with breast cancer. But for now, that's it for this quick summary of important research from the 2022 ASCO Annual Meeting. Stay tuned to Cancer.Net for future updates from upcoming breast cancer conferences. Thank you.

ASCO: Thank you, Dr. Henry.

Finally, Dr. Shakira Grant discusses 3 studies that looked at cancer in people 60 or older. This field is also known as geriatric oncology.

Dr. Grant is an Assistant Professor in the Divisions of Hematology and Geriatric Medicine at the University of North Carolina at Chapel Hill and a board-certified Geriatric Hematologist/Oncologist.

View Dr. Grant’s disclosures at Cancer.Net.

Dr. Grant: Hi, everyone. I am Dr. Shakira Grant. And I'm an assistant professor at the University of North Carolina at Chapel Hill. I'm also a clinician scientist with a focus on social disparities and how they influence the health and aging of older adults with cancer, primarily multiple myeloma. And for today's talk, I have no relevant conflicts of interest to disclose.

It's such a pleasure to be able to talk today about the ASCO 2022 geriatric oncology and presenting key studies, which I believe were really practice-changing or really set up the foundation for informing future research directions. And to start us off, I wanted to start us with abstract 12012 by Dr. Mackenzie Fowler. And this was presented based on the University of Alabama at Birmingham's actual research group. And the title of their presentation was “Rural-Urban Disparities in Geriatric Assessment Impairments and Mortality Among Older Adults with Cancer.” And this was the result of a large registry study, predominantly patients with gastrointestinal cancer-- so cancers such as liver cancer, colon cancer. And what the authors really wanted to do here was to explore if whether or not living in a rural location, for example, is associated with having an impairment based on what people report in their ability to function at home, their quality of life. And they also wanted to see whether or not where you live, meaning a rural location, whether that can be associated with how long you are expected to live or your overall survival.

So this was really a study that took patients who were truly older. There were patients who were above the age of 60. As I mentioned, these were patients predominantly with cancers of the liver, the colon, and the pancreas. And patients completed a baseline, what we call a geriatric assessment, to try to assess their overall or global health. And on these assessments, patients are asked questions about how they would rate their physical function and their quality of life. And what the authors found here is that in general, when patients lived in rural areas, this was associated with patients self-reporting more functional deficits, meaning that they reported that they had impairments in the ability to function at home from a physical perspective. They also had impairments in quality of life—so how you rate your general life and how you're doing from a day-to-day basis. And this was impaired if you lived in a rural residence. And then, importantly, this study also showed that living in a rural location—and, again, this study was centered in Alabama—that that was also associated with a reduced overall survival, meaning that people were found in rural areas to live a shorter life with these cancers compared to those who live in non-rural places or, as we call it, urban.

And I think why I chose this particular study is because it's one of the first studies using a large data set of almost 1,000 patients that they have enrolled and really looking at the idea of the physical environment, so where a person lives, and how that really interacts with everything else to influence the health of an individual. And this study, I believe, really lays the foundation for an area of work in geriatric oncology where we are moving away from just thinking about the older adult, but we're also thinking about the older adult and the other identities. So we're really considering the sociocultural influence. So we think about race. We think about socioeconomic status, income. But now, we're also including the physical environment. And that is where people are living and spending the majority of their time. And that is in this study classified as rural-urban residency. So for this study, overall, I would say that this is really moving the field forward in a direction where we're moving away from just looking at just older adults, but we're thinking about older adults and all of the other stressors that they face, especially when they live in the community and how that impacts their health.

The next study that I wanted to highlight was a study that was performed by Dr. Heidi Klepin at Atrium Health, Wake Forest Baptist. And this was a study that looked at evaluating the association between an electronic health record-embedded frailty measure and survival among patients with cancer. Again, this was an older adult population. It was just over 500 patients involved, and patients were over the age of 65. They had a new diagnosis of the most common cancers, which are lung cancer, colon cancer, and breast cancer. And the good thing about this particular study is that it sought to use data that is readily captured in the electronic health record to characterize a patient as fit, prefrail, and frail. So why is that important for the geriatric oncology community and even beyond is when we're dealing with older adults, we're always thinking about ways in which we can actually characterize their fitness and their ability to hence tolerate their therapies, being chemotherapy, and how likely they are to die if they're having these functional impairments.

And so importantly, what this study showed was that in their sample, they found that up to 17% of people were characterized as frail using this index. And the significance of this finding is that when they looked at how long people were likely to live with these cancers, breaking it down according to if you were fit, prefrail, or frail, those who were frail had the shortest overall survival. So it means the time from which they were diagnosed until they die was much shorter than any of the other categories. And that equated to a difference between those who were fit and those who were prefrail of 10 months for those who were frail for overall survival and more than 54 months for those who were actually considered to be fit. So this is really, really important because what we are seeing is that if you are really fit, you are living on average with these cancers—the overall survival, at least for their institution, was more than 54 months. But then as you move across that spectrum of fitness, we're actually seeing that your survival decreases significantly.

And so why is this important? So this is important because it's one of the first studies that is actually looking to operationalize the frailty measure for us to be able to potentially use and adapt into other health systems using data that we already collect. So it's no longer burdensome on patients to try to fill out additional forms or for other staff to be involved and collect this data. And this data is showing us that there is an association with this particular frailty index and the ability to predict overall survival-- so, again, a critical study in the geriatric oncology population looking at patients with the 3 most common types of cancer, which are lung cancer, colon cancer, and breast cancer, and really showing us that there is a way potentially to operationalize how we characterize the fitness level of an older adult and then using that data not just to say, "Yes, this person is frail," but for us in real-time to see results where we can see that there is a significant difference in terms of overall survival.

Importantly, this is going to be a study where we continue to watch closely the developments over the next few years, especially as the authors and the research team note that their next steps involve looking at how to study how these frailty measures, or the frailty scores that people get when they come in and they're at baseline, how this changes throughout the course of treatment. And that has a lot of implications because now, we have the potential to start thinking about using a frailty-adapted approach to caring for older adults with cancer. What that means is when you're getting your treatment and we are following these scores, as we see things changing, this may be an indicator to us that, "Hey, we need to make some modifications in response to these frailty measures to make sure that our older adult population is able to tolerate their chemotherapies and have maximum benefit while also enjoying a good quality of life."

So finally, I want to highlight this third study. And this was a study that was presented by Dr. Etienne Brain. And. Dr. Etienne Brain was also this year's B.J. Kennedy Award recipient. And each year ASCO recognizes the B.J. Kennedy Award recipient as an outstanding investigator who has made significant contributions in the area of research and clinical care of older adults with cancer. In this particular study, Dr. Etienne presented on behalf of his team the final results from a study that was looking at using endocrine therapy with or without chemotherapy for older adult women, so characterized as those who were over the age of 70, with a diagnosis of estrogen receptor-positive, HER2-negative breast cancer. And the importance for this study is that the question they sought to examine was whether or not patients who are in this age range still derive a benefit from receiving chemotherapy in addition to endocrine therapy.

And what this study really showed is that there was no survival difference. Meaning when they looked at the data for 4 years, those who got chemotherapy plus endocrine therapy lived just as long as those who also just got endocrine therapy alone. And why this is important is because when you think about giving chemotherapy to an older adult population, as oncologists, we are always weighing the risks and the benefits associated with treatment. So we're always thinking about how tolerable is this drug likely to be? We want to minimize side effects because, at the end of the day, our goal is to treat the cancer, but we also want to focus in on the outcomes that matter most to the older adult population. And in general, these are things like maintaining your mobility, maintaining your mentation, maintaining good quality of life. And so we really want to make sure that we're balancing those risks. And this is why this particular study showing that with chemotherapy or without chemotherapy added to endocrine therapy, there seems to be no survival difference. This could be a way in which we move the field forward in thinking about a select group of patients with breast cancer and whether or not those patients truly need that extra toxicity or burden associated with using chemotherapy or whether endocrine therapy is enough.

So with that, I will say across these 3 studies, even though they study different things-- we saw 1 study that looked at the intersectionality between older adults in terms of their chronological age but now starting to examine the influence of physical or social context and how that influences the health and outcomes for individuals with primarily gastrointestinal cancer. We also looked at the development of an electronic frailty index in patients with 3 most common solid tumors - lung cancer, colon, and breast cancer - and found that by using this frailty index collecting readily available data, that there was an association with predicting overall survival. And we saw that those who were characterized as frail had one of the shortest overall survivals. And then finally, in this study, looking at endocrine therapy alone versus chemotherapy and endocrine therapy, we saw that there was no survival difference again in an older adult population. And so what we are seeing here is a theme emerging as the importance of comprehensive evaluations of older adults and the importance also of these measures, when integrated across the research continuum, that they are useful in terms of predictive prognostic abilities and really lay the foundation for future research. So with that, I want to thank you for your time and thank you for listening.

ASCO: Thank you, Dr. Grant.

You can find more research from recent scientific meetings at www.cancer.net.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.

Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

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As a response to the COVID-19 pandemic, Cancer.Net developed several resources for people with cancer, including its post “Coronavirus and COVID-19: What People With Cancer Need to Know,” written by Dr. Merry Jennifer Markham. After publishing this post on March 3, 2020, Dr. Markham reviewed and updated the post for 650 days straight to make sure people with cancer were receiving the most up-to-date and relevant information about COVID-19. In this podcast, ASCO’s Chief Medical Officer, Dr. Julie Gralow talks with Dr. Markham about her role in creating information for people with cancer throughout the pandemic, how the pandemic has shifted her perspective, and where she sees the future of the pandemic response headed. 

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

The beginning of the COVID-19 pandemic brought with it confusion, fear, and uncertainty for most people around the globe. These feelings were often heightened for people with cancer as they experienced disruptions or changes in care, such as following greater safety precautions at their treatment centers, having their appointments shifted to televisits, and facing delays in recommended cancer screenings.

As a response to the COVID-19 pandemic, Cancer.Net developed several resources for people with cancer, including its post “Coronavirus and COVID-19: What People With Cancer Need to Know,” written by Dr. Merry Jennifer Markham. After publishing this post on March 3, 2020, Dr. Markham reviewed and updated the post for 650 days straight to make sure people with cancer were receiving the most up-to-date and relevant information about COVID-19. The post went on to receive the Award of Distinction from the eHealthcare Awards in the Best COVID-19 Pandemic Related Communications category and was translated into Spanish, Portuguese, Russian, and Arabic.

In this podcast, ASCO’s Chief Medical Officer, Dr. Julie Gralow talks with Dr. Markham about her role in creating information for people with cancer throughout the pandemic, how the pandemic has shifted her perspective, and where she sees the future of the pandemic response headed.

Dr. Gralow: Hello. I'm Dr. Julie Gralow, ASCO's Chief Medical Officer. Today, I'm talking with Dr. Merry Jennifer Markham, an ASCO volunteer and the Cancer.Net Associate Editor for Gynecologic Cancers. Cancer.Net is the patient information website of ASCO. Dr. Markham is also chief of the University of Florida, Division of Hematology and Oncology, a clinical professor in the University of Florida College of Medicine, and the associate director for medical affairs at the University of Florida Health Cancer Center.

Dr. Markham played a key role in ensuring that ASCO provides up-to-date information about COVID-19 for patients, survivors, and caregivers through Cancer.Net. Since March 2020, she devoted a remarkable amount of time and energy to this endeavor, including a stretch of 650 straight days of reviewing and updating our patient information about coronavirus. Wow. That's true dedication, Merry Jennifer. So I would like to kick it off to you, Merry Jennifer. First of all, thank you so much for everything you've done during these past couple of years in keeping our Cancer.Net website up to date for patients during these incredibly challenging times. I'm looking forward to having a conversation with you about all of this.

Dr. Markham: Thank you so much. It's been an honor and a pleasure. And the Cancer.Net team has been just fantastic to work with.

Dr. Gralow: Great. Glad to hear it. So Merry Jennifer, when you suggested that ASCO provide some patient-focused content on COVID and cancer, did you think we'd still be talking about this 2 years later?

Dr. Markham: Oh, I had no idea what to expect. No. I think I, like many of us, thought that this would be a very time-limited event and maybe by the Christmas time of 2020, that we would be done. We were all, of course, disappointed to learn that that was not how a pandemic plays out, but I definitely had no idea what my one email to the group would lead to.

Dr. Gralow: What do you remember about March of 2020?

Dr. Markham: It was a really scary time and a very uncertain time. None of us really knew what was going to come. We were watching how the pandemic or just the viral infection was playing out at the time in other countries, but really, we're not sure what was going to happen to our patients. And I was coming off a stint, I believe - the timing is a bit of a blur - on the communications committee for ASCO. And communications is something that I am passionate about, cancer communication with patients and with other colleagues. And I recall being in clinic and answering questions from patients. And really, it felt like there needed to be some broader level of communication that our patients could refer to you but also colleagues and people around the world. That's what I remember. And I remember reaching out and saying, "Hey, I wonder if maybe ASCO should do something." I didn't intend to volunteer myself to do something, but somebody needed to jump in, and I was ready.

Dr. Gralow: Well, I was still practicing at the time, and I know all the different questions that we were getting. It was such a confusing time. We didn't have information. It was changing on a daily basis. I'm impressed that you thought that we were going to be dealing with this maybe even until the end of 2020 because I was thinking, "Oh, 3 or 4 weeks. We can all quarantine for 3 or 4 weeks. Right?" And here we are more than 2 years later. So you worked on the content for 650 days straight. I mean, every single day for 650 days, you looked to make sure that what we had on there was accurate, and now we backed off a little. But you're still looking at the content a couple of times a week. How has that level of focus on COVID-19 affected your perception and experience of the pandemic?

Dr. Markham In the very beginning, the content was really updated daily. I think something was changing on a daily basis. And so it became part of my morning habit, first thing in the morning with a cup of coffee if I had time for that, to read whatever was happening in the news that day and just paying attention to where we were headed, knowing that there would be changes. In the beginning, there was not enough masks, so we weren't recommending everyone “Go out and buy surgical masks." And then the policies changed on that as we had plenty of masks and then, of course, vaccines and so on and so forth.

I think I felt, like many people, a loss of control when the pandemic happened. Right? I think that so many people felt the sense of loss and the sense of uncertainty. And it reminded me actually of what patients with cancer probably experience with a new diagnosis, the sense of loss and uncertainty for what the future holds. And I think like many of my patients who really want to dive in deep to the research of their own cancer and treatment course, it actually gave me a sense of comfort to delve deep into the facts of what we were learning on a daily basis about COVID. Having that knowledge at my fingertips and being able to put it into layman's terms really did help me, I think, not become emotionally tied up in all of the sadness of the pandemic and the loss of travel and the loss of being able to be with loved ones. So for me, it was a little bit of a coping mechanism, I think. I didn't realize that at the time, but in hindsight, I really think it was.

Dr. Gralow: So becoming a true expert in COVID and cancer was your coping mechanism. That's interesting because you were the leading authority here on what everyone was recommending. Do you have any particular moments, good or bad, that really stand out for you from those early days?

Dr. Markham: I think what stands out the most is we focus so much on science as practitioners of oncology and in these health professions and as scientists. And I remember being very disappointed and hurt whenever I encountered someone, whether it was a patient or a family member or a colleague or-- not colleague but acquaintance, perhaps, who didn't believe that this was a real thing. And I was really pouring my heart and soul into the work of providing patient education on this and trying to do the same in my own clinic and with my own family members. And to have people brush it off as a non-thing, it was hurtful, and it was also just very disappointing as a physician and scientist.

Dr. Gralow: And things were changing fast. Now, you yourself ended up with a COVID diagnosis at the end of 2021. Did that personal experience change the way you viewed ASCO's roles in supporting people with cancer throughout the pandemic?

Dr. Markham: So I was minimally symptomatic, which was really thanks to science and thanks to the vaccines and having boosters. So number 1, it was very mild. But like many people who have a diagnosis that's new to them, I was nervous. And so I did feel reassured, though, because I had a pretty good understanding of what was happening and what was going to happen, and I knew that I was protected because of the vaccine and boosters. But it can be a scary time, and I think that it just gave me a little more insight into what people who I've taken care of, who have cancer and then have experienced a COVID diagnosis, have felt. Unlike my patients with cancer, I'm not immunocompromised, so I felt pretty comfortable. But it can certainly be scary. And I did have that appreciation for-- not just the infection but having to isolate myself from my family, I think that really was the hardest part and the inconvenience of it.

Dr. Gralow: Well, I'm glad you just had a mild case, and hopefully, you have no residual symptoms. But it is interesting when you have, either within your family or yourself, a personal confrontation, either with COVID or with cancer, that it gives you a different perspective.

Dr. Markham: Absolutely. That is so true.

Dr. Gralow: So we're now 2-plus years into the pandemic. I know you don't have a crystal ball, and I know we've thought we were on the downswing and things picked up again. But where do you see this going? I mean, not just COVID itself but public health, immunizations, the whole pandemic awareness. Where do you see this going in the U.S. and worldwide? We've had the flu coming around every season. We didn't wear masks. We have vaccines. Not everybody got vaccines. What are we going to learn from all of this, and where do you see the future will be?

Dr. Markham: I think that one of the major learning experiences that all of us who are in medicine and health care and those in health communication and health policy-- what we have learned is that science communication really does matter, and it's hard to do it in a very rapid-fire pace and do it well. But I think we've all seen examples of how communication around factual data and removing misinformation is actually critical. I would love to see this pandemic go away, but I think that what we've seen over the last couple of years with the new variants coming out, it's clear that we're not going to have 99% of our population vaccinated. I think, really, on all fronts, vaccination uptake is not that high. So there will be people who are either unable or unwilling or who will defer getting vaccinated. And unfortunately, this will lead to these waves of new variants coming like the current variant that is circulating. But I do think that there is hope.

One of the reasons that a lot of my patients delayed getting vaccines in the beginning-- many of mine did, but there were some holdouts who really were not comfortable getting vaccinated. There is now more time. And so we do have more safety data, and we know that the vaccinations are safe against-- the COVID vaccinations are safe. So I think that I have seen more patients in those last 6 months become vaccinated. They were holdouts initially, and now more are doing it. And I'm hopeful that this trend will continue. I do think there are pockets where we are seeing vaccination rates start to pick up again. I don't know. I'm happy to keep reviewing content, though, and updating. The updates have become a little less frequent, which is great. I love when our focus on updating is really on new therapies and new vaccines and new vaccine sequences and schedules. So I think we're in a fairly stable place - knock on wood - right now.

Dr. Gralow: In our immunocompromised population, which is only a subset of all of our patients with cancer, do you think we'll see more mask wearing in the future?

Dr. Markham: I do. I do think that actually this is one area where we, as a culture, have probably begun to shift in the United States and especially among people who have a personal risk or a family member with a risk factor that might increase their chances of severe COVID. Just a personal anecdote. I traveled internationally for the first time since COVID a couple of weeks ago, and my entire family, all vaccinated and boosted, wore our masks, as it's the federal requirement to do so on planes. However, we landed in an international location where that was not a requirement. None of us wanted to take our masks off. We felt more comfortable, and I saw a lot of people who also remained masked even though it was not a requirement. So I do think there's a shift in this culture. I'm as tired of the masks as anyone, but it really does have a protective measure and is, I think, important, especially for our patients who have a weakened immune system or other medical risk factors for developing COVID or other infectious diseases.

Dr. Gralow: So kind of in closing, you did such tremendous work for ASCO, for our patients with these regular updates. But what's the experience meant to you as an ASCO member and a member of the oncology community?

Dr. Markham: I joined ASCO when I was a fellow, and I was taught the importance of our organization by my faculty members and my mentors. And as soon as I realized I could, I volunteered to serve on ASCO committees and task forces. And it has been one of the most rewarding parts of my career. And it's something that I encourage junior faculty and fellows to do as well. ASCO is such a leading voice. It is the leading voice for oncology care globally. And just the opportunity to contribute something back has really meant the world to me. It's been an honor to be able to do this work.

Dr. Gralow: Well, on behalf of ASCO, I want to thank you again for all of your commitment to this. We're thrilled to have you as a volunteer, and we will continue to call on you as a volunteer. Really appreciate that. And I do know that throughout the COVID-19 pandemic, a lot of what ASCO was posting, a lot of the webinars we had, etc., were being used around the world. And you contributed majorly to that as well. So for that, I thank you. And I thank all of our listeners. This has been Julie Gralow and Merry Jennifer Markham talking about our Cancer.Net COVID-19 information that Merry Jennifer tirelessly led daily, essentially, for a couple of years. So thank you so much for that. It's been great talking to you.

Dr. Markham: Thank you.

ASCO: Thank you, Dr. Gralow and Dr. Markham. Find all of Cancer.Net’s resources on COVID-19 and cancer at www.cancer.net/covid19.

Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care.

And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology.

Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.

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ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests’ statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses.

In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, 4 Cancer.Net Specialty Editors discuss new research in prostate, bladder, kidney, and testicular cancers presented at the 2022 Genitourinary Cancers Symposium and 2022 ASCO Annual Meeting.

This episode has been adapted from the recording of a live Cancer.Net webinar held June 15th, 2022, led by Dr. Neeraj Agarwal, Dr. Timothy Gilligan, Dr. Petros Grivas, and Dr. Tian Zhang.

Dr. Agarwal directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah.

Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig (TOSS-ig) Cancer Center.

Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine. He is also an associate member of the clinical research division at the Fred Hutchinson Cancer Research Center.

Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center.

Full disclosures for Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang are available at Cancer.Net.

Greg Guthrie: Good afternoon, everyone. I'm Greg Guthrie, and I'm a member of the Cancer.Net content team. I'll be your host for today's Research Round Up webinar focusing on cancers of the genitourinary tract. Cancer.Net is the patient information website of the American Society of Clinical Oncology, known as ASCO. So today, we'll be addressing research from 2 2022 scientific meetings, the ASCO Annual Meeting held in Chicago in June and the Genitourinary Cancers Symposium held in San Francisco in February. Our participants today are all Specialty Editors of the Cancer.Net Editorial Board, and they are Dr. Neeraj Agarwal of the Huntsman Cancer Institute in University of Utah, Dr. Timothy Gilligan of the Cleveland Clinic Taussig Cancer Center, Dr. Petros Grivas of the Fred Hutchinson Cancer Research Center and University of Washington, and Dr. Tian Zhang of the University of Texas Southwestern Medical Center. Thank you, everyone, for joining us today. So starting us off today is Dr. Agarwal who will be talking about research in prostate cancer. Go ahead, Dr. Agarwal.

Dr. Agarwal: Hi. Thank you, Greg. So I'd like to start with 2 studies. They both are in prostate cancer which will be followed by my colleagues presenting studies in other cancers in bladder cancer and kidney cancer. So I’ll start with this abstract, which was highly discussed by the doctors at the ASCO Annual Meeting a few weeks ago, and it has a lot of relevance in our practice. So this is abstract #5000 presented by Dr. Michael Hofman, and this was the update on a clinical trial which compared lutetium PSMA-617, or lutetium PSMA, to put it simply, with cabazitaxel in patients with metastatic castration-resistant prostate cancer who had disease progression after receiving docetaxel chemotherapy.

So, who were the patients who were enrolled on the study? These patients had, as I said, metastatic castration-resistant prostate cancer, who had disease progression after docetaxel chemotherapy, and who had to have high PSMA-expressing prostate cancer. And the way they assessed the presence of high PSMA expression was by using a specialized kind of PET scan known as Gallium 68 PSMA-11 PET scan. In addition, they made sure that these patients do not have another type of prostate cancer, also call it dedifferentiated prostate cancer, by making sure that those patients did not have a traditional PET scan-positive disease.

So this was a highly selected patient population who were expressing PSMA on their prostate cancer. Prior to this presentation, the earlier presentation had shown that lutetium PSMA was superior to cabazitaxel as far as progression-free survival is concerned and also was associated with lower incidence of grade 3 or 4 side effects. In this update, after a longer follow-up of 3 years, Dr. Hofman and Dr. Davis, who is a senior author, they presented the data on overall survival, which was a secondary analysis, and overall survival was similar with cabazitaxel as well as lutetium PSMA in the range of 19 months. We did not see any new safety signal.

So, what does it mean for us? What does this mean for our patients? My key takeaway message here is, lutetium PSMA is a suitable option for men with metastatic castrate-resistant prostate cancer who are expressing high PSMA on their prostate cancer after they had sustained disease progression after docetaxel. However, cabazitaxel is also a valid option in this setting. I would like to add my own view in addition to this because lutetium PSMA was better tolerated and was also associated with better progression-free survival. In my patients who are progressing on docetaxel chemotherapy, I would like to use lutetium PSMA first followed by cabazitaxel chemotherapy. So that would be my key takeaway from this abstract. Now we can move to the next abstract.

This was also an update, a much longer update, on ENZAMET trial. If you recall, ENZAMET trial was one of those trials which established that deeper androgen blockade, or deeper androgen signaling inhibitors such as enzalutamide, apalutamide, or abiraterone, these trials were conducted in 2015 onwards, and all these trials showed that upfront using deeper androgen signaling inhibitors at the time of metastatic hormone-sensitive prostate cancer onset improved survival. So ENZAMET trial used enzalutamide, and it showed in the first analysis, which was presented by Dr. Davis and Dr. Sweeney in the 2019 ASCO Meeting Plenary session, that adding enzalutamide to androgen-deprivation therapy in patients with metastatic hormone-sensitive prostate cancer significantly improved survival. In this longer follow-up of 68 months, so we are talking about almost 6 years of follow-up, now, these investigators from ENZAMET trial, as presented by Dr. Davis, showed that the combination of enzalutamide with androgen deprivation therapy or testosterone suppression therapy continues to significantly improve survival in patients with newly diagnosed hormone-sensitive prostate cancer or metastatic prostate cancer. One interesting part of this unique aspect of this trial was that patients were allowed to receive docetaxel chemotherapy concurrently to the protocol treatment. And in this trial, 45% patients actually receive docetaxel chemotherapy. So 503 patients exactly out of 1,000-plus patients. So if you look at the subgroup analysis of those patients who received docetaxel chemotherapy, enzalutamide does not seem to benefit those patients from the overall survival perspective.

So on the face of it, it looks like enzalutamide is not helping those patients who are receiving docetaxel concurrently. But there are some caveats with that kind of subgroup analysis. The first one is this is not a randomized assignment of docetaxel chemotherapy. Patients were determined to have docetaxel chemotherapy after discussion with their respective oncologist. This was not a prespecified analysis that so many patients with docetaxel will receive enzalutamide. Also, this was not a randomized assignment of docetaxel. And third, that I don't think this trial had enough power to look for that subgroup analysis.

So my take on this trial is that updated results from this trial, almost 6 years of follow-up now show that enzalutamide continues to improve overall survival with a 30% reduction in risk of death in patients with metastatic castration-sensitive or hormone-sensitive prostate cancer. Furthermore, the effect of enzalutamide, in my view, on overall survival is independent of the receipt of docetaxel. If you look at the whole trial population for which the trial was covered for, enzalutamide improved survival for all patients. And based on these results, I feel more confident in saying that upfront intensification of treatment with deeper androgen inhibition remains a standard of care for our patients with metastatic hormone-sensitive prostate cancer and should be offered to all eligible patients with this condition. With that, I would like to wrap up the prostate cancer abstracts. Thank you very much.

Greg Guthrie: And thank you, Dr. Agarwal. Next up, we will have Dr. Gilligan, who is going to be discussing testicular cancer.

Dr. Gilligan: Thank you very much. So I have 2 studies I want to talk about and then just give a headline of some interesting things that I think are kind of coming down the road. Both of these abstracts have to do with improvement over time in specific patient populations we used to worry about. I'm not saying we don't worry about them anymore, but things are looking better now than they had 1 or 2 decades ago. So the first topic addresses late relapses in testicular cancer. And historically, we have been concerned that these patients did worse and had worse outcomes. And late relapse could variously be described as after 2 years or after 5 years. In the current study, they defined late relapse as being after 2 years and very late relapse as being after 5 years. And what was special about the study was that it captured the entire population of patients with testis cancer in Norway and Sweden so that it wasn't based on a center of excellence that gets selective referrals. It was actually a population-based study. And the key conclusion of the study was one I found, once again, that late relapses are rare. So for stage I patients, 2% of patients will relapse after 2 years, 1% after 5 years, and 0.5%, so 5 out of 1,000 patients, after 10 years. So if you're 2 years out, the likelihood of a relapse is quite low.

And if you're 5 years out, it's half of that. In patients with metastatic disease, similarly, 3.6% relapse after 2 years, 1.6% after 5, and 0.8% after 10 years. And what was interesting to me was that if you looked at the more recent patients who were diagnosed after 1995 - I know that doesn't sound very recent, but they had even earlier patients also in the study - the very late relapse rate almost resolved and went away. It went from 2.2% all the way down to 0.8%. So I think with modern imaging, modern care patterns, we're seeing less of this than we used to. But overall, patients were doing better even if they do relapse late.

One thing that was interesting in the study to me also was for stage I disease, we typically recommend surveillance rather than active treatment. So active treatment with non-seminomas would be a retroperitoneal lymph node dissection or more surgery or chemotherapy. With seminoma, it would usually be chemotherapy or radiation, although surgery is being investigated there now. And they did find that in men who chose surveillance, which we still recommend, the late relapse rate was a little bit higher, but it was still affecting a small percent of patients. So the relapse rate beyond 2 years was 4% rather than 1%, but out of 4,000 patients, there were only 3 deaths from late relapse. So this isn't changing the recommendation for surveillance, but it is an alert that patients who are on surveillance for stage I disease have a slightly higher risk of late relapse and that may affect how we follow them and specifically how long we follow them. One of the things that was interesting in the study is in the United States, we often stop scans at 5 years, but in the SWENOTECA countries, they continue scans all the way out to 10 years. I don't know that U.S. guidelines are going to change, but it was a provocative finding.

The key thing, as I alluded to at the beginning, was that 61% of patients with late relapse were alive 10 years later, and while we would like that number to be higher, it used to be around 50% in older studies. So it's a significant improvement from where we were before. A particularly interesting thing to me was that patients relapsing 2 to 5 years out actually had the best prognosis. Patients who relapsed in years 1 to 2 had a worse prognosis and patients relapsing after 5 years had a worse prognosis, whereas the patients relapsing 2 to 5 years had a better prognosis. In the end, I think what this means for us is that patients are doing better. It's not going to really change our treatment patterns, but it's reassuring that we shouldn't be pessimistic about late relapses, and we still have a solid chance of curing them. So again, bottom line, most men with late relapse is cured and late relapse is less common now than it was earlier, particularly in non-seminomas.

Let's go to the next study. So this is a different group of patients who had a particularly ominous prognosis historically and still we have a lot of room for improvement. These are patients with non-seminomas that start in the mediastinum. So in the chest, under the breastbone, under the sternum typically. And patients are treated aggressively upfront, they are considered poor risk at the initial time of diagnosis, and they're treated aggressively at the time with 4 cycles of BEP or 4 cycles of VIP chemotherapy. And then they go for surgery to remove any residual disease. And the hope is they're cured at that point because historically, if there was a relapse after chemotherapy and surgery, it was almost impossible to cure them. Indiana University published their results using high-dose chemotherapy in this population, and they reported that 30% of men who were treated with high-dose chemotherapy had no evidence of cancer after 2 years, and 35% were still alive.

Obviously, we need longer follow-up, but most of the relapses you're going to see are going to be in the first 2 years. So while again, there is significant room for improvement here, this indicates that high-dose chemotherapy is a good option, and that has been a question. So this is reassuring in that regard. But it is a good option for men with relapsed mediastinal non-seminomas of the germ cell tumors. So there's hope there where in the past, this has felt a little bit helpless.

The thing I wanted to also highlight was that there are 3 things I think are going to be interesting to keep an eye on over the next year. One is the use of surgery for early-stage seminomas. There are a number of papers out about that. I still think this is an investigational approach, and so I didn't want to go into great detail about it, but it is looking like that RPLND, or retroperitoneal lymph node dissection, will likely or may be an option for stage I and stage II seminoma in the future. We are getting more evidence for that. It's not quite as promising as we had hoped until there's more data that's needed, but it's looking like that will become an option. So for men with early-stage seminoma, at least raising the question whether surgery is an alternative to chemotherapy or radiation, is an important discussion to have with your oncologist.

Secondly, MRI rather than CT scans for surveillance. So to keep an eye on men who have been treated or men who are just stage I and are being followed and typically come in routinely for CT scans, which expose people to ionizing radiation, which theoretically has a risk of causing cancer, there's more and more data that MRI is just as good as CT, and MRI does not use ionizing radiation. So there's probably going to be an expanding role for MRI as an alternative to CT scans.

And lastly, the use of microRNA rather than just depending on serum tumor markers. So right now, we use the blood tests alpha-fetoprotein, beta hCG, extensively to monitor for relapse, and there's more and more evidence for using what we call microRNAs instead. It may be more accurate in multiple different settings. So it'll be interesting to see how that evolves and that's what I wanted to cover today. Thank you very much.

Greg Guthrie: Thank you, Dr. Gilligan. And now we have Dr. Grivas, who's going to discuss some research in bladder cancer.

Dr. Grivas: Thank you so much, Greg, and thanks Cancer.Net for the great opportunity to discuss this for our patients. We're very excited about the data from the ASCO Annual Meeting, and I would encourage the audience to review as possible other presentations as well. I'm going to cover 3 highlights. I'm going to start with the QUILT-3.032 study. This trial reported the final results of a clinical trial that took place in different centers and involved patients with what we used to call “superficial bladder cancer.” And the modern term is “non-muscle-invasive bladder cancer.” Bladder cancer that does not involve the muscle layers, not that deep in the bladder wall. Non-muscle-invasive bladder cancer is usually treated by our colleagues in urology with installation inside the bladder with an older form of immunotherapy which is BCG. And that's the most common way we treat this disease. And proportion of patients may have tumors that may not respond to BCG that may come back or persist despite the installation of the BCG in the bladder.

And these patients usually have a standard of care of getting what we call radical cystectomy, meaning, removal of the bladder and the lymph nodes around the bladder, radical cystectomy and lymph node dissection. However, many patients may not have, I would say, the opportunity to get the surgery because the body may not be that strong to undergo that significant procedure. Very few patients may have that challenge because of other medical conditions or what we call poor performance status. Or some patients for quality-of-life reasons may try to keep their bladder as long as possible. And for some of those patients, that might be an option.

And we have been looking for those options in the last few years. Intravesical, inside the bladder, installations of chemotherapy have been used with some positive results in some other studies. So that's an opportunity. We call this intravesical, inside the bladder, installations of chemotherapy, and the other option is an FDA-approved agent given intravenously inside the vein called pembrolizumab, which is in the form of immunotherapy. Of course, research continues. And this study I'm showing here from Dr. Chamie and colleagues, looked at this combination of BCG plus this molecule called N-803. This is another form of immunotherapy, and this was tested in patients who have this BCG-unresponsive, as we called it, non-muscle-invasive bladder cancer. The results were very promising. I would say impressive that it was a high response rate if we focus our attention on patients who had the superficial form carcinoma in situ, about 70% had no evidence of cancer upon further evaluation of the bladder. And in many of those patients that this response lasted for more than 2 years. 96% of patients avoided to have worsening of the bladder cancer in 2 years for those who had a response, and about 9 out of 10 avoided cystectomy again from those patients who had received the response. So it was 70% of all the population.

And as you see, all patients, 100% were alive without dying from bladder cancer after 2 years, which again is a very promising finding. This combination, to conclude, this inside the bladder installations of BCG plus the N-803, looks very promising. For those patients with BCG-unresponsive non-muscle-invasive bladder cancer, that might be an option down the road, we have to see.

Now I'm going to shift my attention to patients with metastatic or spread urothelial cancer. I want to point out that I’m a co-author in this abstract and I participated in that survey I will show you the results from. This is a population of patients who have spread cancer from the urinary tract, either the bladder was the most common origin or other parts of the urinary tract, for example, what we call kidney, pelvis and ureter, or rarely the urethra. The urothelial cancer that starts from those areas, again more commonly bladder, if it spreads, if it goes outside the urinary tract system, usually those patients get chemotherapy, what we call with an agent called cisplatin if they can tolerate that chemotherapy drug or carboplatin if they cannot tolerate the cisplatin drug. And usually either of these, cisplatin or carboplatin, is combined with a drug called gemcitabine. That's the most common chemotherapy used as initial therapy for patients with spread metastatic urothelial cancer. In this abstract, Dr. Gupta and colleagues tried to survey 60 medical oncologists, including myself, who treat urothelial cancer that considered experts in this disease type, to see if there are any features that could deter us from using chemotherapy in those patients. In other words, are there any features that may make us think that chemotherapy may be too risky for our patients and we should not do it? We should give immunotherapy instead.

This is probably a small proportion of our patients, maybe 10 to 20% in our practice, may not be able tolerate that chemotherapy. And which are those features? Poor performance status, meaning the body is very tired and the patient is not moving too much, is confined in the chair or the bed most of the day, and rely on others on daily activities. This is what defines the performance status of ECOG 3. Peripheral neuropathy, meaning that there is numbness or tingling or weakness in the hands or the feet that impact the quality of life. And patients may have trouble buttoning buttons or tying laces, so impacting the quality of life. That's grade 2 neuropathy. Symptomatic severe heart failure, there is a grading system, like New York Heart Association Class III or IV that is significant, notable heart failure symptoms. And also, patients with kidney failure with what we call creatinine clearance below 30 cc per minute. That's a marker how we measure kidney function and the creatinine clearance more than 60 is usually close to normal. As the creatinine clearance drops and goes below 30, chemotherapy with these platinum agents may become a challenge by itself or if it's combined with the ECOG performance status of 2, which means more patients are not moving most of the day.

So those features again have to do with the functionality of the day-to-day life. The presence of significant neuropathy, heart failure, and poor kidney function may potentially make the oncologist recommend immunotherapy versus the standard of care, which is chemotherapy, in those patients. And I would say if someone gets chemotherapy, which is the majority of patients, usually they may get immunotherapy later. So pretty much I would say discuss with the medical oncologist what is the right treatment for you. Most patients get chemotherapy up front, followed by immunotherapy. Some others may need to get immunotherapy, and those criteria help us make that patient selection for the right treatment at the right time.

So I just alluded to you that most patients with spread or metastatic urothelial cancer, most of them receive chemotherapy. We discussed some criteria in the previous studies that we may use immunotherapy upfront instead of chemo, but for the vast majority of patients, chemotherapy is used upfront and that was based on the results of phase 3 clinical trial called JAVELIN Bladder 100. This was presented at the ASCO Annual Meeting in 2020 about 2 years ago, and it was published in a big journal. And that study showed that if you give chemotherapy upfront, those patients who can tolerate the chemotherapy, of course, who do not have the previously listed criteria, those patients benefit and live longer, so longer overall survival, meaning they live longer, and they have longer progression-free survival, meaning they live longer without worsening of the cancer if they get immunotherapy with, immunotherapy drug is given through the vein, called avelumab.

If that is given after the end of chemotherapy for patients who have a response or stable disease, meaning no progression on chemotherapy. So if you get a complete response, meaning that the CAT scans look normal after chemotherapy as at least we can tell visually. Partial response, meaning that the CAT scans look better, but still we can see some cancer spots. Stable disease, meaning that the scans look stable compared to the beginning before we start chemotherapy. If someone has worsening of the cancer in chemotherapy, then the concept of maintenance therapy doesn't apply. So it's only for patients with complete response, partial response, or stable disease, SD.

And the poster we had, and I can tell you - I was a co-author in the abstract and co-investigator in the trial, as a disclosure - was sort of the benefit of the patient with avelumab as maintenance therapy after chemotherapy was notable in patients with complete response, partial response, and stable disease. So in any of these 3 categories, avelumab immunotherapy should be offered as level 1 evidence and benefit patients in terms of overall survival and progression-free survival as long as there's no progression to the upfront initial chemotherapy of the patient with metastatic urothelial cancer received. Many other abstracts on these cancers were presented, and I would encourage you to look at them. Thank you so much for the opportunity today.

Greg Guthrie: And thank you, Dr. Grivas. Next, we have Dr. Zhang who will discuss some research in kidney cancer.

Dr. Zhang: Hi everyone, glad to be here today. I'll be discussing 2 highlights from ASCO 2022 in kidney cancer. The first one we wanted to highlight was a trial called EVEREST: everolimus for renal cancer ensuing surgical therapy, a phase 3 study. And in context, this study is a trial of evaluating everolimus, an mTOR inhibitor, in the post-surgical context. And we do have in the landscape 2 approved therapies, sunitinib and pembrolizumab. And as we have seen, some effective therapies in the refractory setting, many of these therapies are being tested in this postoperative space. So this particular study of EVEREST looked at patients with renal cell carcinoma who underwent resection for their primary nephrectomy and looking to evaluate postsurgical treatment. So everolimus has been approved as a treatment on its own in the refractory setting as well as in combination with lenvatinib. And so this question of whether everolimus alone could delay or prevent disease recurrence in the postoperative setting was tested in this EVEREST trial. The study ultimately enrolled more than 1,500 patients and assigned them to receiving either everolimus or placebo in the postoperative setting. Of these patients, 83% had clear cell kidney cancer and the remaining had non-clear cell kidney cancer. And the follow-up was quite long, over 5 years, and actually over 6 years, and the researchers looked at time until disease recurrence. And risk of recurrence was actually decreased by 15% in patients who were treated with everolimus compared to placebo.

But the prespecified cut-off for a statistical significance was not quite reached, and the researchers took a specific look at a group of very high-risk patients defined by larger tumors, invasion of the perinephric fat in renal veins or invasion of nearby organs or known positive disease. And those patients with very high-risk disease had more benefit from everolimus compared to placebo. Of note, 37% of patients who were treated with everolimus had to stop treatment due to their side effects, and the most common severe side effects included mouth ulcers, high triglyceride levels, and high blood sugars. So ultimately this particular study did not show sufficient benefit of everolimus given the toxicity and lack of statistical significance. And so this is a balance between potential benefit in delaying recurrence versus treatment toxicities that we must have in this adjuvant setting.

So what does this particular study mean for patients? Well, it was certainly a large phase 3 trial performed in the cooperative group setting and through the generosity of 1,500 patients and the principal investigators on the study, we learned this answer for a very important question of whether everolimus makes a difference in this postoperative setting. I think we're not using this in clinical context currently, but in this postoperative setting, we are always balancing this risk of toxicity with the potential for benefit and discussing the potential treatment options. I do not think this particular trial changes the standard of care in this adjuvant setting.

And then I think finally for today's prepared talks, this abstract on depth of response and association with clinical outcomes with CheckMate 9ER patients treated with cabozantinib and nivolumab. So this was a post-trial analysis of patients who had kidney cancer with disease spread and treated with cabozantinib and nivolumab compared with sunitinib in the CheckMate 9ER study. And the context, this was the phase 3 trial in which the benefit of cabozantinib and nivolumab was established in the first-line setting and gained the registration and approval of this combination in the first-line treatment of metastatic kidney cancer. This particular analysis, presented at ASCO this year, was a post-trial prespecified analysis evaluating this depth of partial responses and associating those with clinical outcomes of time until disease progression as well as time until death.

These depth of responses were defined as 80 to 100% for PR-1, 60 to 80% for PR-2, and then 30 to 60% as PR-3. And as we saw in this analysis, the deeper the responses on cabozantinib and nivolumab, the more correspondence with higher 12-month rates of disease-free progression compared with those same depths of responses from sunitinib. And there were similar 12-month overall survival rates for patients with similar depth of responses for either the cabozantinib and nivolumab combination compared with sunitinib. So I do think the degree of partial response in these settings is productive of time until progression and establishes further the efficacy and benefit of cabozantinib and nivolumab compared with sunitinib. And what does this trial mean for our patients? I think that early on, as we're looking for responses and radiographic changes for our patients on cabozantinib, nivolumab in the first-line setting, these deeper responses are associated with longer time until disease progression, and we can counsel patients, to discuss whether cabozantinib and nivolumab is working for them. This could be an early indicator for how patients will do overall on this combination. So with that I'd love to wrap up and turn it back over to you, Greg.

Greg Guthrie: Thanks so much Dr. Zhang. And now it's time to move on into our Q&A session.

This is for you, Dr. Agarwal. So the question is utility of triple therapy, ADT plus docetaxel plus ASI and metastatic hormone-sensitive prostate cancer given ENZAMET was inconsistent with PEACE-1 and ARASENS. Would you give ASI concurrent or sequential after chemotherapy for tolerability? I'm assuming ASI here is androgen suppression, correct?

Dr. Agarwal: Yes. Great question. There are 2 questions here. Number 1, if I would use triplet therapy given the negative subgroup analysis of the ENZAMET trial, and number 2, what is the role of triplet therapy in general? The answer to the first question is ENZAMET trial, subgroup analysis is very different from preplanned, prespecified, well-powered analysis from PEACE-1 and the ARASENS trial. So yes, we saw discrepant results, but my impression from ENZAMET trial is enzalutamide is an effective option for all patients regardless of the receipt of docetaxel chemotherapy because that was a subgroup analysis. So I don't think it really affects negatively the results of the ARASENS and the PEACE-1 trial. But a bigger question here is triplet therapy versus doublet therapy? Is triplet therapy for all or doublet therapy for all? Answer is no. Triplet therapy trials only showed that adding a novel hormonal therapy or deeper androgen blockade to the backbone of ADT plus docetaxel improves survival.

These trials did not answer the question, if adding docetaxel chemotherapy to ADT plus, for example, enzalutamide or darolutamide or apalutamide, will improve survival. We do not have that question answered by any of the trials and unlikely any other trial will answer that question. So my take ADT plus docetaxel is replaced by ADT plus docetaxel plus these deeper androgen blocker therapy. So wherever I was going to use docetaxel chemotherapy, so those are the patients with visceral metastases or in my practice, when I do comprehensive genomic profiling, I see those molecular aberrations which predict lack of response to deeper androgen blockade such as baseline AR variants. Or if I see 2 out of 3 mutations of p53, RB loss, p10 loss, if I see 2 out of these 3, I tend to think about docetaxel chemotherapy. So in those patients where I'm using ADT plus docetaxel, I would add another androgen receptor blocker such as abiraterone and darolutamide. But when I'm using enzalutamide or apalutamide which I use for majority of those patients, my patients with metastatic hormone-sensitive prostate cancer, I do not think about triplet therapy.

Greg Guthrie: Thanks, Dr. Agarwal. We actually have a follow-up question, and this is, what is the role of oncology in low-stage early prostate cancer? Can neoadjuvant chemotherapy reduce the number of people who end up with metastatic prostate cancer?

Dr. Agarwal: This answer is very simple. There is no role of neoadjuvant chemotherapy in high-risk localized prostate cancer or any localized prostate cancer setting.

Greg Guthrie: Great. Thank you. Next question. I believe that this is for everybody. How long will it be until the information from the trials discussed will be used in the community clinics? What can patients do to bring this information to their less experienced doctors?

Dr. Grivas: So, Greg, just to clarify the question, is it about the translation of the results of the clinic from ASCO to clinical practice, generically speaking, or any particular tumor type or any particular data results?

Greg Guthrie: The way I read this question, it's more just kind of a broader scope question about just like, how long does the results of clinical trials make it to community practice, and what role can patients have in perhaps fostering this transmission of information?

Dr. Grivas: Of course, I can start briefly, and then my colleagues can add. I would say the world we live in right now, the information travels very quickly. It's much faster compared to the past. And I think there is much more alignment, in my opinion, in terms of information access between academic oncologists and community oncologists. If, for example, a trial result comes at ASCO being presented, and then there's a follow-up approval authority from a regulatory agency, this agent may be accessible to both community and academic practices. Of course, there are always opportunities for education, and Dr. Agarwal is the director of the ASCO Daily News, and he knows that well to disseminate the information well, broadly, in an equitable manner across academic oncologist providers and community providers. And I think CME, continued medical education practices, can help in that regard. And obviously, the other aspect of that is the ongoing clinical trials and how we can do a better job disseminating the opportunity for equitable participation in clinical trials across racial groups, ethnicity groups, minority groups, to give them the chance to participate in ongoing clinical trials that may change the practice down the road, which are just early thoughts. But other colleagues can comment.

Dr. Zhang: Yeah, if I could chime in. I think these continuing medical education programs, particularly in the context after large symposia like the ASCO Annual Meeting we just had, are particularly important. And the Best of ASCO series, as well as ASCO Direct Highlight series - I believe Dr. Grivas and I are hosting 2 of these - are very helpful, I think, to bring the latest findings from the ASCO Annual Meeting to our community colleagues. And they really are our colleagues. We work together with our oncologists within the community to take care of our patients, oftentimes for standard of care treatments. Patients can access them more in their backyards.

And I think from a patient standpoint on the second part of the question, they're able to hear these from patient-friendly platforms and to bring that to the attention of their oncologist, wherever that may be. It all helps in the grand context of clinical care. So I hope that these trial results and the latest findings from ASCO can get inseminated very quickly.

Dr. Grivas: And to also add very briefly, the role of patient advocacy groups, and in the bladder cancer work, there are many, for example, the Bladder Cancer Advocacy Network, World Bladder Cancer Coalition, and many others can help also in that regard and teaming up with all of us to disseminate information and also clinical trial access.

Greg Guthrie: Great. Thank you, everyone. We have a question for Dr. Grivas. After the survey results in the study you described, is there any plan to make a guideline or tool to make sure we standardize the definition of cisplatin/platinum ineligibility?

Dr. Grivas: Great question. Just 1 more thing on my prior answer, kudos to Cancer.Net for serving that mission, Greg and Claire in that-- or the previous question to have a complete answer. Answering this new question here, which is very important. I think the next step is to try to publish the results of the survey. The survey like the previous one done by Dr. Galski about 10 years ago-- it's a survey on expert oncologists, and it's a consensus-based definition. It's criteria that we came up with together. And I think the next step here is to publish this in a peer-review process. And our hope is by publishing these results, we can have a more formal definition to help guide our practices in academia, but also in the community oncology practices and make sure that we have a standardized way that we approach this therapy selection and of course, to help design clinical trials that for this particular patient population in order to improve outcomes in this setting. So hopefully publication will come soon.

Greg Guthrie: Thanks, Dr. Grivas. I'll just drop a really quick pitch there. Here at Cancer.Net, we do have a very broad array of information on clinical trials. And patients can come visit us at Cancer.Net and learn about clinical trials, what they mean, and how they help advance cancer research. We now have a question for Dr. Zhang. Based on the results of EVEREST and other trials approved systemic therapies in the adjuvant setting like sunitinib and pembrolizumab, are there ongoing other trials in this setting and is risk stratification used?

Dr. Zhang: The short answer is yes. There are ongoing adjuvant trials that build on pembrolizumab in the adjuvant setting. There's one that is looking at the addition of belzutifan with pembrolizumab in the adjuvant setting. So that trial is a global trial which is about to get started, if not enrolling already. And in the context of adding on in the adjuvant setting, I do think we really need to discuss with our patients how much of a benefit the treatment will have versus the real toxicity in the postoperative setting, many patients will not have symptoms from their cancer, so they may have some pain or healing side effects from surgery, but they won't have symptoms from cancer. So any toxicities from medications can be further amplified, so are we truly giving a lot of benefit in that context or not. So that's an individualized decision, and I do think conversations must be had to make that decision together.

Greg Guthrie: Thanks, Dr. Zhang. I want to ask a question myself of Dr. Gilligan. You had mentioned that microRNA is an emerging field of study, and I've heard about this in other types of cancer as well. I wonder if you could discuss that a little bit more.

Dr. Gilligan: Yeah, microRNA, the promise that holds is being a more accurate detector, specifically of testicular cancer. So the problem we have with alpha fetoprotein and beta HCG is half of the testicular cancers may not make 1 or both of those markers. So people can relapse without the markers going up, even though markers are most commonly what we see, there are a couple of different scenarios. Someone has stage I testicular cancer, which means their testicles removed and all their scans show no evidence of cancer. We know that 25% or so of non-seminomas and 20% or so of seminomas will relapse, even though we can't see what the cancer is, and the markers are negative in that situation. MicroRNA may be able to detect those people who still have cancer much, much earlier. So we know that they're, in fact, not stage I and that they need active treatment right away. So that's one place. Another place that we're seeing evidence is that men who've had metastatic testicular cancer. They go through chemotherapy, and they have residual masses. And we're wondering if there's cancer in those masses or is it all dead scar tissue or is it teratoma? MicroRNAs may be able to allow us to determine who needs additional treatment, who needs surgery without having it. Right now, we typically go in and operate just to figure that out.

So there are a number of situations in which we could more accurately stage patients and figure out who's cured and who's not cured much earlier in the course of disease. And for a patient, this would be fantastic, because right now, if you've got stage I disease with non-seminomas and you go on surveillance and somebody says you have a 25% risk the cancer is going to come back, that's a 1 in 4 chance that at some point in the next 2 years, most likely, or longer, you're going to have to suddenly drop everything and go through months of chemotherapy. If we knew on day 1, it looks like you're cured, but in fact, there’s cancer hiding there somewhere, and we need to treat you now, that would be helpful to know so they can get it over with. And the other men, we could say we're really extremely confident that there's not a 25% risk, it's a 5% risk or something much lower. So there are a number of ways, if this really gets proven and there's emerging data that's promising, I think we could reassure men, treat them more appropriately, spare them unnecessary treatment, and give them more peace of mind.

Greg Guthrie: Great. Thanks, Dr. Gilligan. I think we have a question from Dr. Grivas now.

Dr. Grivas: Thank you, Greg. This is a great panel. I like to learn from my colleagues here. One question for Dr. Zhang, you have done so much work in the field, leading the field there, Dr. Zhang. Any comments about the ideal end points in the adjuvant setting in kidney cancer, urothelial cancer, disease-free survival or overall survival? Would you comment about how we design trials, and what will be an acceptable benchmark? And what is meaningful for patients, too, in the adjuvant treatment after radical surgery for kidney cancer and urothelial cancer?

Dr. Zhang: Oh, that's a great question, Petros. Thank you so much for asking. We have discussed this many times together because you and bladder cancer and myself and kidney cancer, we're thinking a lot along the same lines right as new immunotherapies get approved in the postoperative setting, so disease-free survival as an endpoint and recurrence-free survival as an endpoint is a valid endpoint. It's a direct result of the randomized treatment on the trial, so I do think that is the valid endpoint, and it's an endpoint that the FDA has approved the sunitinib and pembrolizumab indications in kidney cancer, nivolumab and bladder cancer. So I think it's certainly a valid endpoint to delay disease recurrence. How much of that is meaningful degree of improvement for an individual patient? Their own measure of recurrence is either yes or no. It's much more binary than population effects. So how much does that translate into benefits for the patient? I think that warrants deeper individualized discussion. But these disease-free survival endpoints in all of these studies is a valid endpoint to see whether the treatment is worthy in delaying disease recurrence in each of these disease types.

Greg Guthrie: Thanks, Dr. Zhang. We have one last question here, and I believe this is a follow-up for Dr. Gilligan. And what is the time frame for the rollout of microRNA 371 to the community?

Dr. Gilligan: I don't know the answer to that. I'm not sure that we have enough data right now that it's going to get approved. I think we're headed in the right direction, but it's very hard to know what the timing of that is. There are trials going on, so I don't know at the moment of exactly what the scenarios are in which people are going to be, which patient populations are going to be eligible, but there are trials going on. I think I'm hoping within the next 2 years or so, but I really don't know what the time frame is, unfortunately.

Dr. Grivas: And if I may add a more generic comment to Dr. Gilligan's wonderful answer is that when we have what we call biomarkers that are like metrics that can give us information about how the patient does over time, it's important to tease out what we call prognostic, meaning how can this biomarker give us a sense of the chance of recurrence, as Dr. Gilligan said, or death from the cancer. But also, the bigger question is, is it going to give us information to predict benefit from an individual therapy? And that's a bigger question in oncology that is a harder one. This predictive question and try to identify biomarkers and validate them to make sure they have, they're clinically useful. They can help us make treatment decisions in the clinic. And I'm very excited about what Dr. Gilligan discussed about the promise in the future. But more trials are needed for many biomarkers.

Dr. Gilligan: I think when we do this update next year, we'll have significantly more data then, I'm hopeful.

Greg Guthrie: Thank you to you all. Thank you, Dr. Agarwal. Thank you, Dr. Grivas. Thank you, Dr. Gilligan. Thank you, Dr. Zhang, for sharing this great research with us, as well as your expertise. It's been a real pleasure this afternoon. And to all of our viewers, thank you for joining us. You can find more coverage of the research from ASCO Annual Meeting and other scientific meetings at the Cancer.Net blog, which is at www.cancer.net/blog.

And if you're interested in more Cancer.Net content, please sign up for a monthly Inside Cancer.Net newsletter or follow us on social media. We're on Facebook, Twitter, and YouTube where our handle is always @CancerDotNet, with dot spelled out. Thank you all, and be well. Thanks.

ASCO: Thank you, Dr. Agarwal, Dr. Gilligan, Dr. Grivas, and Dr. Zhang. You can find more research from recent scientific meetings at www.cancer.net.

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In this podcast, members of the Cancer.Net Editorial Board discuss new research in molecular testing, also known as biomarker testing or tumor marker testing, to help guide treatment for people with early-stage non-small cell lung cancer. This podcast is led by Dr. Ryan Gentzler, Dr. Xiuning Le, Dr. Brendan Stiles, and Dr. Vamsidhar Velcheti.

Treatments, Tests, and Procedures

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Today, we're going to be talking about clinical practice guidelines, including what they are, how they're developed, and how they can impact care for people with cancer. Our guests today are Dr. Jeffrey Meyerhardt and Dr. Scott Tagawa. 

Cancer Basics

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Today we're going to be talking about the psychosocial challenges unique to survivors of gynecologic cancers and how survivorship care plans can be helpful to survivors of these cancers. Our guests today are Dr. Fay Hlubocky and Dr. Merry Jennifer Markham. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago in Chicago, Illinois. She is also the Cancer.Net Associate Editor for Psychosocial Oncology. Dr. Markham is Chief of the Division of Hematology and Oncology and a clinical professor in the Department of Medicine at the University of Florida in Gainesville, Florida. She is also the Cancer.Net Associate Editor for Gynecologic Cancers. 

After Treatment and Survivorship

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In this podcast, Dr. Kedar Kirtane discusses new research from the 2022 Multidisciplinary Head and Neck Cancers Symposium, held February 24-26 in Phoenix, Arizona, including research on disparities in head and neck cancer, treatment for HPV-positive oropharyngeal cancer, and strategies for reducing side effects from treatment while still keeping high effectiveness.

Cancer Research News

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Today, we're going to be talking about the ASCO provisional clinical opinion, “Somatic Genomic Testing in Patients With Metastatic or Advanced Cancer.” Our guests today are the co-chairs of the team that wrote these recommendations. Dr. Funda Meric-Bernstam from the University of Texas MD Anderson Cancer Center in Houston, Texas and Dr. Mark Robson from Memorial Sloan Kettering Cancer Center in New York City. 

Treatments, Tests, and Procedures

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In this podcast, Dr. Christopher Flowers covers highlights from the 2021 American Society of Hematology Annual Meeting, held December 11 to 14 in Atlanta, Georgia. He discusses new treatments for diffuse large B-cell lymphoma, advances in immunotherapy, and a session on improving inclusivity in clinical trials.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Norah Lynn Henry will discuss new research presented at the 2021 San Antonio Breast Cancer Symposium, held December 7-10, 2022.

Cancer Research News

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In this podcast, experts will discuss targeted therapy for lung cancer, including 2 new treatments that target a specific type of mutation or change in the EGFR gene in some cancer cells, called an EGFR exon 20 insertion. They will explain how targeted therapy works to treat cancer, why this specific mutation is different from other, more common EGFR mutations, and what these 2 new treatments mean for people with this type of cancer.

Treatments, Tests, and Procedures

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In this podcast, Dr. Tian Zhang and Dr. Afreen Shariff discuss common and sometimes serious side effects caused by a type of immunotherapy called “immune checkpoint inhibitors.” They also explain why it is important for people with cancer to track the side effects they experience and discuss them with their health care team.

Side Effects

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In today’s episode, Cancer.Net Associate Editors discuss new research in brain tumors and gastrointestinal cancers presented at the 2021 ASCO Annual Meeting, held virtually June 4-8.  First, Dr. Glenn Lesser will discuss new research in 2 types of brain tumors, craniopharyngioma and glioblastoma. Next, Dr. Jeffrey Meyerhardt will discuss new research in esophageal and colorectal cancer. 

Cancer Research News

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In this podcast, we're going to be discussing how parents can talk with their children about a metastatic cancer diagnosis and their prognosis. The information discussed in this podcast is based on a study published in JCO Oncology Practice titled, “Talking with Children About Prognosis: The Decisions and Experiences of Mothers with Metastatic Cancer.” Our guests today are Dr. Eliza Park and Dr. Paula Rauch. Dr. Park served as the lead author on the study, and Dr. Rauch served as a co-author on the study.

Cancer Basics

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In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, 3 Cancer.Net Associate Editors discuss new research in cervical cancer, melanoma, and cancer in adults 65 and over, presented at the 2021 ASCO Annual Meeting, held virtually June 4th through 8th.

This episode has been adapted from the recording of a live Cancer.Net webinar, held August 9th, and led by Dr. Merry Jennifer Markham, Dr. Ryan Sullivan, and Dr. William Dale.

Cancer Research News

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In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s episode, 3 Cancer.Net Associate Editors discuss new research in lung cancer, breast cancer, and sarcomas presented at the 2021 ASCO Annual Meeting, held virtually June 4-8.

Cancer Research News

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In this podcast, we're going to be talking about social determinants of health and how they can impact people with cancer. We'll cover economic stability, neighborhood, community, education, food access, and health systems. Our guest today is Dr. Karen Winkfield. Dr. Winkfield is a board-certified radiation oncologist and Ingram Professor of Cancer Research at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, and the executive director of the Meharry-Vanderbilt Alliance. She is also the Cancer.Net Associate Editor for Radiation Oncology and Health Equity.

Cancer Basics

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In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today’s podcast, 4 Cancer.Net Specialty Editors discuss new research in prostate, bladder, kidney, and testicular cancers presented at the 2021 Genitourinary Cancers Symposium, and 2021 ASCO Annual Meeting.

This episode has been adapted from the recording of a live Cancer.Net webinar, held June 16th, 2021, and led by Dr. Neeraj Agarwal, Dr. Tian Zhang, Dr. Petros Grivas, and Dr. Timothy Gilligan.

Cancer Research News

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Today, we're going to be talking about genetic conditions linked to kidney cancer and what people with these conditions should know about genetic counseling. Our guests are Dr. Brian Shuch and Lauren Bear. Dr. Brian Shuch is the director of the Kidney Cancer Program at UCLA Health in Los Angeles, California. He is also 1 of the specialty editors for genitourinary cancers at Cancer.Net. Lauren Bear is the lead genetic counselor at the Familial Renal Cell Carcinoma and VHL Disease Clinic at Massachusetts General Hospital in Boston, Massachusetts. 

Cancer Basics

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Before any new cancer treatment can be approved for general use, it must be studied in a clinical trial in order to prove it is safe and effective. In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across kidney, bladder, and prostate cancer.

Cancer Research News

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In this podcast, Dr. Lidia Schapira and Dr. Daniel Mulrooney discuss a study published in the Journal of Clinical Oncologyabout mental health outcomes for AYA cancer survivors and how young survivors can get the mental health support they need after cancer.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Norah Lynn Henry discusses new research presented at the 2020 San Antonio Breast Cancer Symposium, held virtually December eighth through eleventh.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Michael Williams talks about new research and advances in the field of lymphoma, including 3 recent U.S. FDA drug approvals. The research discussed was presented at the 2020 American Society of Hematology Annual Meeting, held virtually December fifth through eighth. 

Cancer Research News

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In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across prostate, bladder, and kidney cancer. This podcast will be led by Dr. Timothy Gilligan, Dr. Neeraj Agarwal, Dr. Tian Zhang, and Dr. Brian Shuch.

Cancer Research News

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Cancer does not affect all people equally. Some groups of people, including racial and ethnic minorities, poor people, sexual and gender minorities (LGBT+ people), adolescent and young adult populations, and older adults, are more likely to be diagnosed with cancer, or have poorer outcomes.

This is known as “health disparities.” In today’s podcast, Dr. Petros Grivas and Dr. Edith Mitchell discuss health disparities in cancer clinical trials, why it is important for clinical trials to be inclusive, and resources for people with cancer who face barriers to care.

Cancer Research News

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In this podcast, Dr. William Dale will discuss new research presented at the International Society of Geriatric Oncology 2020 Annual Meeting, held virtually on October 1st. Dr. Dale is director of the Center for Cancer and Aging Research at City of Hope, a comprehensive cancer center near Los Angeles. He is also the Cancer.Net Associate Editor for Geriatric Oncology. 

Cancer Research News

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In today’s podcast, Dr. Paul Appelbaum, Dr. Allison Magnuson, and Dr. Jonathan Marron, will discuss their article “Medical Decision-Making in Oncology for Patients Lacking Capacity,” from the 2020 ASCO Educational Book. They discuss what it means for someone to be unable to make significant medical decisions for themselves, known as “decisional capacity,” and offer practical tips for families and caregivers.

Family, Friends, and Caregivers

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In this podcast, Dr. Neeraj Agarwal discusses new research in kidney, prostate, and bladder cancer presented at the European Society for Medical Oncology Virtual Congress 2020. 

Cancer Research News

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In the annual Research Round Up podcast series, Cancer.Net Associate Editors answer the question, “What was the most exciting or practice-changing research in your field presented at the ASCO20 Virtual Scientific Program?” In this final episode of 2020, editors discuss new research in the fields of central nervous system tumors and lymphoma.

Cancer Research News

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In today's podcast, Dr. Sumanta (Monty) Pal, Dr. Neeraj Agarwal, Dr. Timothy Gilligan, and Dr. Tian Zhang discuss 3 clinical trials that are exploring new treatment options across prostate, germ cell, and kidney cancer. 

Cancer Research News

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In the annual Research Round Up podcast series, Cancer.Net Associate Editors answer the question, “What was the most exciting or practice-changing research in your field presented at the ASCO20 Virtual Scientific Program?” In this episode, editors discuss new research in the fields of head and neck cancer and melanoma.

Cancer Research News

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In this podcast, Dr. Andrew Artz and Dr. Jessica Hwang discuss ASCO's updated provisional clinical opinion on hepatitis B virus screening and management for patients with cancer prior to therapy.

Cancer Research News

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In the annual Research Round Up podcast series, Cancer.Net Associate Editors answer the question,“What was the most exciting or practice-changing research in your field presented at the ASCO20 Virtual Scientific Program?” In this episode, 3 editors discuss new research in the fields of breast cancer, sarcoma, and palliative and supportive care.

Cancer Research News

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Today, ASCO published a new guideline on the prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers. Dr. Charles Loprinzi discusses the guideline recommendations and what this guideline means for patients. 

Side Effects

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In today’s podcast, Dr. Timothy Gilligan, Dr. Sumanta (Monty) Pal, Dr. Petros Grivas, and Dr. Tian Zhang discuss 3 clinical trials that are exploring new treatment options across prostate, bladder, and kidney cancer. 

Cancer Research News

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In the annual Research Round Up podcast series, Cancer.Net Associate Editors answer the question, “What was the most exciting or practice-changing research in your field presented at the ASCO20 Virtual Scientific Program?” In this first episode, 3 editors discuss new research in the fields of leukemia, colorectal cancer, and lung cancer.

Cancer Research News

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En este episodio vamos a discutir los ensayos clínicos para encontrar nuevos tratamientos para el cáncer, y específicamente, la participación de los adultos mayores en los ensayos clínicos. Nuestro invitado hoy, es el doctor Enrique Soto, un oncólogo clínico que se especializa en el cuidado de los adultos mayores con cáncer. El doctor Soto, trabaja en el Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, en la ciudad de México y es un miembro de la Junta Directiva de la Sociedad Estadounidense de Oncología Clínica y un miembro de la Junta Editorial de Cancet.Net.

Cancer Research News

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In this podcast, Dr. Charles Loprinzi and oncology social worker and survivor Hester Hill Schnipper discuss the new ASCO Guideline, Management of Cancer Cachexia.

Family, Friends, and Caregivers

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Before any new cancer treatment can be approved for general use, it must be studied in a clinical trial in order to prove it is safe and effective. In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across prostate, bladder, and kidney cancer.

Cancer Research News

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Hoy hablamos sobre la evaluación geriátrica integral y su utilidad en el cuidado de las personas con cáncer. Nuestro invitado hoy es el doctor Enrique Soto, un oncólogo clínico que se especializa en el cuidado de los adultos mayores con cáncer. 

Quality of Life

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Before any new cancer treatment can be approved for general use, it must be studied in a clinical trial in order to prove it is safe and effective. In today’s podcast, members of the Cancer.Net Editorial Board discuss 3 clinical trials that are exploring new treatment options across prostate, bladder, and kidney cancer. This podcast will be led by Dr. Sumanta (Monty) Pal, Dr. Neeraj Agarwal, Dr. Petros Grivas, and Dr. Tian Zhang.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Michael Williams will discuss some of the new research in lymphoma that was presented at the 2019 American Society of Hematology Annual Meeting, held December seventh through tenth in Orlando, Florida. 

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Norah Lynn Henry discusses several studies presented at the 2019 San Antonio Breast Cancer Symposium, held December tenth through fourteenth in San Antonio, Texas. 

Cancer Research News

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In this podcast, oncology social worker and 2-time breast cancer survivor Hester Hill Schnipper discusses ways to cope with the fear of recurrence. 

After Treatment and Survivorship

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In today’s podcast, Dr. Ryan Nipp and Dr. Electra Paskett will discuss their article “Overcoming Barriers to Clinical Trial Enrollment,” from the 2019 ASCO Educational Book. They discuss why it is important for people with cancer to participate in clinical trials and some of the reasons people may not be able to participate in clinical trials. They also discuss finding financial resources, the informed consent process, and the role of patient navigators.

Cancer Research News

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The European Society for Medical Oncology 2019 Congress was held in Barcelona, Spain, from September 27 to October 1. In this podcast, Dr. Ricardo Cubedo shares highlights from the meeting, including treatment advances in ovarian and lung cancer. He also discusses a new type of clinical trial known as “basket trials” and the ways they are changing the shape of cancer research.

Cancer Research News

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Today, we're going to be talking about some research highlights from the upcoming Supportive Care in Oncology Symposium.

Cancer Research News

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The 2019 World Conference on Lung Cancer was held September 7 to 10 in Barcelona, Spain. In this podcast, Dr. Vamsidhar Velcheti will discuss a study presented at this meeting that looked at the effects of a new drug targeting a specific genetic change, or mutation, in some people with non-small cell lung cancer.

Cancer Research News

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In this episode, we're going to discuss 2 studies on patient experiences with clinical trials that will be presented at ASCO's 2019 Quality Care Symposium. This annual meeting brings together health care experts to share strategies for cancer care issues and integrate these methods into patient care. 

Cancer Research News

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In this podcast, registered dietitians Julie Lanford and Debra Benfield will discuss food anxiety before, during, and after cancer treatment, including potential causes and healthy ways to address food anxiety at any stage of treatment.

Quality of Life

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The 2019 ASCO Annual Meeting, held May 31 to June 4, brought together physicians, researchers, patient advocates, and other health care professionals from around the world to present and discuss the latest research in cancer treatment and patient care. In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients.

Cancer Research News

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El verano es una época en que las personas suelen hacer comidas, parrilladas y pícnics al aire libre. En este pódcast, las integrantes del personal del Departamento de Agricultura de los Estadios Unidos, Janice López‑Muñoz y Clara Yuvienco, explican por qué la seguridad de los alimentos es particularmente importante para las personas diagnosticadas con cáncer y comparten consejos para evitar enfermedades transmitidas por los alimentos cuando se come al aire libre.

Quality of Life

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In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients. In this podcast, Dr. Vicki Keedy will discuss 2 different studies in soft-tissue sarcoma, and explain how the results of these studies have lead to important conversations in the field of sarcoma, and Dr. Ryan Sullivan will discuss 2 studies in melanoma, including 1 that looked at treatment for melanoma that has spread to the brain, and 1 that is a long-term follow-up on targeted therapy for melanoma with a BRAF mutation. 

Cancer Research News

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The 2019 ASCO Annual Meeting, held May 31 to June 4, brought together physicians, researchers, patient advocates, and other health care professionals from around the world to present and discuss the latest research in cancer treatment and patient care. In the annual Research Round Up podcast series, Cancer.Net Associate Editors share their thoughts on the most exciting scientific research to come out of this year’s ASCO Annual Meeting and what it means for patients. This podcast covers research in breast cancer, head and neck cancer, and care for nausea and vomiting. 

Cancer Research News

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In this podcast, we’ll discuss lymphedema,or swelling, in the legs after cancer treatment, including what can cause lymphedema, and how to prevent and manage it. This podcast will be led by Dr. Andrea Cheville, the Director of Cancer Rehabilitation and Lymphedema Services in the Department of Physical Medicine and Rehabilitation at Mayo Clinic in Rochester, Minnesota, and Jenny Bradt, a LANA-Certified Lymphedema Therapist and Clinical Lead Physical Therapist in the Department of Physical Medicine and Rehabilitation at Mayo Clinic.

Side Effects

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In this episode, we will discuss genetic testing for hereditary cancers. Our guest is Dr. Allison Kurian, a medical oncologist at Stanford University. She is also the Director of the Stanford Women's Cancer Genetics Clinic and serves as a Specialty Editor for Cancer.Net.

Cancer Basics

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Dr. Merry Jennifer Markham and Dr. Danielle Gentile recently published a study in the Journal of Oncology Practice that describes potential benefits and drawbacks of people with cancer using social media. Today, we're going to discuss with them some of the findings from their study, as well as what people with cancer should know about using social media and how it can provide support.

Quality of Life

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In this podcast, Cancer.Net Associate Editor Dr. Guillermo Garcia-Manero will discuss some of the new research in leukemia and myelodysplastic syndromes, or MDS, that was presented at the 2018 American Society of Hematology Annual Meeting, held December first through fourth in San Diego, California.

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Norah Lynn Henry discusses new research that was presented at the 2018 San Antonio Breast Cancer Symposium, held December fourth through eight in San Antonio, Texas. 

Cancer Research News

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In this podcast, Cancer.Net Associate Editor Dr. Michael Williams will discuss some of the new research in lymphoma that was presented at the 2018 American Society of Hematology Annual Meeting, held December first through fourth in San Diego, California. 

Cancer Research News

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In this podcast, Cancer.Net Editorial Board members Dr. Brian Rini and Dr. Jorge Garcia discuss new research in kidney and prostate cancer presented at the European Society for Medical Oncology 2018 Congress, held October nineteenth through twenty-third in Munich, Germany.

Cancer Research News

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ASCO President Dr. Monica Bertagnolli has chosen “Caring for every patient. Learning from every patient,” as her presidential theme. Putting actions to words, from 2018 to 2019, she is hosting a series of ASCO Presidential Community Town Halls with local groups across the United States to hear from patients, providers, and the general public about real-world barriers to quality cancer care and to talk about ways to provide the best care to every person diagnosed with cancer. In today’s podcast, Dr. Colin Weekes and the Reverend Joel Guillemette discuss the recent town hall event they hosted at the Sudbury United Methodist Church in Sudbury, Massachusetts on September 10. 

Family, Friends, and Caregivers

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In today's podcast, Suzanne Dixon and Julie Lanford discuss nutrition during and after treatment for colorectal cancer, including ways to manage side effects and guidelines for eating with a colostomy.

Side Effects

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While most people may think of visiting a doctor to receive medical care, today, technology such as computers and smartphones can connect doctors and patients who are separated physically. This is known as “telemedicine.”

In today’s podcast, Dr. Ana María López, Dr. Joseph Sirintrapun, Dr. Joseph Greer, and Dr. Karen Edison will discuss their article from the 2018 ASCO Educational Book, “Telemedicine in Cancer Care,” including specific methods used in telemedicine, and the ways it helps bring high-quality medical care to people who might not otherwise be able to access this care.

Cancer Research News

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Many people are aware that quitting smoking or other tobacco use will reduce the risk that someone will develop cancer. In today’s podcast, Dr. Noelle LoConte, Dr. Jeffrey Gershenwald, and Dr. Cynthia Thomson will discuss their article from the 2018 ASCO Educational Book, “Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction,” and share tips for other changes people can make to reduce their cancer risk.

Cancer Screening and Prevention

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Caring for a loved one with cancer can be challenging as well as rewarding. But you are not alone. In this series of podcasts, developed in collaboration with LIVESTRONG, Aditi Narayan and Mike Threadgould interview family caregivers, who share their stories and offer advice for others facing similar situations.

In today’s podcast, Scott Joy, a testicular cancer survivor and patient advocate, discusses his experience when his wife Judy was diagnosed with multiple myeloma, including some of the bright spots and challenges, things he wishes he had known at the time, and tips for other caregivers.

Family, Friends, and Caregivers

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Many common cancer treatments can temporarily or permanently affect a woman’s fertility, which is the ability to have children. In today’s podcast, Dr. Karen Lisa Smith shares highlights from her article from the 2018 ASCO Educational Book, “Advances in Fertility Preservation for Young Women With Cancer.”

Treatments, Tests, and Procedures

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The ASCO Annual Meeting brings together physicians, researchers, patient advocates, and other health care professionals to discuss the latest in cancer care. The research presented at this meeting frequently leads to treatment advances and new ways to improve the quality of life for people with cancer. In today’s podcast, Cancer.Net Associate Editors share their thoughts on the most exciting and practice-changing news to come out of the 2018 ASCO Annual Meeting.

Cancer Research News

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In today’s podcast, Dr. Timothy Gilligan and Liz Salmi will discuss their article “Patient-Clinician Communication Is a Joint Creation: Working Together Toward Well-Being,” from the 2018 ASCO Educational Book. They cover several ways people with cancer and members of their health care team can work together in order to improve their communication, including a study on sharing clinical notes with patients, a recent guideline from ASCO on physician-patient communication, ways to address religion and spirituality, and tips for patients.

Quality of Life

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The ASCO Annual Meeting brings together physicians, researchers, patient advocates, and other health care professionals to discuss the latest in cancer care. The research presented at this meeting frequently leads to treatment advances and new ways to improve the quality of life for people with cancer. In today’s podcast, Cancer.Net Associate Editors share their thoughts on the most exciting and practice-changing news to come out of the 2018 ASCO Annual Meeting.

Cancer Research News

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This podcast features an interview with Martha “Meg” Gaines, Distinguished Clinical Professor of Law at the University of Wisconsin-Madison and Director of the Center for Patient Partnerships. She shares her personal experience with cancer and explains how it led her to advocate for others with cancer and found the Center for Patient Partnerships. She also discusses patient-centered care, and shares tips for patient advocates.

Cancer Basics

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The ASCO Annual Meeting brings together physicians, researchers, patient advocates, and other health care professionals to discuss the latest in cancer care. The research presented at this meeting frequently leads to treatment advances and new ways to improve the quality of life for people with cancer. In today’s podcast, Cancer.Net Associate Editors share their thoughts on the most exiting and practice-changing news to come out of the 2018 ASCO Annual Meeting.

Cancer Research News

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Approximately 70% of people diagnosed with cancer are 65 or older, and often older adults with cancer have different needs and concerns than young adults or children. In this podcast, we will discuss new recommendations from ASCO about how doctors can assess older adults in order to ensure they get the care they need.

Quality of Life

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In this podcast, Dr. Paul Celano discusses what patients should know when taking medication for cancer treatment, including tips for safely storing the medication, special considerations for oral chemotherapy and opioids, as well as resources to help dispose of unneeded or expired medications.

Cancer Basics

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In this podcast, Professor Nicholas Turner discusses liquid biopsy, which is a procedure that uses blood to test for cancer in the body. 

Treatments, Tests, and Procedures

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Treatment for head and neck cancer can often cause side effects that make it difficult to eat. In this podcast, dietitians Maureen Gardner and Annette Goldberg discuss several side effects that may be caused by head and neck cancer treatment and offer tips for managing these side effects and taking in enough nutrients, including information about feeding tubes.

Side Effects

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In this podcast, Dr. Timothy Gilligan will discuss new research presented at the 2018 Cancer Survivorship Symposium: Advancing Care and Research, held February 16-17 in Orlando, Florida. This multidisciplinary meeting brings together primary care physicians, oncologists, patient advocates, and others to discuss ways to address cancer survivors’ unique concerns. 

The research discussed in this podcast includes mention of suicide. If you need help, contact the National Suicide Prevention Lifeline.

Cancer Research News

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Research into new forms of biologic therapy, such as immunotherapy or targeted therapy, have made dramatic advances in treating and managing cancer, but these therapies can be very expensive. You may be familiar with generic drugs, which are identical copies of brand-name drugs, and are often much cheaper. However, the manufacturing process for biologic therapies is so complex, it is not possible for a different manufacturer to make an identical copy. In this podcast, Dr. Gary Lyman discusses biosimilar agents, which are similar, but not identical, copies of these drugs. 

Treatments, Tests, and Procedures

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In today’s podcast, we’ll discuss some of the new research that was presented at the 2017 San Antonio Breast Cancer Symposium, held December fifth through ninth in San Antonio, Texas. This podcast will be led by Cancer.Net Associate Editor, Dr. Erica Mayer. 

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In today’s podcast, Cancer.Net Associate Editor, Dr. Michael Williams will discuss some of the new research that was presented at the 2017 American Society of Hematology Annual Meeting, held December ninth through twelfth in Atlanta, Georgia.

  Cancer Research News

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In today’s podcast, Dr. Noelle LoConte discusses the relationship between alcohol use and cancer, and explains why ASCO has released a statement on this topic. 

Cancer Screening and Prevention

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There are many benefits to being physically active during and after cancer treatment. However, the side effects of cancer treatment can make it challenging to get to a gym or complete standard exercises. In this podcast, we discuss these challenges, tips for staying physically active, and the benefits of participating in a fitness program designed for cancer survivors, like LIVESTRONG at the YMCA. 

After Treatment and Survivorship

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A ketogenic diet is a high-fat, low-carbohydrate diet that has some specific neurological effects. In today’s podcast, Annette Goldberg talks with Dr. Roy Strowd about this diet, its history, and its potential benefits in people with certain types of brain tumors.

Cancer Research News

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Many people with cancer receive long-term therapy after their primary cancer treatment—such as surgery or chemotherapy—has ended, in order reduce the risk of their cancer returning or worsening. In today’s podcast, Dr. Ryan Nipp discusses the unique challenges faced by people who receive this extended therapy and their caregivers. Dr. Nipp also talks about the importance of survivorship care plans and having open communication between patients and their health care team in addressing these challenges.

After Treatment and Survivorship

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The ASCO Annual Meeting is the premier educational and scientific event where physicians, researchers, and other health care professionals gather to discuss the latest in cancer care and treatment. In today’s podcast, Cancer.Net Associate Editors answer this question: “What was the most exciting or practice-changing news you heard at the 2017 ASCO Annual Meeting?”

  Cancer Research News

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In today’s podcast, Dr. Judith Paice discusses options for managing cancer-related pain, including opioid medications, and medication-free alternatives. She also discusses the use of cannabinoids, which are derived from marijuana, including recent clinical research and associated risks and barriers. 

Side Effects

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In today’s podcast, we’ll discuss some of the new research that was presented at the 3rd World Congress on Thyroid Cancer, held July 27th through 30th in Boston, Massachusetts. This podcast will be led by Cancer.Net Associate Editor, Dr. Ezra Cohen. 

  Cancer Research News

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The ASCO Annual Meeting is the premier educational and scientific event where physicians, researchers, and other health care professionals gather to discuss the latest in cancer care and treatment. In today’s podcast, Cancer.Net Associate Editors answer this question: “What was the most exciting or practice-changing news you heard at the 2017 ASCO Annual Meeting?”

  Cancer Research News

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In today’s podcast, Dr. Erika Ramsdale and Dr. Andrew Chapman discuss new options for improving care for older adults with cancer, including online tools and telecommunications options. Dr. Ramsdale is a board-certified specialist in geriatric medicine and medical oncology at the University of Rochester Medical Center. Dr. Chapman is the co-director of the Jefferson Senior Adult Oncology Center and a board-certified medical oncologist and hematologist at Thomas Jefferson University.

Cancer Research News

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The ASCO Annual Meeting is the premier educational and scientific event where physicians, researchers, and other health care professionals gather to discuss the latest in cancer care and treatment. In today’s podcast, Cancer.Net Associate Editors answer this question: “What was the most exciting or practice-changing news you heard at the 2017 ASCO Annual Meeting?”

  Cancer Research News

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A therapy animal has been trained to visit hospitals and other healthcare environments to provide comfort, help decrease a patient’s pain or discomfort, encourage movement, and even serve a role in a patient’s treatment program. In today’s podcast, Leslie Horton will discuss what is involved in training a dog or other pet to become a therapy animal.

Family, Friends, and Caregivers

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Genetic testing can help estimate a person’s chance of developing cancer in their lifetime based on changes, or mutations, in their genetic code. Genetic counselors are specially trained medical professionals who can assess and advise people on their individual risk of cancer based on their family’s history of cancer and the results of genetic testing. In this podcast, Tiffani DeMarco explains the role of a genetic counselor and discusses how genetic testing has changed over time.  

Cancer Screening and Prevention

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Voices on Cancer is a Cancer.Net Blog series where advocates share their stories and the lessons they have learned about being a cancer advocate. In this Voices on Cancer podcast, young adult cancer survivor Matthew Zachary shares his advocacy story and shares tips to help advocate for young adults with cancer.

Cancer Basics

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Through art therapy, someone with cancer can explore and express feelings that they may not be able to say aloud. In today’s podcast, Michelle Itczak will discuss the role of art therapy in cancer care, and what someone with cancer should know about working with an art therapist. 

Cancer Basics

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In today’s podcast, Dr. Anthony Alberg explains why it’s not too late to quit smoking after a cancer diagnosis, including the immediate and long-term benefits during and after cancer treatment. He also addresses common myths around quitting smoking and provides resources for someone who wants to quit.  

Cancer Research News

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In today’s podcast, Dr. Arti Hurria, Dr. Lee Jones, and Dr. Hyman Muss will discuss their article “Cancer Treatment as an Accelerated Aging Process: Assessment, Biomarkers, and Interventions.” They discuss research on why aging-related problems—such as physical conditions or cognitive decline—occur more frequently in cancer survivors, and how these aging-related problems can be prevented or minimized.  

Cancer Research News

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In today’s podcast, Dr. Sumanta Kumar Pal will discuss three studies highlighted at the 2017 Genitourinary Cancers Symposium, including two studies on metastatic kidney cancer and one study on metastatic prostate cancer. 

  Cancer Research News

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In today’s podcast, Dr. Lidia Schapira will discuss 3 new studies presented at the 2017 Cancer Survivorship Symposium: Advancing Care and Research, held January 27 and 28 in San Diego, California.

  Cancer Research News

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In today’s podcast, we’ll discuss some of the new research that was presented at the 2016 American Society of Hematology Annual Meeting, held December third through sixth in San Diego, California.

  Cancer Research News

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In today’s podcast, we’ll discuss some of the new research that was presented at the 2016 San Antonio Breast Cancer Symposium, held December sixth through tenth in San Antonio, Texas. 

  Cancer Research News

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In today’s podcast, Dr. Howard Bailey will discuss human papillomavirus, or HPV, and explain why it’s associated with certain types of cancer. He also discusses HPV vaccines, and how they can help lower the risk of these cancers. 

Cancer Screening and Prevention

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In this podcast, Dr. Michael Fisch, Dr. Melissa Accordino, and Dr. Arlene Chung discuss their article, “Using Technology to Improve Cancer Care: Social Media, Wearables, and Electronic Health Records,” and explain how doctors are using digital technology to communicate with their patients, and each other.

Cancer Research News

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Cancer care has become increasingly complex, so someone with cancer will be treated by a collaborative team of health care providers that includes doctors, nurses, and a wide range of additional specialists. In today’s podcast, Wendy Vogel discusses the role of oncology advanced practitioners, or APs, as a part of this multidisciplinary team. 

Cancer Basics

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In today’s podcast, Lillie Shockney discusses her article, “The Value of Patient Navigators as Members of the Multidisciplinary Oncology Care Team.” Nurse navigators, also known aspatient navigators, help a person with cancer “navigate” the hospital and human services bureaucracies. This includes assisting with decision making, coordinating services, and advocating for the patient with the other members of the health care team. 

Cancer Basics

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In today’s podcast, we will discuss direct-to-consumer genetic testing. You may have seen these at-home genetic testing kits advertised on television or the internet. Genetic testing can be used to estimate a person's risk of developing specific diseases, such as cancer. However, direct-to-consumer genetic testing may have significant limitations, and the decision to be tested for cancer risk is complex. This podcast will be led by Dr. Nadine Tung, the Director of the Cancer Risk and Prevention Program at Beth Israel Deaconess Medical Center. 

Cancer Screening and Prevention

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Patient-reported outcomes, or PROs, are anything reported directly by the patient, such as symptoms or emotions. In today’s podcast, Dr. Lee Schwartzberg discusses his article, “Electronic Patient-Reported Outcomes: The Time Is Ripe for Integration Into Patient Care and Clinical Research,” and explains how electronic PRO systems can help improve communication between patients and their health care team. 

Cancer Research News

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To fast is to partially or completely reduce one’s food intake for a period of time. In today’s podcast, Suzanne Dixon and Annette Goldberg discuss the history of fasting, different types of diets, and why some scientists are researching the effects of fasting during or after cancer treatment. They also provide tips for someone considering fasting during treatment.  

Quality of Life

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In today’s podcast, Cancer.Net Associate Editor Dr. Jyoti Patel discusses some of the new research on lung cancer presented at the 2016 ASCO Annual Meeting.

  Cancer Research News

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In today’s podcast, Cancer.Net Associate Editor Dr. Jonathan Berek discusses some of the research on gynecological cancers presented at the 2016 ASCO Annual Meeting. 

  Cancer Research News

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In today’s podcast, Dr. William Tew and Dr. Andrew Artz explain new research presented at the 2016 ASCO Annual Meeting on older adults with cancer. They discuss why it’s important to include older adults in cancer research and what to consider when older adults receive treatment.

  Cancer Research News

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In today’s podcast, Cancer.Net Associate Editor Dr. Susan Chang discusses some of the research on brain tumors presented at the 2016 ASCO Annual Meeting.

  Cancer Research News

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In today’s podcast, we will discuss new recommendations developed jointly by ASCO and the Society for Gyncologic Oncology on when women with newly diagnosed, advanced ovarian cancer should receive  neoadjuvant chemotherapy, which is chemotherapy given before surgery. These recommendations are intended to help guide doctors and their patients in making treatment decisions based on current research. 

Cancer Research News

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In today’s podcast, Cancer.Net Associate Editor Dr. Brian Rini discusses some of the new research on kidney and bladder cancer presented at the 2016 ASCO Annual Meeting.

  Cancer Research News

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In today’s podcast, ASCO’s Chief Medical Officer (2013–2021), Dr. Richard Schilsky, discusses ASCO’s first-ever clinical trial, the Targeted Agent and Profiling Utilization Registry, or TAPUR Study. The TAPUR Study is a clinical trial for people with later-stage cancer, focused on whether specific targeted therapies can benefit more patients and lead to more personalized treatments.  Dr. Schilsky explains the objectives of the study, and provides information about who might be eligible to participate, as well as what is involved.

Cancer Research News

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In today’s podcast, Cancer.Net Associate Editor Dr. Charles Loprinzi discusses some of the new research that came out of the 2016 ASCO Annual Meeting on how to better manage side effects of cancer treatment, including peripheral neuropathy, fatigue, nausea and vomiting, and skin rash. He also discusses several studies on the benefits of early palliative care during cancer treatment. 

  Cancer Research News

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In today’s podcast, Dr. Apostolia-Maria Tsimberidou discusses several areas of current cancer research—including immunotherapy and precision, or personalized, medicine—that were highlighted at the 2016 American Association for Cancer Research Annual Meeting, held April sixteenth through twentieth in New Orleans, Louisiana.  

  Cancer Research News

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In today’s podcast, Suzanne Dixon and Annette Goldberg discuss and dispel several common myths about nutrition and cancer.  Suzanne Dixon is a Registered Dietitian and Epidemiologist, with a nutrition and research consulting business in Portland, Oregon. Annette Goldberg is an Outpatient Dietitian at the Boston Medical Center Cancer Care Center.

Cancer Basics

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Over 60% of people who have cancer are 65 or older. In today’s podcast, we will discuss some of the unique challenges older adults with cancer may face, including special considerations for preparing for and recovering from surgery. 

Quality of Life

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In today’s podcast, Peggy Burhenn, a nurse and professional practice leader in Geriatric Oncology at City of Hope National Medical Center discusses several strategies for getting a better night’s sleep.  

Quality of Life

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In today’s podcast, Cancer.Net Advisory Panelist Dr. Arash Asher talks to Dr. An Ngo-Huang about prehabilitation and why it is becoming a more common element of cancer treatment. 

Quality of Life

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In today’s podcast, Mattie Miracle Cancer Foundation co-founders Peter Brown and Vicki Sardi-Brown tell the story of their son Mattie’s journey with cancer, and explain how it inspired them to advocate for the development of evidence-based psychosocial standards of care for children with cancer and their families. 

Family, Friends, and Caregivers

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Palliative care focuses on preventing, managing, and relieving the symptoms of cancer and the side effects of cancer treatment. In this podcast, Dr. Kavitha Ramchandran discusses the basics of palliative care, including when a person with cancer should consider palliative care and the role of a multidisciplinary palliative care team. 

Quality of Life

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In this podcast, Dr. Ezra Cohen discusses some of the research presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium, held February eighteenth through twentieth in Scottsdale, Arizona. 

  Cancer Research News

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In today’s podcast, we’ll discuss new research presented at the 2016 Quality Care Symposium, held February 26-28. This symposium brings together multidisciplinary leaders to share strategies and methods for measuring and improving the quality and safety of cancer care. The three studies highlighted in this podcast explore different ways to make sure patients are getting the most appropriate care, while minimizing the costs of cancer care.

  Cancer Research News

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Some side effects of cancer treatment—such as taste changes and appetite loss—can prevent a person receiving cancer treatment from eating and drinking enough. In this podcast, oncology dietitians Maureen Gardner and Annette Goldberg will discuss how they work with people with cancer and their families to address these and other common nutrition concerns.

Cancer Basics

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In this podcast, Dr. Smitha Krishnamurthi discusses three studies highlighted at the 2016 Gastrointestinal Cancers Symposium, which examined two new treatment options for people with advanced neuroendocrine tumors and a new pre-surgical treatment option for people with locally advanced rectal cancer. 

  Cancer Research News

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In today’s podcast, Dr. Sumanta Pal discusses one study highlighted at the 2016 Genitourinary Cancers Symposium that examines whether regular aspirin use lowers the risk of dying from prostate cancer. 

  Cancer Research News

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In today’s podcast, we’ll discuss some of the new research that was presented at the 2015 San Antonio Breast Cancer Symposium, held December eighth through twelfth in San Antonio, Texas. This podcast will be led by Cancer.Net Associate Editor, Dr. Erica Mayer.

  Cancer Research News

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In this podcast, Dr. Michael Williams discusses some of the new research that was presented at the 2015 American Society of Hematology Annual Meeting, held December fifth through eighth in Orlando, Florida. 

  Cancer Research News

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In this podcast, Dr. Heidi Klepin, Dr. Miriam Rodin, and Dr. Arti Hurria, will discuss their 2015 ASCO Educational Book article “Treating Older Adults with Cancer: Geriatric Perspectives,” which explores some of the unique concerns that should be considered when older adults are being treated for cancer.

Cancer Research News

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In this podcast, Dr. Michael Thompson discusses his article, “Using Social Media to Learn and Communicate: It Is Not About the Tweet” with Dr. Nathan Pennell.

Cancer Research News

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In this podcast, Dr. Paul Chapman discusses some of the recent advances in treating stage IV or metastatic melanoma, which is melanoma that has spread to other parts of the body. 

  Cancer Research News

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In this podcast, Dr. Bernardo Goulart discusses his article, "The Value of Lung Cancer CT Screening."

Cancer Research News

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In this podcast, Dr. Edward Kim discusses his article, “The Future of Molecular Medicine: Biomarkers, BATTLEs, and Big Data.”

Cancer Research News

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In today’s podcast, Dr. Leslie Schover discusses her article, “Sexual Healing in Patients with Prostate Cancer on Hormone Therapy," from the 2015 ASCO Educational Book.

Cancer Research News

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In this podcast, Dr. Susan Chang discusses some of the research on brain tumors presented at ASCO’s 2015 Annual Meeting. 

  Cancer Research News

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In this podcast, Dr. Jeffrey Meyerhardt discusses some of the research on gastrointestinal, or GI cancers presented at ASCO’s 2015 Annual Meeting. 

  Cancer Research News

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In this podcast, Dr. Robert Maki discusses some of the research on sarcoma presented at ASCO’s 2015 Annual Meeting. 

  Cancer Research News

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In this podcast, Dr. Melissa Hudson discusses some of the research on childhood cancer survivorship presented at ASCO’s 2015 Annual Meeting.

  Cancer Research News

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In this podcast, Dr. Brian Rini discusses some of the research on kidney cancer presented at ASCO’s 2015 Annual Meeting.

  Cancer Research News

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In this podcast, Dr. Paul Chapman discusses some of the research on melanoma presented at ASCO’s 2015 Annual Meeting.

  Cancer Research News

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In this podcast, Dr. Ezra Cohen discusses some of the research on head and neck cancers presented at ASCO’s 2015 Annual Meeting. 

  Cancer Research News

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In this podcast, Dr. Charles Loprinzi discusses some of the research on improving the quality of life for people living with cancer, including new treatments for common side effects and the importance of honest discussions with medical providers. 

  Cancer Research News

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This podcast is part of a series for patients who have just been diagnosed with a specific genitourinary, or GU cancer. In this series, Dr. Charles Ryan, a medical oncologist and professor who specializes in the genitourinary tract at the UCSF Helen Diller Family Comprehensive Cancer Center, speaks with experts on specific GU cancers to shed light on what happens after an initial diagnosis.

Today’s guest is Dr. Thomas Powles, clinical professor of genitourinary oncology at Barts Cancer Institute in London. In this podcast, Dr. Ryan and Dr. Powles discuss what happens after a diagnosis of metastatic bladder cancer, including new advances in immunotherapy for bladder cancer.

Cancer Basics

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In today's podcast, we'll discuss one study highlighted at ASCO's 2015 Annual Meeting that examined whether a type of surgery known as elective neck dissection improves survival and reduces the risk of a recurrence for people diagnosed with early oral cancer.

Read a patient-friendly summary of this study.

  Cancer Research News

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In this podcast, we’ll discuss one study highlighted at ASCO’s 2015 Annual Meeting that examines whether taking an over-the-counter form of Vitamin B3 reduces the risk of being diagnosed with non-melanoma skin cancer.

Read a patient-friendly summary of this study.

  Cancer Research News

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In this podcast, we will discuss new recommendations for radiation therapy to treat locally advanced non-small cell lung cancer, developed by the American Society for Radiation Oncology and endorsed by ASCO.

Cancer Research News

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Today’s podcast is about new advances in immunotherapy for treating lung cancer, including the recent FDA approval of nivolumab to treat advanced squamous non-small cell lung cancer (NSCLC).

  Cancer Research News

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This podcast is part of a series for patients who have just been diagnosed with a specific genitourinary, or GU cancer. In this series, Dr. Charles Ryan, a medical oncologist and associate professor who specializes in the genitourinary tract at the UCSF Helen Diller Family Comprehensive Cancer Center, speaks with experts on specific GU cancers to shed light on what happens after an initial diagnosis. 

Today’s guest is Dr. Brian Rini, an associate professor of medicine and a staff member in the Department of Solid Tumor Oncology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Ryan and Dr. Rini discuss the decisions that doctors make when a patient is diagnosed with kidney cancer, including some of the factors that go into recommending certain treatment options.

Cancer Basics

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In this podcast, we’ll discuss the role of pathologists in cancer care.

Cancer Basics

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Today’s podcast is about living with lymphedema, a build-up of fluid that may occur after cancer treatment. This podcast will be led by Dr. Judith Nudelman, a family physician and certified lymphedema therapist. 

Side Effects

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A diagnosis of cancer can bring up many emotions and cause stress, anxiety, or depression for both patients and their families. In this podcast, we’ll discuss how seeing a Licensed Marriage and Family Therapist can help a person with cancer, how to find a marriage and family therapist, and what to expect from your visits. 

Cancer Basics

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In this podcast, we’ll discuss a study highlighted at the 2015 Gastrointestinal Cancers Symposium that examines the relationship between Vitamin D levels and survival in patients with advanced colorectal cancer. 

  Cancer Research News

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In this podcast, we’ll discuss some of the breast cancer research announced at the 2014 San Antonio Breast Cancer Symposium, held December ninth through the thirteenth in San Antonio, Texas. 

  Cancer Research News

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In this podcast, we’ll discuss some of the research on multiple myeloma announced at the 2014 Annual Meeting of the American Society of Hematology, held December fifth through the ninth in San Francisco, California. 

  Cancer Research News

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In this podcast, we’ll discuss phase I clinical trials. 

Treatments, Tests, and Procedures

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In this podcast, Dr. Lidia Schapira discusses ways to cope with feeling anxious about having scans for cancer and waiting for the results.

Treatments, Tests, and Procedures

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In this podcast, Debra Haynes talks with Alejandro Muzio, George Donald, and Mariano Siles about meeting and working with a medical interpreter.

Cancer Basics

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In this podcast, Dr. Howard Sandlerdiscusses recommendations endorsed by ASCO for radiation therapy after prostatectomy, which is the removal of a man’s prostate. 

Treatments, Tests, and Procedures

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In this podcast, Dr. Rebecca Smith-Bindman explains the cancer risks associated with computed tomography, or CT, scans and the importance of discussing the risks and benefits of this imaging test with your doctor.

Treatments, Tests, and Procedures

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In this podcast, we’ll discuss meeting and working with a Child Life Specialist and some of the techniques they teach children to help them cope with their diagnosis and treatment. 

Cancer Basics

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In this podcast, we’ll discuss a study highlighted at the 2014 Quality Care Symposium that examines the influence of being a parent on treatment decisions. 

  Cancer Research News

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Many people are familiar with physical therapists, or PTs, for sports injuries or for issues with muscles, joints, and bones, but PTs can treat a variety of functional problems. In this podcast, we discuss how seeing a PT can help a person with cancer, including how to know if you should visit a PT and what to expect during your visits. 

Quality of Life

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In this podcast, we’ll discuss one study highlighted at the 2014 Breast Cancer Symposium that presents research on the impact of sending reminders to women overdue for breast cancer screening with mammography. 

Read a full transcript of this podcast.

  Cancer Research News

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In this podcast, we’ll discuss one study highlighted at the 2014 Breast Cancer Symposium that presents research on the impact that Angelina Jolie’s choice of having surgery to prevent breast cancer had on genetic testing for genes linked to breast cancer risk. 

Read a full transcript of this podcast.

  Cancer Research News

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In this podcast, we’ll discuss one study highlighted at the 2014 Breast Cancer Symposium that presents research on breast cancer recurrence after chemotherapy given before surgery. 

Read a full transcript of this podcast.

  Cancer Research News

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In this podcast, we’ll discuss two studies highlighted at the 2014 Breast Cancer Symposium that relate to surgery for breast cancer treatment and prevention. 

Read a full transcript of this podcast.

  Cancer Research News

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In this podcast, we’ll discuss some of the research on lung cancer presented at ASCO’s 2014 Annual Meeting. 

  Cancer Research News

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In this podcast, we’ll discuss some of the research presented at ASCO’s 2014 Annual Meeting that is likely to be practice-changing, including advances in prostate cancer, breast cancer, and immunotherapy, as well as issues regarding the cost of cancer care. 

  Cancer Research News

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In this podcast, we’ll discuss some of the research on childhood cancers, also called pediatric cancers, presented at ASCO’s 2014 Annual Meeting, including strategies to help choose treatments, new types of treatments, and the long-term effects of treatment.

  Cancer Research News

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In this podcast, we’ll discuss some of the research on brain tumors presented at ASCO’s 2014 Annual Meeting.

  Cancer Research News

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In this podcast, we’ll discuss some of the research on bladder and prostate cancer presented at ASCO’s 2014 Annual Meeting. 

  Cancer Research News

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In thds podcast, we’ll discuss some of the research on melanoma presented at ASCO’s 2014 Annual Meeting. 

  Cancer Research News

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In this podcast, we discuss some of the research on lymphoma presented at ASCO’s 2014 Annual Meeting. 

  Cancer Research News

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In this podcast, we discuss several studies on immunotherapy for melanoma and cervical cancer highlighted at ASCO’s 2014 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss studies on hormonal therapy for breast and prostate cancers, as well as two studies regarding other treatments for colorectal cancer and breast cancer highlighted at ASCO’s 2014 Annual Meeting. 

  Cancer Research News

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In this podcast, we’ll discuss several studies about targeted therapy highlighted at ASCO’s 2014 Annual Meeting, specifically for ovarian cancer, lung cancer, leukemia, and thyroid cancer. 

  Cancer Research News

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In this podcast, we’ll discuss several studies related to patient care and quality of life highlighted at ASCO’s 2014 Annual Meeting, including new research on fertility preservation, caregiving, end of life care, and bone health. In addition, one study discussed focuses on radiation therapy for head and neck cancers. 

  Cancer Research News

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A recording of the May 14, 2014 webinar for patient advocates, patients, survivors, and caregivers on the news coming out of the 2014 ASCO Annual Meeting.

  Cancer Research News

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In this podcast, we discuss the role of an oncology nurse.

Quality of Life

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Dr. Jonas de Souza describes the progress that’s been made in head and neck cancer research. Listen to these highlights from the 2014 Multidisciplinary Head and Neck Cancers Symposium.

  Cancer Research News

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Iris Cohen Fineberg, PhD, MSW, ACSW, OSW-C, and Penelope Damaskos, PhD, LCSW, OSW-C, discuss how social workers help patients get holistic care in partnership with the rest of the health care team. 

Cancer Basics

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Common costs related to cancer care.

Quality of Life

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In today’s podcast, Cancer.Net’s Editor-in-Chief, Dr. Robert Miller talks with patient advocate Wendy Poage about her experience at the 2014 Genitourinary Cancers Symposium.

  Cancer Research News

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This podcast explains what clinical trials are, and how they are conducted.

Cancer Basics

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In this podcast, we review some of the news announced at the 2014 Genitourinary Cancers Symposium, co-sponsored by ASCO.

  Cancer Research News

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In this podcast, we’ll review some of the news announced at the 2014 Gastrointestinal Cancers Symposium, co-sponsored by ASCO.

  Cancer Research News

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In this podcast, we discuss how to choose a doctor for your cancer care.

Cancer Basics

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In this podcast, we discuss palliative care.

  Side Effects

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In this podcast, we talk about follow-up care after cancer treatment.  

  After Treatment and Survivorship

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In this podcast, Dr. Lidia Schapira discusses how to cope with some of the common challenges people with cancer face during the holidays.

  Family, Friends, and Caregivers

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In this podcast, we discuss vaccines and how they may prevent or treat certain types of cancer. We also talk about how cancer vaccines are being tested in clinical trials.

  Treatments, Tests, and Procedures

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In this podcast, we discuss flu vaccination and other ways to lower your risk of getting the flu.

  After Treatment and Survivorship

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In this podcast, we discuss what you can expect if you are scheduled for a biopsy.

Cancer Screening and Prevention

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In this podcast, we discuss some of the news announced at the 2013 Quality Care Symposium.

  Cancer Research News

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In this podcast, Dr. Richard Schilsky, an oncologist and the Chief Medical Officer of ASCO, provides an overview of ASCO’s second Top Five List in Oncology, issued in October 2013.

  Cancer Basics

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In this podcast, Robert Miller and Kala Visvanathan discuss ASCO’s recommendations on drugs to lower breast cancer risk.

  Cancer Screening and Prevention

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In this podcast, we discuss how to understand a cancer research study.

  Cancer Basics

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In this podcast, we discuss the role of Physician Assistants in cancer care. This podcast will be led by Heather Hylton and Todd Pickard.

Quality of Life

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In this podcast, we discuss what to expect as your role of caregiver comes to an end.

  Family, Friends, and Caregivers

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In this podcast, we discuss some of the news announced at the 2013 Breast Cancer Symposium, an educational meeting co-sponsored by ASCO.

  Cancer Research News

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Warmer weather often means more time is spent outdoors in the sun. However, it is important to remember a few simple steps to reduce exposure to the sun's harmful rays, called ultraviolet or UV rays, because UV exposure is the leading cause of skin cancer.

  Cancer Screening and Prevention

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This podcast deals with how to cope with the common fear that cancer will return after treatment is complete.

  After Treatment and Survivorship

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In this podcast, we discuss some of the research on kidney cancer presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on head and neck cancers, including oropharyngeal cancer and cancers related to the human papilloma virus, or HPV, presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on multiple myeloma presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on brain tumors presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on melanoma presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on colorectal cancer and managing the side effects of colorectal cancer treatment presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on lymphoma and chronic lymphocytic leukemia, or CLL, presented at ASCO’s 2013 Annual Meeting.

  Cancer Research News

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In this podcast, we give an overview of the research presented at ASCO’s 2013 Annual Meeting that combines the management of side effects with cancer treatment.

  Cancer Research News

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This podcast talks about 5 steps that people with cancer can take to stay healthy and comfortable during warmer weather.

  Quality of Life

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In this podcast, we talk about how cancer treatment affects the body and options for men and women to preserve their fertility. We'll end with some questions to ask the doctor that you may want to jot down.

  Side Effects

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In this podcast, we discuss one study highlighted at ASCO’s 2013 Annual Meeting on a new type of drug for lung cancer.

  Cancer Research News

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In this podcast, we discuss one study highlighted at ASCO’s 2013 Annual Meeting on the drug sorafenib for patients with locally advanced or metastatic thyroid cancer.

  Cancer Research News

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In this podcast, we discuss one study highlighted at ASCO’s 2013 Annual Meeting that compares two treatments for metastatic colorectal cancer.

  Cancer Research News

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In this podcast, we discuss anxiety, including its causes and symptoms, and how it can be treated.

  Side Effects

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A person who has been touched by cancer often wants to make a difference in the lives of people with the disease by becoming a cancer advocate. In this podcast, we'll talk about what advocacy is as a concept, as well as how advocates play an important role in the cancer community through their activities.

  After Treatment and Survivorship

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In this podcast, we talk about how to recognize three serious conditions that require an call to your doctor. You will also learn how to help prevent these conditions and receive a list of questions to ask your health care team.

  Side Effects

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In this podcast, we discuss the role of an oncology pharmacist. This podcast is led by Drs. R. Donald Harvey and John Valgus.

Quality of Life

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This podcast discusses the concept of self-advocacy and how it can help you partner with your health care team in making decisions about your medical care.

  Cancer Basics

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In this podcast, Dr. Robert Miller explains electronic health records, including what they are, how they are used today and will be in the future, and why they are important for patients.

  Cancer Basics

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In this podcast, we'll talk about how to follow four basic steps to make meal planning and grocery shopping a little easier.

  Quality of Life

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In this podcast, we discuss what to expect during radiation therapy.

  Treatments, Tests, and Procedures

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During this podcast, you'll receive some key facts about colonoscopy and an explanation of what happens during this test, to help you prepare for your own colonoscopy. You will also be offered a list of questions to ask your doctor about your test and its results.

Treatments, Tests, and Procedures

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In this podcast, we discuss myths about developing, treating, and coping with cancer.  

  Cancer Basics

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This podcast explains what to expect during a positron emission tomography scan.

  Treatments, Tests, and Procedures

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In this podcast, we discuss how to safely handle, store, and dispose of medications used to treat cancer and cancer-related side effects.

  Cancer Basics

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In this podcast, we review some of the news announced at the 2013 Genitourinary Cancers Symposium, co-sponsored by ASCO.

  Cancer Research News

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In this podcast, we discuss steps patients can take after cancer treatment is completed.

  After Treatment and Survivorship

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Many people look forward to the winter season. But when the temperature drops, people living with cancer need to take some extra steps to stay as healthy as possible. In this podcast, we’ll explain four steps that people with cancer can take to reduce their risk of illness and stay more comfortable during colder weather.

  Quality of Life

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In this podcast, we review some of the news announced at the 2013 Gastrointestinal Cancer Symposium, co-sponsored by ASCO.

  Cancer Research News

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In this podcast, we discuss ASCO’s recommendations for managing a symptom of cancer and cancer treatment called febrile neutropenia. This podcast is led by Dr. Christopher Flowers, who is an associate professor at the Winship Cancer Institute in the Department of Hematology/Oncology at Emory University in Atlanta.

Treatments, Tests, and Procedures

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In this podcast, we discuss chemotherapy.

  Treatments, Tests, and Procedures

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In this podcast, we discuss some of the highlights of ASCO’s 2012 Clinical Cancer Advances report.

  Cancer Research News

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In this podcast, we discuss some of the news announced at the 2012 Quality Care Symposium.

  Cancer Research News

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Explains what dietary and herbal supplements are, and things to ask if you are considering using them during cancer treatment.

  Cancer Screening and Prevention

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In this podcast, you'll receive a definition of chemoprevention, what these medications can and cannot do, and how they are being studied. We'll also look at some examples of chemoprevention that are being used or studied for their potential benefit in preventing cancer.

  Cancer Screening and Prevention

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This podcast explains what to expect during a mammogram.

Treatments, Tests, and Procedures

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Listen to this podcast to learn how to evaluate your cancer treatment options on the internet.

  Cancer Research News

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What to expect when you meet with a genetic counselor.

  Cancer Screening and Prevention

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In this podcast, we discuss the benefits of stopping tobacco use, also called tobacco cessation, after a cancer diagnosis.

  Cancer Research News

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This podcast explains what to expect during a Pap test, or Pap smear.

Treatments, Tests, and Procedures

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In this podcast, we discuss some of the research on long-term heart problems in childhood cancer survivors presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the news announced at the 2012 Breast Cancer Symposium, an educational meeting co-sponsored by ASCO.

  Cancer Research News

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In this podcast, we discuss some of the research on melanoma presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on the use of surgery for early-stage breast cancer, vitamin D supplementation for women with breast cancer, and making decisions about advanced cancer care planning presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on head and neck cancers presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on prostate cancer presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on ovarian cancer presented at ASCO's 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on aromatase inhibitors, bisphosphonates, and HER2 targeted therapies for breast cancer presented at ASCO’s 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on leukemia presented at ASCO's 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on brain tumors presented at ASCO's 2012 Annual Meeting.

  Cancer Research News

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In this podcast, Hope Rugo, MD discusses some of the research on breast cancer presented at ASCO's 2012 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on colorectal cancer, liver cancer, and cancers of the upper portion of the gastrointestinal tract presented at ASCO's 2012 Annual Meeting.

  Cancer Research News

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This podcast explains what to expect during an ultrasound scan.

  Treatments, Tests, and Procedures

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In this podcast, we discuss news highlighted at ASCO's 2012 Annual Meeting regarding advances in targeted treatments for lung cancer, melanoma, and gastrointestinal stromal tumor.

  Cancer Research News

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In this podcast, we discuss some of the news highlighted at ASCO's 2012 Annual Meeting regarding new combinations of existing therapies and patients' participation in clinical trials.

  Cancer Research News

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In this podcast, we discuss the news highlighted at ASCO's 2012 Annual Meeting that covers research on ovarian cancer treatment, acute lymphoblastic leukemia in adolescents and young adults, kidney cancer treatment choices, and a new targeted treatment for melanoma, kidney cancer, and non-small cell lung cancer.

  Cancer Research News

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Grief is a natural response to loss. It is a process that occurs over time and involves a wide range of emotions, as well as thoughts, behaviors, and physical sensations.

  Family, Friends, and Caregivers

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A recording of the May 16, 2012 webinar for patient advocates on the news coming out of the 2012 ASCO Annual Meeting.

  Cancer Research News

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This podcast explains what to expect during a magnetic resonance imaging, or MRI, scan.

  Treatments, Tests, and Procedures

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In this podcast, we talk about how to cope when switching to a new doctor, where to search for oncologists, and how to narrow down your list of doctors to find the right one for you.

  Cancer Basics

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This podcast discusses what to expect from anesthesia, including the four most common types.

  Side Effects

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Strategies that you can use to get a good night's sleep.

  Quality of Life

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In this podcast, Dr. Allen Lichter provides an overview of the Top Five List in Oncology. This is a list of five common practices in cancer care that are not supported by evidence and that should be questioned before use. This list was created as part of ASCO's participation in the American Board of Internal Medicine Foundation's Choosing Wisely® campaign.

  Cancer Basics

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How to cope with the fear of side effects before starting cancer treatment.

Side Effects

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In this podcast, we talk about some practical steps that may help you make important decisions about your cancer treatment.

Cancer Basics

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How to choose a treatment facility for your cancer care.

  Cancer Basics

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In this podcast, we discuss some helpful tips on such practical topics as organizing medical paperwork, finances, and appointments.

  Treatments, Tests, and Procedures

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How teenagers with cancer can balance school and treatment.

Quality of Life

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Ezra Cohen, MD, discusses the research highlights from the 2012 Multidisciplinary Head and Neck Cancers Symposium in Phoenix, Arizona.

  Cancer Research News

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Getting a second opinion when making cancer treatment decisions.

  Cancer Basics

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Nicholas Vogelzang, MD, discusses the research highlights from the 2012 Genitourinary Cancers Symposium in San Francisco, California, including research on prostate cancer.

  Cancer Research News

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Morton Kahlenberg, MD, discusses the research highlights from the 2012 Gastrointestinal Cancers Symposium in San Francisco, California, including research on pancreatic, colorectal, and esophageal cancers and neuroendocrine tumors.

  Cancer Research News

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This podcast explains what to expect during a computed tomography, or CT, scan.

  Treatments, Tests, and Procedures

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In this podcast, we discuss some of the highlights of the 2011 San Antonio Breast Cancer Symposium, held December 6 - 10, 2011. This podcast is led by Dr. Andrew Seidman and helps put major research advances into context and explain what they mean for patients.

  Cancer Research News

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Highlights of ASCO's 2011 Clinical Cancer Advances report that summarizes the most important advances in clinical cancer research over the past year.

  Cancer Research News

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What to expect as a caregiver to a person with cancer and tips on effectively giving care.

  Family, Friends, and Caregivers

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In this podcast, we talk about the first steps to take when you are diagnosed with cancer.

Cancer Basics

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In this podcast, we talk about what lymphedema is and why it can occur after cancer treatment. We also review the signs and symptoms you should be aware of, as well as some practical steps to take to reduce your risk.

  Side Effects

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How to help a child with cancer understand and prepare for medical tests and procedures.

  Treatments, Tests, and Procedures

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In this podcast, Dr. Gary Lyman discusses nausea and vomiting. Some cancer treatments, including radiation therapy and chemotherapy, may cause these types of side effects. The best way to treat vomiting is to prevent it with medications called antiemetics. To help doctors give their patients the best possible care, ASCO has developed evidence-based recommendations for the use of drugs that prevent vomiting. These guidelines were updated in 2011 to reflect the latest research, and the purpose of this podcast is to summarize these findings.

  Side Effects

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How to balance being a caregiver for your parent with cancer when you are also a parent with young children.

  Family, Friends, and Caregivers

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Andrew Seidman, MD, discusses the research highlights from the 2011 Breast Cancer Symposium in San Francisco, California.

  Cancer Research News

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In this podcast, we discuss some of the research on head and neck cancers presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on multiple myeloma presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on prostate and kidney cancers presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on colorectal cancer, breast cancer, and the cost of cancer care presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on brain tumors presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on lymphoma presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss some of the research on gynecologic cancers presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss several topics presented ASCO's 2011 Annual Meeting, including advances in breast cancer care, personalized treatment options, fertility preservation, and survivorship care.

  Family, Friends, and Caregivers

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In this podcast, Richard Goldberg, MD discusses some of the research on stomach cancer, biliary tract cancer, pancreatic neuroendocrine tumors, and colorectal cancer presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, Julie Gralow, MD discusses some of the research on breast cancer presented at ASCO's 2011 Annual Meeting.

  Cancer Research News

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In this podcast, we discuss news highlighted at ASCO's 2011 Annual Meeting regarding melanoma and neuroblastoma.

  Cancer Research News

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In this podcast, we discuss some of the news highlighted at ASCO's 2011 Annual Meeting regarding new drugs for melanoma and leukemia, selecting treatment for lung cancer, and predicting survival for men with prostate cancer.

  Cancer Research News

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In this podcast, we discuss news highlighted at ASCO's 2011 Annual Meeting regarding personalized medicine and childhood leukemia.

  Cancer Research News

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In March 2011, the Food and Drug Administration, or FDA, approved a medication called ipilimumab, or Yervoy, for the treatment of later-stage melanoma. To help explain the treatment risks and side effects is Lynn M. Schuchter, MD

  Cancer Research News

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A recording of the May 18, 2011 teleconference for patient advocates on the news coming out of the 2011 ASCO Annual Meeting. It includes a discussion of research on HPV testing for cervical cancer, screening and a new treatment for ovarian cancer, PSA testing for prostate cancer, predicting the risk of nerve damage from chemotherapy, treatment for advanced cancers, and the effects of smoking for women with a high risk of breast cancer.

  Cancer Research News

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In this podcast, we discuss dealing with workplace discrimination after a cancer diagnosis.

  After Treatment and Survivorship

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This podcast is led by ASCO member, Evan J. Lipson, MD. Dr. Lipson recently launched a website, called Seize the Days, that offers people with cancer and their families an opportunity to record and preserve audio interviews as a way to share their personal stories with others. In this podcast, Dr. Lipson discusses Seize the Days and provides stories from patients about how a cancer diagnosis affected their lives. ASCO would like to thank Dr. Lipson and his patients for sharing these stories.

  Quality of Life

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In this podcast, ASCO's president, Dr. George Sledge, discusses advanced cancer care planning. Advanced cancer care is cancer that cannot be cured. It's also called end-stage cancer or terminal cancer. However, incurable does not mean untreatable, and people with advanced cancer still have treatment options. ASCO is working with oncologists to help patients and their families talk about advanced cancer to identify the best individual treatment plan for each patient.

  Treatments, Tests, and Procedures

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Nicholas Vogelzang, MD, discusses the research highlights from the 2011 Genitourinary Cancers Symposium in Orlando, Florida, including research on prostate cancer.

  Cancer Research News

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In this podcast, Dr. Charles Loprinzi discusses an essay from that deals with the importance of talking about end-of-life care.

  Treatments, Tests, and Procedures

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In this podcast, Dr. Charles Loprinzi discusses essays from The Art of Oncology that deal with the importance of treatment to relieve symptoms and improve a patient's quality of life, also called palliative care.

  Treatments, Tests, and Procedures

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Morton Kahlenberg, MD, discusses the research highlights from the 2011 Gastrointestinal Cancers Symposium in San Francisco, California, including research on esophageal cancer, anal cancer, colorectal cancer, and gastrointestinal stromal tumor.

  Cancer Research News

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In this podcast, Dr. Charles Loprinzi discusses an essay from that deals with the challenge of deciding when to continue or stop treatment.

  Treatments, Tests, and Procedures

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In this podcast, Dr. Charles Loprinzi discusses several essays from that deal with the difficulty of choosing treatment options when a person has advanced cancer.

  Treatments, Tests, and Procedures

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In this podcast, Dr. Charles Loprinzi provides an introduction to ASCO's The Art of Oncology series. This series is a collection of essays written by doctors about the most difficult conversations that patients and doctors have, including topics such as understanding the chance of recovery, choosing a treatment plan, relieving symptoms and side effects, and end-of-life planning.

  Treatments, Tests, and Procedures

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Five tips to help people with cancer best enjoy the holiday season.

  Family, Friends, and Caregivers

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In this podcast, we'll talk about the types of cancer treatments that may cause oral side effects, as well as the ways people with cancer can prevent and manage such dental problems.

Side Effects

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In this podcast, we discuss the updated ASCO policy statement on genetic testing for cancer susceptibility, published in January 2010. This podcast is led by Dr. Kenneth Offit, and will help explain what this policy statement means for patients.

  Cancer Screening and Prevention

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An illness such as cancer can be one of the most stressful events in a person's life. In this podcast, we'll discuss some practical tips for reducing stress.

  Quality of Life

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In this podcast, we'll review why people treated for certain types of cancer have a higher risk of leg lymphedema, symptoms to watch out for, and some things to do to reduce the risk of leg lymphedema.

  Side Effects

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In this podcast, we'll explain what happens during a barium enema and how you can prepare for the procedure, including a list of questions to ask your doctor.

Treatments, Tests, and Procedures

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In this podcast, Cancer.Net speaks with U.S. Olympic swimmer Eric Shanteau about his experience with testicular cancer.

  Treatments, Tests, and Procedures

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In this podcast, we'll talk about why it's useful to keep your own medical record, what to include, how to compile it, and ways to organize and store your records for safekeeping.

  Treatments, Tests, and Procedures

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This podcast is about a not-for-profit organization called Patient Resource Publishing, which offers a printed information guide for people newly diagnosed with cancer, as a way to provide basic information about treatments and cancer care facilities that may be helpful as they make decisions about their health care.

  Cancer Basics

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In this podcast, we'll review why people with cancer have a higher risk of dehydration, what symptoms to watch out for that may signal dehydration, and offer five simple ways to help keep your body's fluid supply in balance.

Quality of Life

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This podcast talks about six steps that people with cancer can take to stay healthy and comfortable during warmer weather.

  Quality of Life

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This podcast addresses the importance of donating bone marrow.

  Treatments, Tests, and Procedures

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This podcast talks about Planet Cancer, an advocacy and support community of young adults with cancer.

  Quality of Life

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This podcast talks about Imerman Angels, a not-for-profit organization providing one-on-one cancer support by partnering people living with cancer with those who are survivors of the same type of cancer.

  Quality of Life

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Mark Kris, MD discusses changes to the Cancer.Net section on lung cancer, and gives updates on the latest treatments for lung cancer.

  Cancer Research News

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In this podcast, you will be offered some important questions to ask when reading a news story about cancer, to help determine its value to you.

  Cancer Basics

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Mary Jane Massie, MD, discusses the Look Good...Feel Better program from the Personal Care Products Council Foundation. Look Good...Feel Better offers free support programs across the country for women with cancer.

  Quality of Life

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This is the first in a new series of Patient Advocate Guest Columns and Podcasts, launched as a forum for patient advocates to address a topic, issue, or trend within the cancer community through Cancer.Net, the patient information website of the American Society of Clinical Oncology (ASCO).

  After Treatment and Survivorship

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This podcast discusses a decision aid tool developed by ASCO and Cancer Care Ontario to help people who have had surgery for non-small cell lung cancer talk with their doctor about whether to have chemotherapy after surgery.

  Treatments, Tests, and Procedures

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What to expect as you approach the end of your active treatment for cancer.

  After Treatment and Survivorship