Cancer.Net Podcast

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, Dr. Allison Magnuson talks to Beverly Canin, a cancer survivor and patient advocate, about the importance of specialized cancer care for people over 65. They discuss how the health care team can assess and provide specific support for people over 65, why people over 65 should be included in cancer research, and tips for people with cancer in this age group.

Dr. Magnuson is an associate professor of medicine and a board-certified medical oncologist and geriatrician at the University of Rochester Medical Center. Ms. Canin is a patient advocate, research partner, and the co-chair of the Cancer and Aging Research Group's Stakeholders for Care in Oncology & Research for Our Elders Board, or SCOREboard. Dr. Magnuson is the Cancer.Net Associate Editor for Geriatric Oncology, and Ms. Canin is an advisory panelist on the Cancer.Net Editorial Board. You can view their disclosures at Cancer.Net.

Dr. Magnuson: Hi, I'm Dr. Allison Magnuson. I'm a geriatric oncologist from the University of Rochester, and I'm here with a good colleague and friend of mine, Ms. Beverly Canin, who is a patient advocate that I work closely with in geriatric oncology. And we're here today to have a conversation about why geriatric oncology is important, and what advice Beverly would have for older adults with cancer as they're navigating the cancer care process. Beverly and I do not have any relevant relationships to disclose. Good morning, Beverly, how are you?

Beverly Canin: Good morning. I'm very happy to be here. I'm well, thank you. And looking forward to our conversation.

Dr. Magnuson: Me too. Beverly, I thought maybe we could start by you just sharing your story about how you became involved as an advocate in geriatric oncology. I think it's such an interesting story. So I'd love the listeners to hear about that.

Beverly Canin: I'm very happy to do that. I was originally diagnosed with breast cancer in 2000. And for over 10 years, I was a very active advocate for breast cancer doing support for individuals of all ages and also peer review in the California Breast Cancer Research Program, the Department of Defense Breast Cancer Research Program. I worked in NCI, National Cancer Institute, committees and with the FDA. And in all those years of doing both personal support for breast cancer patients and committee work at national, state, and local levels, I was never made aware of special issues for older adults with cancer until I heard a session at the Annual Meeting of ASCO, the American Society of Clinical Oncology. I had been attending that Annual Meeting, but had never noticed that there was a session on cancer and aging. I was attending sessions that pertained to breast cancer only. And I was kind of blown away at what I heard and the fact that I had been an advocate for so long and didn't understand that there was such severe issues pertaining to cancer care for older adults. And it seemed to be based on 2 basic concepts or realities. In simplistic terms, it was that older adults were systematically ineligible for clinical trials, which meant that the results of clinical trials didn't necessarily apply to older adults. So treatments were being recommended that were based on a different population. And the other thing that struck me was that oncologists didn't have any training or minimum training in geriatrics, and geriatricians had little or no training in oncology. So that's what really caused me to see what I could do as an advocate to address these issues.

Dr. Magnuson: That's great. And you know those are some of the reasons why I am so passionate about geriatric oncology and really trying to move forward research about how to best care for older adults with cancer and ensure that older adults are included on clinical trials. I think delving into that piece a little bit more, Beverly, thinking about members of our audience that might be older adults who are talking with their oncologists about treatment options, knowing that some treatment options might be less studied in older adults or there may be less data. Do you have advice for your patients when they're talking with the oncologists about kind of how to talk about this and how to ask questions about how they might tolerate treatment or respond to treatment in that regard?

Beverly Canin: Well, of course, the first thing is to know what studies they're basing their recommendations on. And whether they included older adults in the results of the study. And unfortunately, all too often, we're going to find that the answer is going to be no. So, unfortunately, it really is incumbent upon patients to advocate for themselves and to do some research. And there are places, of course, here at Cancer.Net, and it is a very good resource. We also have the Cancer and Aging Research Group, which I have worked with now for over 10 years. And on their website, there is help and suggestions for older adults with cancer. The basic idea, I think, no matter who the patient is, is to have someone with you to make notes so that you can look back and study later. And to also understand that in most cases, there is time to make decisions. We tend to get very panicked about any kind of cancer and some, obviously, are much more aggressive, much more quickly than others. But for the most part, there is time to do a little bit of research and not make decisions hastily.

Dr. Magnuson: I think that is such important advice. Yeah, always bringing extra supports to help kind of absorb the information too is so key and really being able to have somebody to talk to about kind of that information in the context of your own personal goals and preferences is so important. And I agree also that patients and their support system can be such an advocate about aging-related issues or concerns that they might have that kind of interface with their cancer treatment plan. And I know ASCO and also the ACCC [Association of Community Cancer Centers] are really working hard to kind of disseminate information into academic and community oncology practices about caring for older adults with cancer. So I think we're all working hard to kind of spread that knowledge and patients can help us in that too.

Beverly Canin: It just occurred to me, it's really important also to understand that one of the primary issues and the thing that really needs to be explored with older adults with cancer is what are their goals? What's their hope for their life? Are they more interested in prolonging their life no matter what that means or in the quality of their life? And we have to remember with older adults or with anybody, we actually have 3 ages. We have a chronological age, we have a biological age, and we have a functional age. And those vary with every individual. I mean, the chronological age is fixed. That we know. But what that means for your biology or for your function is not relevant at all. And that is something that has to be explored and that patients need to be thinking about themselves because some patients are willing to tolerate toxicity for a short term in order to extend their life for varying periods of time. To me, a 2-month extension of my life might be very valuable because there may be something that I wanted. I may want to go to a wedding or see my granddaughter graduate or whatever it is. There may be a specific goal that I would like to live to see, but for someone else, that may not be important. They don't want to undergo that kind of toxicity because it may also impair your function or probably will impair the function.

Dr. Magnuson: I think that's so well said. Yes. And I think it's important for us to kind of comment on how doctors do have ways to talk with patients to assess their functional age and really kind of help understand where patients are coming at in relation to their chronological age. And how that might relate to kind of treatment and also supports that we might put in place to try to optimize that treatment experience. But your advice on the goals and values and talking about what your values are with your oncologist, I think, is so important. And really, no matter what your age is.

Beverly Canin: Right. And be honest. Be honest. Sometimes we are reluctant to discuss these things, and that can be a real impediment to the right choices for treatment. And it's not always easy to be honest with yourself. You have to really think of yourself, and your family, those who are also affected by what happens to you. And so it is complicated. It isn't easy. It takes determination. And it's good to be fearless as a patient and not be intimidated by your physicians, by your doctors.

Dr. Magnuson: Yeah, I heard a colleague once say that really, patients are the experts on their own bodies, right? And their own goals and preferences. So really, they are the experts there, right? And so kind of having that knowledge really makes patients such an important, that perspective is so important in the conversation. So making sure there's time and space to talk about that is really important.

Beverly Canin: I also appreciate the clinician who admits that they learn from their patients and that it's impossible to keep up with everything on their own and that they really need to learn from their patients so they appreciate what patients can bring to them.

Dr. Magnuson: Absolutely. Yeah. Beverly, we talk a lot about what we refer to as supportive care during treatment, meaning kind of aside from just the cancer treatment, all the extra things that we might put in place for patients to try to help them through their cancer treatment journey as well as survivorship journey. And sometimes, as a geriatric oncologist, I'm really using information about aging-related things. Maybe physical function or cognitive status. I wonder if just from a patient standpoint, you might comment on kind of why some of those aging-related aspects might be important in our cancer care and how doctors might create a supportive care strategy for patients.

Beverly Canin: I think we're beginning to learn how to do this. I think that's an aspect that has been missing for a long time in intensive care, not just for older patients, but especially for older patients where there are all kinds of issues. And we have not mentioned specifically the geriatric assessment. But this is an important way of getting to these issues. And unfortunately, again, it's something that may be used in academic centers, but you're not finding that this is happening throughout the health care system. And it's very, very important that you use some kind of tool to assess these different ages that we refer to on each patient. And we know that there are several. We know one that is used quite frequently is the one that is found on the Cancer and Aging Research Group site, or CARG site, and which has been validated and used widely. But again, not widely enough, but it is a good way to get to these different issues that are not strictly medical.

Dr. Magnuson: I always use an example of if we have an older patient come in and we assess how their balance is and how quickly they're able to walk, that helps us estimate, are they at an increased risk of falling at home? Because we know a fall can really be a life-changing event. And starting on cancer treatment or chemotherapy might increase our risk for falls. So we really want to be aware of kind of all of those other aspects that might interplay with the cancer treatment so that we can try to head those off and mitigate them. So sometimes we might refer patients to physical therapy to try to improve their balance and strength as we're starting on that cancer treatment journey to try to lower that chance of falling. And I think the most important step is kind of assessing that, as you said, and figuring out where are those vulnerabilities and how can we intervene to try to help support patients in those spaces better?

Beverly Canin: The other thing patients can do is to connect with other patients who are going through what they're going through. And there don't seem to be specific support groups for cancer and aging or organizations that are focused on older adults with cancer. I'd like to see that happen so that we do have that resource available. But for the moment, I think, for the most part, it's a matter of through whatever organizations there are, if they have support groups, to join the support groups and try to meet other patients who are older adults.

Dr. Magnuson: Excellent. I would love to hear your thoughts on research, Beverly. You've been so active as a research advocate and we've worked together, collaborated in that space. But I'd love to hear your advice for patients, older patients who are considering clinical trials, or supportive care research studies. What recommendations you have to them about participating in research and why that might be important.

Beverly Canin: Oh, it's very important as I mentioned early on. One of the issues that is still prevalent is that the eligibility criteria for participation in clinical trials traditionally excluded older adults for reasons that didn't really make any sense. It was fear of comorbidities. Older adults are likely to have other illnesses as well. So they were feeling it might confound the results to have this mix, which didn't make any sense at all. And so now we don't have upper age limits on most clinical trials. But there is a need for patients to engage in clinical trials. And I think there are a lot of misconceptions about participation in clinical trials. And particularly, any of those that have to deal with medical treatment, that patients feel like, "I want to know what I'm getting. I don't want to go into a clinical trial that is having some people on a drug and some people are not on a drug, and I don't know which group I'll be in." But what I think is behind that concern is that you might not be getting the best care that's available at the time. And that's not true because any clinical trials you have to be assured that the participants have at least existing standard of care. And so I think dispelling myths such as that.

The other thing, which you're bringing up, is that there are many, many, many trials that are so important about supportive care for older adults with cancer. And because these are the issues that fall by the wayside, but really, really influence how patients are going to respond to treatments. And so I think it's really, really important for older adults to ask their doctors about clinical trials, if they're eligible for clinical trials, and really consider participating in clinical trials. Many older adults will do so not for themselves, not expecting of results to be helpful to them, but for the future generations, to help future generations. And it's very, very important to think in that way, think in those terms. It's also important to find out, if you do start investigating any clinical trial, to find out what the costs might be to you. The ideal situation is that the patient will incur no cost at all, but we have found that that is not always true. And so it's really, really important to investigate that and understand if there is a risk of incurring any expense, which most patients can't do. And understandably.

Dr. Magnuson: Thanks, Beverly. We've talked a little bit about where patients might be able to go for more resources about cancer and aging information, but I'd love to highlight that. So if you have some just suggestions for patients where they might be able to access that information?

Beverly Canin: We don't have cancer support organizations the way we do for breast cancer or lung cancer and of the association that supports that. We don't have one that does that, but the best sources, I think ASCO here in Cancer.Net is providing information for patients. The Cancer and Aging Research Group website also has a page with information. The SIOG, the International Society of Geriatric Oncology, also has a page for patients. So it's really a matter of addressing the organizations that are focused on cancer and aging, for mostly focus for the research, for the scientists, but many of them also have pages that help patients. And ACCC I believe as well is a source for that.

Dr. Magnuson: Absolutely. Great advice. Lots of resources out there for patients.

Beverly Canin: Yeah, I mean, I wish it were easier than that. It's what we need to develop. We really do need to develop that. But we do have a group, we're engaging patients more and more in research, not as participants in the research but as partners with the researchers. This has been a very, very important development in advancing the issues and improving the research that is being done about cancer and aging.

Dr. Magnuson: Absolutely. As a researcher myself, who's worked with patient advocates and what I refer to as research collaborators, my partners on research, I can't emphasize that statement enough. It has been a critical part of my learning as a researcher and I think really strengthened all of our studies here at Rochester, for sure.

Beverly Canin: We have formed a research group called SCOREboard, Stakeholders For Care and Oncology and Research for our Elders, which is composed of older adults who are in treatment or were treated for cancer as older adults. And caregivers of such patients as well as advocates. And it has been very, very effective. We've been in existence now for over 10 years, about 12 years. And work very closely with the CARG researchers.

Dr. Magnuson: Well, thank you so much, Beverly, for chatting today about this. I hope there were some pearls of wisdom that our listeners were able to take away from you, and I always enjoy talking to you so much. I feel like I learn more every time, Beverly. So thank you for making the time today.

Beverly Canin: Well, I thank you for having me and giving me this opportunity to share my story.

ASCO: Thank you, Dr. Magnuson and Ms. Canin. Learn more about cancer care for adults over 65 at www.cancer.net/olderadults.

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.

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. 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 the data described here may change as research progresses.

In this podcast, Cancer.Net Associate Editor Dr. Norah Lynn Henry covers new research in breast cancer treatment, prevention, and survivorship presented at the 2022 San Antonio Breast Cancer Symposium, held December 6-10.

Dr. Henry is a Professor and Interim Chief of 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 in Ann Arbor, Michigan.

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 from the 2022 San Antonio Breast Cancer Symposium. I have no conflicts of interest for any of the trials that I will talk about today. First, I'm going to give a very brief overview of the types of breast cancer, and 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 treat those cancers with anti-estrogen treatments, which block estrogen or lower estrogen levels. We often combine anti-estrogen treatments with other medications to try to make them work even better against the cancer. 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 HER2 receptors. These are called triple-negative breast cancer and are also often fairly aggressive cancers.

One of the most exciting takeaways from the San Antonio meeting was the promise of new medications on the horizon to treat hormone receptor-positive, HER2-negative metastatic breast cancer. A commonly used treatment for metastatic breast cancer that is hormone receptor-positive and HER2-negative is fulvestrant, which is a type of medicine called "SERD," or selective estrogen receptor degrader. At the meeting, we heard new data about 2 new SERD medications: elacestrant that was tested in the EMERALD trial and camizestrant that was tested in the SERENA trial, both of which are oral pills instead of injection medications and both of which may work particularly well against tumors that have mutations in the estrogen receptor called ESR1. In addition, we heard about capivasertib, which is an AKT inhibitor that was shown to work well when combined with fulvestrant and had less toxicity than some of the similar drugs that had previously been tested.

For treatment of HER2-positive metastatic breast cancer, there are now a lot of medications that have been FDA approved, so some of the questions that clinical trials are now examining are related to what order we should use the medications in when we are treating patients. We heard about 2 studies of the medication trastuzumab deruxtecan, which I'm going to refer to as Enhertu. This drug is a combination of the anti-HER2 antibody trastuzumab plus a chemotherapy drug, and the antibody targets the drug to a cancer like a guided missile. Enhertu is currently routinely used to treat patients with metastatic HER2-positive breast cancer. We heard updated data that showed that when Enhertu was compared head-to-head against trastuzumab emtansine, also known as Kadcyla, patients who were treated with Enhertu were able to stay on the medication for a lot longer compared to patients who were treated with Kadcyla. We also heard that for patients who had already been treated with Kadcyla but it was no longer working, it is reasonable to switch to treatment with Enhertu at that point, because it is still likely to be effective. These studies may help oncologists decide what order to use these newer medications when treating patients with HER2-positive breast cancer.

To switch gears a little bit, I'll now talk about another study I found interesting. This one is in the setting of people who are at high risk of developing breast cancer, but who haven't actually been diagnosed with cancer yet. In general, people are recommended to take either tamoxifen or an aromatase inhibitor medication, which is the same as treatment for patients who have been diagnosed with hormone receptor-positive breast cancer. But in this case, it's trying to prevent them from ever getting breast cancer in the first place. However, many people don't take the medications because they are concerned about side effects. A study was therefore performed in Italy that compared the 5-milligram dose of tamoxifen, which is only one-quarter of the full dose, with placebo for 3 years. After 7 years of follow-up, this low dose of tamoxifen, which is being referred to as "babytam," was shown to reduce the risk of developing breast cancer by about half, which is similar to the effects seen with the full dose of the medication. Plus, there were fewer side effects. This lower dose is likely to be used regularly for prevention of breast cancer based on these findings, although this lower dose of tamoxifen has not yet been tested to see if it is as effective as the full dose of medication for preventing breast cancer recurrence, so it is not routinely recommended for patients who have a diagnosis of breast cancer to receive this lower dose.

Finally, I will touch briefly on exciting results from the POSITIVE trial, which is a trial conducted around the world that examined whether it is safe for young women with hormone receptor-positive breast cancer to stop taking anti-hormone therapy to become pregnant. The women on this trial stopped taking endocrine therapy after taking it for about 18 to 30 months, and then spent up to 2 years trying to become pregnant. About three-quarters of the patients had at least 1 pregnancy during that time, and importantly, there was no increased risk of breast cancer recurrence seen in these patients. Once patients were done with their pregnancy, it was recommended that they restart taking endocrine therapy again.

There were a lot of other research findings presented that were related to treatment for both early-stage and metastatic breast cancer at this meeting. Importantly, we got glimpses of the many new drugs on the horizon for treatment of breast cancer, including the 3 that I mentioned already. 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 San Antonio Breast Cancer Symposium. Stay tuned to Cancer.Net for future updates from upcoming breast cancer conferences. Thank you.

ASCO: Thank you, Dr. Henry. 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.

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 interim of 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.

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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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 what health equity and quality care mean in the context of cancer care and discuss highlights from the 2022 Quality Care Symposium in these areas. Our guests today are Dr. Fay Hlubocky and Dr. Manali Patel. Dr. Hlubocky is a licensed clinical health psychologist with an expertise in psychosocial oncology and a health care ethicist at the University of Chicago. She's also the Cancer.Net Associate Editor for Psychosocial Oncology. Thanks for joining us today, Dr. Hlubocky.

Dr. Fay Hlubocky: Thank you, Brielle. Hello, everyone. So wonderful to be with you all today.

Brielle Gregory Collins: Thank you so much. And Dr. Patel is an assistant professor at Stanford University in the division of oncology and a staff thoracic oncologist at the Veterans Affairs Palo Alto Health Care System. She's also the Cancer.Net Associate Editor for Health Equity. Thanks for joining us today, Dr. Patel.

Dr. Manali Patel: Of course. And thanks for hosting both me and Fay to discuss this really fun topic.

Brielle Gregory Collins: Of course, we're looking forward to it. Before we begin, we should mention that Dr. Hlubocky and Dr. Patel do not have any relationships to disclose related to this podcast, but you can find their full disclosure statements on Cancer.Net. So to start, Dr. Patel, can you first describe what the term health equity means and how it relates to cancer care?

Dr. Patel: Great question. Nice one to start off this podcast. So I think we've always been really focused on health disparities. So I love that you've asked, what is health equity? Health equity is really reframing disparities or differences in cancer outcomes with more of a justice lens. And the full definition, which I love from the Robert Wood Johnson Foundation, describes health equity as meaning that everyone has a fair and just opportunity to be as healthy as possible. This means that you remove obstacles that may impede people's ability to attain their highest health, such as poverty, discrimination, and the consequences of such powerlessness, lack of access to good jobs, having fair pay, quality education and housing, safe environments, and health care. And as it relates to cancer care, it means that everyone has a fair and just opportunity to be as healthy as possible, even with a cancer diagnosis. This means having a fair and just opportunity to receive all of the evidence-based care that we know makes a difference, as well as high quality care that matters from screening to the end of life.

Brielle Gregory Collins: Thank you so much for explaining that. And Dr. Hlubocky, talking about quality care, what does quality care mean in the context of cancer care?

Dr. Hlubocky: Thank you, Brielle. So according to the Institute of Medicine, now known as the National Academy of Medicine, quality care requires the safety, the efficacy, and the efficiency of care delivery. It's also timeliness and a patient-centered approach that's coordinated by an inter-professional oncology team with the integration of evidence-based or research-based practices to continually improve cancer care. It's a very comprehensive, a very value-based form of care that adheres to evidence-based guidelines. It assures the treatment of symptoms, and the side effects of cancer, and the cancer treatment. And it's also coordinated care with strong communication amongst all clinicians and patients, which might involve a written care plan that details all of cancer care, the care in a clinical trial, if that's a potential option for patients. And it also involves shared decision-making, including honest and frank discussion about prognosis, the intensive therapy, patient's values, and also preferences regarding care. As well, it's a research-based support for psychosocial needs. It provides palliative care throughout the course of treatment from diagnosis through the end of life, and end of life care involving hospice.

So quality cancer care was first coined by Dr. Joseph Simone, who was a pediatric oncologist and was the first, really, to advocate for quality-based cancer programs in pediatric oncology for both leukemia and lymphoma. And he was the one who truly started this movement that involves centering on every patient with cancer and every care program. So this year in Chicago at the Quality Care meeting, these interdisciplinary experts really highlighted the latest quality improvement research, as well as guidelines that helps us to improve the quality of cancer care from diagnosis through treatment to survivorship, and again, through end of life care.

Brielle Gregory Collins: Great. Thank you so much for walking through that. And yeah, we're excited to discuss more research from the Quality Care Symposium, too, a little later in this podcast. Dr. Patel, we know that health equity and quality care are linked. So how do health equity and quality care relate to better overall cancer care?

Dr. Patel: Great question. I love the fact that you brought up the Institute of Medicine's definition of quality because in my mind, doing work in health equity for over a decade now, really looking at health equity and quality, I've always thought of them as being intricately linked. But what I loved about the ASCO symposium and now some of the word choices that we're using, really does think that equity is not just a single component of quality, which previously it was. And now, the Institute of Medicine moved equity into being more of a cross-cutting dimension where it is an underpinning of all aspects of what Fay just outlined, in terms of effectiveness, safety, timeliness of care, etc. I think equity, in order to actually achieve high quality care, especially in the cancer realm, health equity has to be a fundamental component of such care. And so now, I'm going to take a step back because I think for years, we've been looking at equity as more of an issue of just access. But you heard in Fay's definition, and the definitions that are out there, that exist for quality, that equity and quality are not really just about access. In other words, differences in cancer care and inequity in cancer care is due to the fact that some populations, such as racial and ethnic minorities, for example, have poorer access to care than others. That is true, but this is just one factor, and it's not the only factor. Even when access is equal, we know that some populations tend to receive lower quality cancer care than others, be it by race and ethnicity, be it by socioeconomic status, gender identity and sexual orientation, or even age. So really, equal access does not equate to equitable care.

What's nice about linking quality and equity and this intricate linkage of the 2 means that you're addressing the effectiveness of the care. You're ensuring that, when you think of quality in terms of equity, the outcomes you're thinking about in terms of race and ethnicity and actually moving towards considering, for example, what different things mean to different patients in terms of effectiveness, safety, timeliness of care, and ensuring that not only are people receiving the care, but that they're all receiving high quality care. I hope that makes sense.

Brielle Gregory Collins: It absolutely does, and I appreciate you, again, walking through that and just explaining how those 2 are connected. And I want to go into some of the research that was presented at this year's Quality Care Symposium. So Dr. Hlubocky, can you introduce some of the key studies or themes that came out of this year's symposium that addressed quality care?

Dr. Hlubocky: Thank you. Absolutely. There were several key quality cancer care themes that had to illuminate the cutting-edge research that is being conducted today and the advances by noted experts in the field, specifically at the symposium. The first being financial toxicity, or financial hardship, and problems that patients may encounter that's caused by the cost of treatment. This was identified as a major thematic session, where multidimensional approaches to addressing financial toxicity were presented, things like screening interventions, survivorship advocacy, and policy. Additional interventions to address financial toxicity were presented. And Dr. Ezekiel Emanuel, from the University of Penn, he's Vice Chair of Global Affairs, but a well-known ethicist in the country. He actually launched the meeting with a phenomenal keynote that was entitled, "New Directions for Cancer Care in the U.S.: Building a Transformational Research and Development Ecosystem and Healthy Payment Landscape That Better Supports Our Patients." We then heard about how screening tools add value to identify patients with financial hardship and how to best implement them. We learned what other cancer centers have implemented regarding financial toxicity programs, and how any cancer center or any practice can implement these tools and interventions aimed at helping our patients with financial toxicity or hardship.

Additionally, smart solutions like leveraging digital health tools to improve cancer care delivery, this also included a study on how health technology can be utilized to improve the delivery of cancer care today and the future, which evaluated the use of web versus mobile devices for ePRO reporting [electronic patient-reported outcomes reporting] and severe symptom responses. I believe it was 6 cancer centers. Symptom monitoring and what we refer to as patient-reported outcomes was also a key topic. And we heard about severe symptom reporting in medical oncology patients at a community center that was assessed through a platform, as well as severe symptom reporting and surgical patients assessed through an EHR-integrated ePRO questionnaire, again, at 6 centers by Dr. Wong at Dartmouth. Physical impairment, pain, and fatigue were top concerns that were identified, and Dr. Wong and her team also identified predictors of severe symptoms so that population surveillance should be considered a priority. And she also encouraged that interventions are really needed to address common severe symptoms and that these future studies should define what is the most effective migration strategies for these symptoms.

Successful integration of health care and health services research interventions in oncology was also another thematic session, and it offered a framework for leveraging health care services research to improve cancer care delivery across the diverse populations. And we know that leaders in the field discussed a variety of these interventions, including hospital at home and geriatric assessment. For example, guidance and geriatric assessment and clinical practice was also presented by the former Cancer.Net geriatrics editor, Dr. William Dale, which included a need to use to inform treatment decisions which would systematically change cancer care delivery.

And finally, an interactive roundtable on rethinking advanced care planning was also held here. These panel experts examined the current model of advanced care planning. What is the merits? How can it be reimagined? And how do we measure outcomes and tools, and what is the impact on caregivers? And finally, regarding the smart solutions, leveraging the digital health tools, we looked at big-tech solutions to common care delivery obstacles, leveraging electronic health records to support treatment and achieving equitable screening. Especially, for example, lung cancer was discussed. I think that hit most of the studies that were presented. What do you think, Manali? Did I miss anything?

Dr. Patel: You did a really nice job of highlighting all of them. There were so many exciting studies that were presented, and it was really a fun meeting not only to spend time with you, Fay, but then also to meet up with colleagues and to see the cross-cutting research across both equity and quality, and the linkage between the 2. On that note, I think I can talk about the different ones that were kind of more focused on equity. And the opening theme was a really nice theme about the structural barriers to equitable care delivery. And again, when you think about quality and equity as being intricately linked, if people are unable to get the highest evidence-based care, providing care-- we can provide care, but if it's not evidence-based care, then are you really moving the quality needle forward? And so the opening theme really looked at, I think, reframing and shifting our views of the focus on the patient as the reason for disparities and inequities to really thinking about structural barriers and barriers that may exist not only at the policy level, but also barriers that exist just in the way that our system is set up with structural racism, ways to overcome structural racism through system-level changes.

Another theme that I thought was really nice that was highlighted was the impact of social determinants and complications from social determinants of health on being able to achieve the highest quality of cancer care for patient populations. And a lot of studies looked at associations of the impact of housing and other health-related social needs such as transportation aspects, which we all know are a clear indicator and a clear barrier for some in terms of being able to achieve the highest quality care. We also saw a lot of abstracts both in the poster discussion, as well as in the main plenary session, including Dr. Otis Brawley's presentation that talked about this very question really here that you're asking us, which is about the linkage between quality and equity. And that entire plenary session that I would love for others to go back and to listen to had some very key poignant takeaways about the linkage, and how that has changed and morphed over time, and also, how our view of equity and this intricate linkage-- again, I know I keep saying intricate linkage, but that's because that's what it is. But this component being more of an underpinning, looking at quality from a whole, from the lens of equity, he did a really nice job of shedding light on this topic.

Brielle Gregory Collins: And Dr. Patel, I do want to ask one follow-up question. So you mentioned this term, social determinants of health. Can you just briefly describe for our audience what that term means?

Dr. Patel: Yeah, very good question. And I think there's a lot being done at ASCO, but also at the national level. And the social determinants of health are these structures that are set up within the way that our social system is set up. So things like housing, transportation, food. Interpersonal violence, for example, is one kind of health-related social need that can come out of not having access. But these are the social structures that are set up that determine how healthy you can be. So if you take a step back and you think about cancer care, for example, and you look at individuals that may not have a home and may have homelessness, and you think about how our treatments may impact. So many of our treatments may cause people's white blood counts to lower during periods of their treatment where we hope they aren't living in congregated areas such as homeless shelters, for example, where they can then become really infected with what we call opportunistic or other infections during treatment. How the homelessness situation impacts someone's health. We know that it not only impacts their ability to receive and our ability, as clinicians, to provide the highest evidence care for individuals living in those situations, but it also impacts other health. And we know that homelessness really does impact an ability for one to be able to be as healthy as possible.

The same with food. We know that the pandemic and some of the work that we've done, Fay and I together, as well as others, have looked at the impact of the pandemic on food insecurity. Now, food insecurity has been a large issue for people, and a determinant of health is what I call it, a social determinant of health. But we know that food is medicine, and for people during the pandemic, we saw food insecurity significantly rise due to wage loss, due to other issues regarding income loss. And that then led to being unable to be able to eat as healthily as possible. If you don't have access to the right food, we know that that makes a difference in terms of your ability to make it through particular cancer treatments. For example, if you're unable to get enough magnesium, calcium, potassium, that can influence what we call your electrolytes and your labs, and make it very difficult for us to give treatment. But even prior to a cancer diagnosis, we know that food determines how healthy you are. And if you're unable to attain food sustenance even from an early age, that can really lower your ability - if you go back to the definition of health equity - your ability to be as healthy as possible.

And these social structures then, which I loved about the ASCO Meeting this year, is-- I've been going to the ASCO Quality Meeting for many years and have kind of been-- Fay knows, right? We've kind of been like these lone people out in our little group of people that come to the ASCO Meeting and the Quality Meeting. We all speak the same language, but there was a real emphasis on interventions this time around, and how can you overcome what, traditionally in the medical realm, we don't think of as being linked with health or at least in oncology? I think primary care physicians and pediatricians have been focused on this for many years. But for us, in oncology, it hasn't really been first and foremost as part of our problem that as oncologists, if we know that people cannot get to our clinic, we need to intervene on transportation. But these other issues like homelessness and food insecurity and poverty really are also in our realm as well in terms of impacting one's ability to achieve health equity.

Brielle Gregory Collins: Thank you so much. That's a really helpful explanation. And too, I want to get into-- there was all this great research to come out of quality, but I want to talk a little bit about what changes are happening in cancer care to improve health equity and quality care. So Dr. Hlubocky, we can start with you. Can you talk a little bit about some of the changes you're seeing happening in cancer care to improve health equity and quality care?

Dr. Hlubocky: Well, I love what Manali has said about coming together first as a community at the meeting, where we're not just friends and colleagues, but we're collaborators and mentors to one another, and we are stimulated by one another's presentations to truly design research that optimizes care for every patient everywhere. And I think that's now the priority in that. And it's important to learn about some of the best practices that can help clinicians really reshape strategies and make key decisions to improve, as we said, that quality, that safety, and the efficiency of cancer care delivery. Certainly at ASCO, we're doing quite a bit with the QOPI Initiatives, the Quality Practice Initiatives, where every cancer center or practice has access to measures that are evidence-based, so we can identify what are the key symptom issues that patients are experiencing so we can use these measures. And ASCO has really been a wonderful partner for many practices along the way. So it's really, really seeing this research is such a motivator. And I wonder, Manali, what additional highlights stick in your mind as to what is the future when it comes to cancer care?

Dr. Patel: Yeah. I mean, that's a fantastic question. I love this question, Brielle, that you're asking us to reflect on. As I mentioned, I really do think that there's been a real shift. And sadly, I think it took George Floyd's murder to link us to the huge discourse. Now that's happening not only in our own small circles locally, but also at the national and policy level, that equity, more so than I've ever seen at a meeting, even at our annual meetings in ASCO, has really become the forefront. And I've started to see meaningful change of not just talking about equity, but also thinking about interventions. I certainly, we think that we're seeing more discussion about equity, more awareness of the importance of equity. The question that you just asked about social determinants of health now is now part of our vernacular and our lingo now, which is wonderful, that we don't always have to describe the impact that social structures and our systems set up for us to be either healthy or not. But what we're also seeing are more dollars being put into incorporating equity, not just research dollars. I think what we saw at the ASCO Quality Meeting was there's a lot of research in this area and there are a lot of like-minded folks that are collaborating together to try to overcome this. But there are also programmatic dollars. And I think even within ASCO and within other organizations that are traditionally medically focused, there's a highlight of equity as part of the mission statement now, which is hugely different than where we were just a couple of years ago when both Fay and I were on the Health Equity Committee, that was not part of the mission statement. So the fact that that's being applied in a visual statement is really different.

We're also seeing policies being made both at the local level. For example, in California, lots of policies being made for MediCal organization. We're starting to see more of a reflection of inequities in care and really, interventions to try to move that on the ground, both within clinics reporting on data, like Fay mentioned, I think is extremely important. A basic step, yes, but one that just has not-- it's been lacking. We conducted a project that was led by Lori Pierce and others through ASCO that looked at just who are the people that are coming into your center? And how many are being enrolled on clinical trials? And what are the race and ethnicity and income and social status of these individuals? And many centers just are unable to report that because we don't collect data on it.

So Fay mentioned that something that does seem very basic now is becoming part of the fabric and there's now more understanding as to why these things are important, and why we need to measure them. And what are we going to do about it? So I really like that there's research happening in parallel where, again, as I mentioned, there were a lot of abstracts that were focused on the association of housing. But at the same time, then you've got interventions that address housing. People that are working with housing authority, or even at the VA, for example, creating safe housing for people during treatment. It doesn't address the whole issue of homelessness, but it does try to band-aid the situation until we have national policy that can provide better housing for individuals overall, or to address some of these issues. And I think that it's been really refreshing-- I don't know about you, Fay, but just for me, refreshing to see interventions that are solution-focused. And what can we take away from these abstracts and really try to implement at home? Or what are some novel ideas that we can do to overcome some of these issues? I hate being stuck in the description paradox of disparities, disparities, inequity, but no real solution as to what we can try to do at home.

Dr. Hlubocky: I fully 100% agree with Manali's statement right there.

Brielle Gregory Collins: Absolutely. And it's so exciting to hear about improvements being made and the needle being moved forward in these areas. I'm sure it's very reassuring for patients to hear that. And speaking of that, there's so much information in this area. For both of you, where do you recommend patients can go online to learn a little bit more about health equity and quality care?

Dr. Hlubocky: Yeah. First and foremost, Cancer.Net. Of course, we have such wonderful content associated with many of the topics that we discussed today, such as financial toxicity, and various symptoms, and psychosocial issues, depression, anxiety, palliative care, end-of-life care. So that's definitely the first stop. As well as the American Cancer Society would be the next one. And the National Coalition for Cancer Survivorship. And of course, the National Cancer Institute, which centers-- they all center on quality care issues, such as those we just discussed today. And of course, I don't know about you, Manali, but really talking also to your cancer team. So that's the first step. But really, I think so many patients are fearful to address some of these issues with the team, [and think that] that we don't have time, and we make time. We make time. Our patients are very important to us, and we really want to optimize care the best that you can. So if any of these issues are a burden and barriers to getting the best care, please reach out to us. There are financial navigators, there's palliative care clinicians, psychosocial clinicians, and many cancer centers, as well as some practices in that. So talking to your oncologist, talking to your nurse practitioner, and they are great resources as the first step to attaining care after you've read some of these resources. Are there others that come to your mind, Manali?

Dr. Patel: Yeah. I mean, great question. I love how you brought it back to the local teams. In terms of thinking about resources, I agree, there are a lot of resources that are local. And so ask your clinical teams, but then also other patient advocacy groups may have more information about resources to overcome some of the barriers that some patients are having, particular barriers, just to get general information about health equity. As Fay mentioned, we love Cancer.Net. I mean, I think it's one of the best resources that I've seen. In fact, my mother and my father go to the website pretty often. They are both cancer survivors as well. But there's a nice piece, again, about health equity and how it integrates into all facets of care and all facets of one's journey through cancer. I think, as I mentioned before, the Robert Wood Johnson Foundation really has nice resources on health equity and also other web-based portals that you can delve into. So there's as much information as you want to learn about health equity, and also solutions focused more on the general picture that's maybe not related to cancer, but again, is linked to cancer. The American Public Health Association is also another really nice website that has a broad swath of how health equity and the issues that we talked about today, the social and economic structures, impact one's health overall. Again, not cancer-related, but everything is cancer-related. And so you can bring back some of those take-home messages to how it may impact one's cancer care.

And then I really love-- for me, personally, the University of California Berkeley is a nice, free resource that has publications, depending on how deeply you want to delve into the questions and some of the brief topics that we've talked here, that are all focused on health equity. And it's a really nice website that hopefully, we can put into the link of the podcast description.

Brielle Gregory Collins: Absolutely. Those are great resources. Thank you both for sharing those. And thank you again for your time and for sharing your expertise today. This was such a great discussion. It was really great having you both.

Dr. Patel: Well, thank you for even highlighting this important topic of health equity and quality. Again, for me, it seems just completely, almost a no-brainer, that these 2 go together. But it's not always as easy as you think to link the 2. And so it's really nice that you all have come up with this podcast idea and also brought wonderful Fay and me together to do this. [laughter] There's so much admiration for what Fay is doing, and it was really humbling to be on a podcast with you, Fay.

Dr. Hlubocky: Oh, it's an honor and a pleasure to be with you, Manali. You truly are an advocate and a guru, a wisdom when it comes to equity and equity issues and illuminating the issues nationally. So such an honor and pleasure to be with you. And of course, with Claire and Brielle, and to all the patients and caregivers and our colleagues, we're here for you. So don't forget to reach out to your oncology team and here with us at Cancer.Net.

Brielle Gregory Collins: Thank you both so much.

ASCO: 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.

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, 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.

Dr. Le is an assistant professor in the Department of Thoracic/Head and Neck Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston, Texas. She is also a 2022 Lung Cancer Advisory Panelist on the Cancer.Net Editorial Board.

You can view Dr. Le's disclosures at Cancer.Net.

Dr. Le: Hi everyone. This is Xiuning Le. I'm an assistant professor here at MD Anderson in the Department of Thoracic/Head and Neck Medical Oncology department. I am a medical oncologist. I am a clinical investigator and also translational researcher. So today is a great opportunity to discuss some of the new meeting updates from 2022 North America Conference on Lung Cancer. Let me begin with the information about the meeting itself. So this conference, North America Conference on Lung Cancer, is organized by an organization called the International Association for the Study of Lung Cancer. As reflected in the name, this is an international organization for all the lung cancer researchers to get together to share our research, experience, and also patient advocates as well as patients participate in this fantastic organization. This organization also has meetings every year, including a World Lung Conference as well as the meeting we're going to talk a little bit about today, focusing on the progress we made in the North America. Therefore, it's called North America Conference on Lung Cancer. In this year's meeting, we had a very active agenda with multiple presenters from different parts of the U.S. And we also had international participants as well. We had exciting updates on some of the targeted therapy trials as well as updates from immunotherapy trials. So it was a very productive meeting.

Let me start with some of the updates from the targeted therapy space. During the meeting oral presentation, there were 3 abstracts selected for oral presentations. The first talk I would briefly discuss today is an update study for ADAURA trial using osimertinib as an adjuvant therapy for resected lung cancer patients whose tumor has EGFR mutation. This was presented by Dr. Roy Herbst, key investigator on the trial from Yale Cancer Center. So ADAURA trial is a multicenter international trial taking patients whose lung cancer have EGFR classical mutation at the diagnosis, or stage 1B to 3A, and then undergoing chemotherapy as the initial adjuvant treatment. But after completion of those treatments, patients were offered opportunities to go on to the trial receiving either osimertinib for 3 years or best supportive care placebo. The primary report of this trial became available in year 2021, where the osimertinib-treated patient had a significant clinical benefit reflected as the disease-free survival was much higher in the patient population who received osimertinib. The results of the ADAURA trial led to the FDA approval of using osimertinib in the surgically resected EGFR-mutant non-small cell lung cancer. So that's the background of this year's update and presentation.

Now, in the fall of 2022, after additional long follow-up, the data become more mature because although we still don't have overall survival results, we start to have 3-year disease-free survival. So in the study population, each is over 300 patients each arm, the 3-year disease-free survival rate was 84% for patients who receive osimertinib and then for placebo group is 34%. As you can see, this is a 2.5-fold significant benefit in the patient who received the treatment. The presentation was also a breakdown the patient population by their stage by different subgroup analysis across the board. The patient who received osimertinib derived benefit and then the hazard ratio remained to be between 0.2 to 0.3, depending which population we're looking at. Really, this data validated and confirmed the prior knowledge of this approach of offering adjuvant osimertinib really works and really should be offered to every single patient who qualifies for this study. One update on the subgroup analysis is the benefit for preventing brain metastasis to happen in the patients. Very impressive. We observe a hazard ratio of 0.24, meaning that if a patient goes on to osimertinib has a 4-fold benefit of not to develop brain metastasis. Overall, the conclusion of this presentation is that this data becoming more mature, and then the mature data reinforced that adjuvant osimertinib really should be the standard of care which we have been using pretty widely in the clinic.

The second abstract I want to talk about is a presentation that's presented by Dr. Lyudmila Bazhenova from University of California, San Diego. So she presented a pooled updated analysis on a novel EGFR exon 20 insertion medication. And then this medication currently is under U.S. FDA evaluation with breakthrough therapy designation. The drug's chemical name is called DZD9008, and then the drug's brand name is sunvozertinib. This is a great addition to the treatment option that we already start to see for EGFR exon 20 as a new inhibitor coming at the horizon. EGFR, we now start to classify all the mutations into classical mutation versus exon 20 mutation, as we are using different targeted therapy for different patients. For EGFR exon 20 insertion, we have already 2 FDA-approved drugs. One is amivantamab, the other is mobocertinib. But we still need more options for our patients. And this new medication, DZD9008, is having a great potential of becoming the next-generation EGFR exon 20 drug, as it showed good efficacy and pretty low toxicity.

So let's review the data that's presented here. In this meeting abstract, the authors combined 2 studies. One is called WU-KONG1. The other is called WU-KONG2. The first one was conducted in the U.S., and the second one was conducted in China. So there is a value of pooling different patient populations together and then not just getting the sample size greater but also understand different patient population, are they all having very similar benefit? Here the focus on analyzing the patient population that EGFR exon 20 lung cancer who have already received the chemotherapy. In the total of 71 patients analyzed here, in the subgroup of receiving 300 mg daily dose, the response rate was observed to be 40% to 45% depending on if you're using the central review system or you're using the investigator evaluation. But again, showing a very promising response. I want to put those numbers in the reference. For example, the currently FDA approved, the mobocertinib, in their population also had prior treatment. The response for mobocertinib was 28%. In the over 100 patient population, in these 71 patients, they see a 40% to 45% response. So potentially this one is having an even better efficacy really translate into clinic can be a great opportunity for the patients who had chemotherapy and needs something else. Also, we reviewed the toxicity profile. This drug is overall pretty well tolerated. We have to say that the population is relatively small. In order to truly understand toxicity, we usually want to look at the multi-hundred patients' experience, but I believe the data will mature over time. I would have to say the result here is very exciting.

The third abstract I will be talking about today is presented by myself, Xiuning Le from MD Anderson. In this abstract, we evaluated tepotinib, which is a MET inhibitor, their efficacy and safety in MET amplified non-small cell lung cancer patients. As we already know, MET exon 14 skipping represents a molecular subgroup that can benefit from MET TKI, including tepotinib. But MET amplification without MET exon 14 is another patient subgroup that could potentially benefit from MET inhibition. As in those cancers, MET not using exon 14 skipping as driving events rather than amplify. So the gene makes many copies of itself, so that drives the tumor growth that way. In this abstract, in this analysis, MET amplified non-small cell lung cancer patients were identified and offered tepotinib. So in this group, there are 24 patients who were treated on the VISION trial cohort B, and we observe a response rate of 42%. For a targeted therapy, having a 42% of response is really pretty encouraging. And the duration of response also is expected at multiple months. We showed that the therapy was particularly beneficial for patients who are treatment-naive. In that setting, the response rate can be as high as 70%.

This time, this year, we updated our molecular analysis for this patient cohort trying to understand deeper, do we have other signals to help us to decide which patient could benefit more and which patient might benefit less and then need something else? In the molecular analysis, we find that focal MET amplification is quite important. In another word, if MET amplification is the only event, then more likely this MET TKI will work in that patient population. However, if the tumor also has p53 or RB loss or certain other genetic alterations, then the response rate can be more inferior. So I think we are starting to understand each of the molecular-driven patient population group into even more molecular detail, understanding the co-mutations' impact to the clinical outcome. So I think this abstract is interesting in pointing directions of how to use an existing medication to patients to magnify the benefits that we can potentially achieve.

So this year's North America Lung Conference was really productive. We had a lot of stimulating presentations and a lot of discussions. Other than the targeted therapy session, we have seen 2 exciting abstract on the immunotherapy updates. Other than that, we start to have more opportunities to learn about cancer screening, cancer prevention, smoking addiction, and then the cancer survivorship. There are 2 abstracts presented at the oral section for that topic as well. So this meeting is particularly interesting opportunity for North America investigators, especially in their junior stage, to network, to present their work, and then to have exposure to major investigators in the field as well.

Dr. Le: Thank you, Dr. Le. 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.

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, 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.

First, Dr. David Ilson discusses treatment advances in liver, colorectal, and gastric, or stomach, cancers. Dr. Ilson is an attending physician and member at Memorial Sloan Kettering Cancer Center and a professor of medicine at Weill Cornell Medical College.

You can view Dr. Ilson's disclosures at Cancer.Net.

Dr. Ilson: Hi, I'm Dr. David Ilson from Memorial Sloan Kettering Cancer Center in New York. I'm a GI medical oncologist, and it's my pleasure today to review some important presentations in GI cancers from the recent ESMO meeting in Paris from 2022. I have no relevant relationships to disclose for this discussion. So, important presentations were made in hepatocellular cancer, in colorectal cancer, and gastric and other cancers, and I'm going to highlight some of the key presentations from the meeting.

One of the most anxiously awaited presentations was one in hepatocellular or liver cancer. For patients that have advanced disease who are not candidates for surgery or local treatments, standard therapy now, it used to be lenvatinib and sorafenib, and that's now been replaced by the combination of an immunotherapy drug, atezolizumab combined with the drug bevacizumab. That's the new standard of care. And recently, we had a promising data for another immunotherapy combination using the drug durvalumab combined with tremelimumab.

So what we saw this year was another important global study looking at the first-line use of immunotherapy in hepatocellular cancer. This trial took 794 patients with advanced hepatocellular cancer and assigned them to a standard treatment with a drug called lenvatinib. Lenvatinib and sorafenib were the old standard treatments for hepatocellular cancer. And lenvatinib alone was compared to a combination of lenvatinib and pembrolizumab, an immunotherapy drug. The primary endpoint was to see whether adding immunotherapy to lenvatinib improved survival. And this was a negative trial. It did not show an improvement in survival for adding pembrolizumab to lenvatinib over lenvatinib alone, and there was really no significant difference in the time that patients were on treatment. The response was slightly higher with the addition of pembrolizumab to lenvatinib, but again there was no survival difference. So this combination will not move forward. And again, as I said earlier, the new standard first-line treatment is atezolizumab plus bevacizumab.

In colorectal cancer, probably one of the most exciting presentations was the use of immunotherapy treatments in locally advanced colon cancer. There is an important subset of colorectal cancer that has what's called an MSI-high status. MSI-high colon cancers are very responsive to immunotherapy drugs, and there has been a lot of interest in patients with localized colorectal cancer using immunotherapy drugs prior to surgery rather than conventional chemotherapy or radiation. So this important trial looked at 112 patients with localized colorectal cancer. Most of the patients were stage 3, and they all were documented to have this MSI-high status, which indicated a higher chance of response to immunotherapy. And patients received a brief course of immunotherapy, 2 doses of the drug nivolumab combined with 1 dose of ipilimumab over only 6 weeks followed by surgery. What they showed in these 112 patients who went to surgery, there was almost 100% response to this treatment. In fact, almost two-thirds of patients had no cancer found at surgery, even only after several weeks of immunotherapy. And in the 112 patients treated, there have been no recurrences in any of these patients.

So it's quite remarkable that immunotherapy could induce a complete remission in two-thirds of patients, and that was only after a few weeks of exposure of the drug. So I think we're going to see more interest in using immunotherapy treatments as a potential pre-surgical treatment for colon cancer. And we could argue with such a high rate of complete remission, if we gave immunotherapy longer, maybe we could consider nonsurgical management, to just keep treating the patients with immunotherapy. This is actually the case that's now been seen in rectal cancer, a recent study presented from my institution where they treated patients with rectal cancer with immunotherapy, and we also achieved 100% remission, and none of the patients in this small study required surgery. So I think this important study, which is called the NICHE-2 trial, indicates a high degree of effectiveness of immunotherapy in MSI-high colon cancers. And certainly, it raises interest in using this as a preoperative treatment and potentially could lead to some patients getting treatment with immunotherapy alone without surgery.

Then I'm going to comment a little bit about advanced metastatic colon cancer. Another important presentation was studying a new drug called fruquintinib. Fruquintinib is an oral drug that targets the VEGF pathway, which is an angiogenesis pathway in colon cancer. Standard treatment for colon cancer when it's stage 4 disease is now use of chemotherapy, like FOLFOX and FOLFIRI, drugs like bevacizumab, cetuximab, and panitumumab. And in more chemotherapy-resistant cancers, we use drugs like regorafenib and TAS-102. So this trial looked at a large group of patients, over 690 patients who had received all conventional treatments. They had progressive disease on all conventional treatments, including the late-line drugs regorafenib and TAS-102. And this was a placebo-controlled trial in which patients either received the drug fruquintinib or they received placebo plus supportive care. It was reasonable to offer a placebo in this trial because there really was no other standard treatment option for these patients. The primary endpoint of overall survival was improved with fruquintinib. Survival was improved with a reduction in the risk of death by about 30% and improvement in time on treatment. Very few patients responded to fruquintinib, so this was largely a drug that stabilized the cancer, but it did lead to modest improvements in time on treatment and modest improvements in survival. So this drug may potentially be evaluated as a new treatment option in very chemotherapy-resistant colorectal cancer.

I just want to mention briefly another new class of agents for which we had data presented at the ESMO meeting. These are drugs that inhibit a mutation in their cancer called KRAS G12C. There are promising drugs that target this pathway. And there were 2 drugs that were followed up on at ESMO, one was a drug called sotorasib and another drug was adagrasib. These are drugs that target KRAS G12C mutations in colon cancer. And both of the trials that were presented used these drugs combined with drugs that target the EGFR pathways, so either panitumumab or cetuximab, and very encouraging responses were seen on these trials. The trial that looked at the combination of adagrasib plus cetuximab achieved a response in about 46% of patients, which is very encouraging. The trial that studied sotorasib, combined sotorasib with panitumumab, and they observed a 30% response, and some of these responses were durable. So the take-home message is that these drugs, adagrasib and sotorasib, are promising new agents to target KRAS G12C mutations in patients with advanced colon cancer and indicate that we may get even a higher degree of activity when we add EGFR-targeted drugs including panitumumab or cetuximab to these agents.

So the other area that I want to comment on is gastric cancer. Recently, in the United States, we had a regulatory approval for the drug trastuzumab deruxtecan in patients who have HER2-positive gastric cancer that's advanced and is being treated with chemotherapy alone, HER-2-positive patients who had received previous trastuzumab or Herceptin. So trastuzumab deruxtecan is a promising drug used in patients that develop resistance to trastuzumab. So there was an update of the trial called Gastric-DESTINY02, which was a phase 2 trial of trastuzumab deruxtecan in Wwestern patients as a second-line treatment for patients with HER2-positive gastric cancer, and the updated analysis again showed a promising response in 40% of patients. The response duration was about 8 months, and patients achieved a survival of a year or more. So this updated presentation really reinforced that this is an active drug for patients with HER2-positive gastric cancer whose disease progresses on previous treatment with trastuzumab.

So this was a very exciting ESMO meeting. There were a lot of other studies and important presentations, but I've tried to highlight today what I think are the most important as we move forward in trying to identify new treatments for patients.

ASCO: Thank you, Dr. Ilson.

Next, Dr. Sumanta (Monty) Pal and Dr. Tian Zhang discuss new research in kidney, bladder, and prostate cancers.

Dr. Pal is the co-director of City of Hope's Kidney Cancer Program and is the head of the kidney and bladder cancer disease team at the institution. Dr. Zhang is an Associate Professor of Internal Medicine at UT Southwestern Medical Center and is a medical oncologist at the Harold C. Simmons Comprehensive Cancer Center.

You can view disclosures for Dr. Pal and Dr. Zhang at Cancer.Net.

Dr. Pal: Welcome to this Cancer.Net podcast. My name is Monty Pal. I'm a medical oncologist in the City of Hope in Los Angeles. I'm thrilled to be here today with my dear friend and colleague, Dr. Tian Zhang from UT Southwestern. Tian, mind giving us a quick intro?

Dr. Zhang: Hi, Monty. Great to be here with you today. Tian Zhang at UT Southwestern in Dallas, Texas, where I'm a GU medical oncologist. I'm really excited to talk through the ESMO trials with you today.

Dr. Pal: A little bit of housekeeping first. Let's go ahead and get some of our disclosures out of the way. I get travel support from CRISPR Therapeutics and from Ipsen. Tian, how about you?

Dr. Zhang: Sure. I've received honoraria from Exelixis, BMS, Genentech, AstraZeneca, and Janssen, all relevant to our discussion today.

Dr. Pal: Very good, very good. Well, thank you so much for joining us today. We've got a lot to talk about in about 15 minutes. The first thing that I wanted to chat about is adjuvant therapy. First of all, before we dive into the weeds here, can you just kind of tell our audience what adjuvant therapy is in broad strokes?

Dr. Zhang: In kidney cancer, we think a lot about how we might prevent disease recurrence after surgery. So adjuvant treatment refers to systemic treatment that's given after a big surgery. And so in kidney cancer, that's usually after nephrectomy or removal of the kidney.

Dr. Pal: Excellent, excellent. You beat me to the punchline. We are going to focus on kidney cancer, no doubt. This year at the European Society of Medical Oncology, or ESMO, meeting, which was held in early September, we actually had some really key studies presented in this space, one of which I'll disclose that I led. Studies I would say were maybe a little bit disheartening there, but nonetheless, I do think we can learn a lot from them. One of these trials was called PROSPER. This was a really interesting study that actually didn't just look at adjuvant therapy but actually looked at treatment before surgery, which we called neoadjuvant therapy. Tian, can you kind of walk us through the design of that trial really quickly?

Dr. Zhang: This was a trial done in the ECOG Cooperative Group, and patients were randomized to receiving either nivolumab, which is an immune checkpoint inhibitor, before surgery, followed by a year of nivolumab after surgery, or to surgery and observation with ongoing scans. So it was really trying to look at a perioperative approach of using nivolumab.

Dr. Pal: So how about this? Maybe we'll kind of discuss some of these results in amalgam, but maybe let's go through these trial designs first. The second trial that was highlighted this year at ESMO was called IMmotion010. That's one thing that I just love about these studies. They all have very clever names. I don't know what an IMmotion is, but tell us about IMmotion010 and what that trial design looked like.

Dr. Zhang: Sure. So IMmotion010, again, also was an adjuvant trial for resected intermediate- and high-risk kidney cancers, randomized folks to either atezolizumab for a year or placebo for a year. And so this is in the context of having had resected kidney cancers and following folks for the treatment results, and the primary endpoint there was disease-free survival.

Dr. Pal: Okay. So we've got an immune therapy called nivolumab and the PROSPER trial that was looked at before and after surgery. We've got atezolizumab, a different checkpoint inhibitor that was looked at following surgery. Tell us about the third trial. This is the last study in the space called CheckMate 914. What did that trial look at?

Dr. Zhang: That one, again, also a phase 3 adjuvant trial, enrolling folks after surgery that had high-risk kidney cancer and randomized to either the combination of nivolumab with ipilimumab, both checkpoint inhibitors versus placebo. And again, this treated patients for about 6 months and also primary endpoint of disease-free survival.

Dr. Pal: Now, whenever we do these studies, we always define them as being positive or negative, and that's really not meant to sort of cast any aspersions on how well the study was done or any really sentiments around the trial itself. It's really objective, and it's based on whether or not a study hits what we define ahead of the trial as being called a primary endpoint. So we actually, in these studies, looked at a primary endpoint of something called recurrence-free survival. And so that's really the proportion of patients who actually are living on without any sort of recurrence of their kidney cancer. I think it might be easy enough to sort of describe whether or not these trials hit that endpoint were positive or negative. What was the final report here on these trials, Tian?

Dr. Zhang: Well, Monty, I think all 3 of these trials were, quote-unquote, "negative," and we all had high hopes for all 3 of these trials. And certainly, many, many patients participated, and we will learn eventually a lot from these trials. But none of these 3 met their prespecified primary endpoint of recurrence-free survival endpoint.

Dr. Pal: So this is a little bit tricky because we did have these 3 negative studies presented at ESMO this year, but there was 1 positive trial that's adjuvant or postoperative space presented previously and then now published, actually, in the New England Journal of Medicine with an FDA approval to boot. Can you tell us about that, Tian?

Dr. Zhang: Well, that one was called KEYNOTE-564 and randomized patients to either a year of pembrolizumab or placebo. And so you're absolutely right. It did show an improvement in disease-free survival comparing pembrolizumab with placebo. And so pembrolizumab is approved in this adjuvant setting after nephrectomy.

Dr. Pal: And so this can be kind of a tough space because I can imagine our listeners are hearing this saying, "OK. Well, at ESMO, we've got 3 negative trials looking at postoperative therapy, and we've got 1 positive trial looking at pembrolizumab in the space." So what's one to do in this setting? What are you telling patients these days about whether or not to use adjuvant treatment for kidney cancer?

Dr. Zhang: Yeah. I think it's a conversation that patients have with their oncologist after surgery, and it really depends on their own risk factors, their clinical and pathologic features at the time of resection. It depends a lot on patient preferences and their own priorities and things such as their tolerance for toxicity or how often they're coming into the treatment center. And I do think this is a time point where they have a shared decision-making that we can help our patients understand the totality of the data and then decide if a year of pembrolizumab is worthwhile or if they'd rather continue with surveillance after surgery.

Dr. Pal: I totally agree with you, and I love that term "shared decision-making," because it's never one of those situations where I walk into the clinic room and say, "Here's what you're going to do." And it's also never the situation where the patient walks into the clinic room and says, "Here's what I want." It's always this really sort of mutual process, isn't it, where you sort of look at a patient's clinical state. You look at some of the features under the microscope, but then it comes down to really, really lengthy and personal discussions around what that patient wants to get out of treatment. So I think that's very well said, Tian.

I'm going to move to actually a different setting, which is termed "metastatic disease." So we've talked about localized kidney cancer, where the disease is sort of confined to the kidney for the most part. We talked about what we do after we remove visible evidence of disease. But there is, unfortunately, a number of patients where we can't necessarily remove all the disease burden. So we lean more heavily on what we call systemic treatments. These are treatments that enter into the bloodstream either by mouth or through the veins. And in kidney cancer, just to give you a really, really brief synopsis, there's been this huge evolution over time. When I started in the field, it was really the advent of using a single oral therapy for kidney cancer. And over the next five 5 years, we sort of saw this evolution towards using doublet therapies, which is a mix of pills and IVs or maybe IVs alone. And more recently, there's been a lot of excitement. You can probably see where this is going, right? We've looked at 1 drug, and it works. We've looked at 2 drugs, and they seem to work. Logic would perhaps suggest that maybe you could get away with using 3 drugs in concert. So, Tian, this year at ESMO, there was a really important trial called COSMIC-313 that looked at 3 drugs versus 2 drugs. Can you tell us a little bit more about the design of the study?

Dr. Zhang: COSMIC-313, the large phase 3 study, which randomized more than 850 patients to either the triplet, as you're speaking of, the cabozantinib, nivolumab, and ipilimumab versus nivolumab and ipilimumab with placebo standing in for cabozantinib. And so this was a very large trial, looking particularly at progression-free survival, comparing the triplet versus the immunotherapy doublet.

Dr. Pal: And then tell us about the results of this because I have to tell you. I mean, I spent a lot of time looking over this, and I struggled with the end results a little bit. We talked about the primary endpoint of studies when we were discussing adjuvant therapy. And one of the things we'd mentioned is that you decide on this beforehand. And the primary endpoint in this trial was actually the delay in cancer growth. And as you pointed out, the study met that endpoint. But how do you interpret the results overall? How are you incorporating triplet therapy now?

Dr. Zhang: Sure. I think it did certainly meet the progression-free survival primary endpoint. The median was not reached for the triplet versus 11.3 months for the doublet. And so importantly, I think it was a, quote-unquote, "positive trial." But how are we using this? Well, we have not seen the overall survival data of these patients. And so when you're thinking about combining all 3 drugs in the frontline setting, I think it's really important to think about what might come after and whether these folks truly live longer with using all 3 upfront versus a sequential approach. So I think the jury is still out. It certainly met its primary endpoint, and it's quite promising. But I'm still waiting for the overall survival data to really inform or change my practice.

Dr. Pal: I've got to agree with you there. One of the things that we always discussed in clinic is whether or not a particular treatment strategy is going to increase longevity. It comes up in every conversation, I would say, whenever we're thinking about approaching a new line of treatment. And I wish I could say definitively that this triplet strategy improves longevity, but to be totally fair, that data just doesn't exist yet. So it's a really difficult conversation. I agree with you. Maybe a little pause before we start incorporating triplets.

So I've got to say, it was certainly a big year for kidney cancer, one of my fellows put this table together, and it really showed that this year amongst the past maybe 10 years in kidney cancer, we had more big phase 3 trials being reported as more than any year previously. But there are also some pretty key developments in other diseases that you and I treat, Tian, and one of those is bladder cancer. And a trial that I think was really quite important has the name EV-103. Tough name to remember, but it actually looked at a disease space that I think can be a bit of a challenge for us, and that's the patient who is presenting in the clinic has actually advanced bladder cancers spread to other parts of the body and is quite ill and perhaps can't receive conventional aggressive chemotherapy with a drug called cisplatin. So what did this proportion of EV-103 that was presented show us?

Dr. Zhang: Well, people hear about Cohort K thrown around, and so this trial actually has had multiple cohorts. And this particular cohort came out of some really exciting data from their dose escalation studies, and also Cohort A, where patients were treated with an antibody drug conjugate, this enfortumab vedotin, or EV, with an immune checkpoint inhibitor called pembrolizumab. And in the early cohort of 40 patients, they saw a pretty high objective response rate. That means the rate of patients where tumors were shrinking. And so that was about 70% of those 40 patients had objective responses. And so they designed this Cohort K to randomize patients to either enfortumab vedotin with pembrolizumab or enfortumab vedotin on its own, which has been approved in refractory metastatic urothelial cancer but particularly for first-line cisplatin-ineligible patient population. And so they randomized about 150 patients in the setting and looked at objective responses, and I agree with you. Certainly, very promising in terms of having objective response rate of about 65% and compared with enfortumab vedotin on its own, which came in around 45%. It does seem that this combination has more activity than the monotherapy.

Dr. Pal: Yeah. That's a great summary. And to the patients out there listening, when we talk about responses, we're talking about pretty deep responses here, meaning 30% or more reductions in the size of tumors. And Tian mentions that you've got 65% to 70% of patients with these responses. It really does entail a sizable reduction, not just a small decrease in the volume of tumors. And I'm telling you, just from having been in the scene for 15 years now, I mean, it's just remarkable sort of progress that we're making.

We're going to wrap up by talking about prostate cancer, and just to really describe some overarching results. So there's a setting in prostate cancer that I always find to be a bit of a challenge, and these are patients who have had surgery for their prostate cancer. So extensively no visible spread of their disease, but they start having their PSA creep up afterwards. And there was a trial that sort of addressed that. Tian, can you give us the sort of quick and dirty summary of the study?

Dr. Zhang: Sure. So we call this PSA recurrence or biochemical recurrence setting. And this trial was led by Dr. Rahul Aggarwal in the Alliance Cooperative Group. But everyone who had biochemical recurrence were randomized to receiving androgen deprivation therapy alone, which is usually our standard of care; a combination of that androgen deprivation therapy with apalutamide, which is an androgen receptor blocker; or the combination of a triplet of the androgen deprivation therapy, the apalutamide, and then an abiraterone acetate, which is a blocker of steroid synthesis in the adrenal glands. And so this trial enrolled ultimately about 500 patients and randomized them 1 to 1 to 1 to these 3 cohorts. And interestingly, the combinations of either the androgen receptor, androgen deprivation therapy with apalutamide or the triplet with combined abiraterone acetate all prolonged PSA progression-free survival compared to androgen deprivation therapy alone. So I think it was a really well-done study in the cooperative groups and helps answer some questions around intensifying treatment in that biochemical recurrent space.

Dr. Pal: Yeah. These cooperative groups studies, each one of them are so critical. These are just funded by our federal government, and they really offer us a chance to really ask pure questions, so really, really important study design. And maybe in 30 seconds, let's go over this last study over here. I don't want to keep our listeners on for too long, but there was a study called PROpel. Again, you got to love these study names. So this PROpel study looked at advanced prostate cancer. So again, this is prostate cancer where the disease has spread from the prostate to other organ systems. This is potentially a new paradigm for the disease. Before, we used to just basically give everybody hormone therapy in this setting. We've doubled down and given patients more advanced hormonal therapy with drugs like abiraterone that you alluded to, but now there's this potential to use targeted treatments. And maybe you can tell us a little bit about how that's been incorporated in PROpel, Tian.

Dr. Zhang: Sure. Well, PROpel randomized patients to a combination of abiraterone with olaparib, which is what we call PARP inhibitor, and it blocks DNA damage repair, basically, in cancer cells. And olaparib has been approved as a single agent in more refractory, metastatic, castration-resistant prostate cancer. And so this trial randomized folks with a combination in sort of earlier lines of castration-resistant disease to either that combination or abiraterone with placebo. We saw earlier this year, actually, that the primary endpoint was improved for all comers, but I don't know if we saw some more subgroup analysis of patients with BRCA alterations and also with homologous recombination repair alterations. And I think that's very important, the fact that we saw more of an improvement in those subpopulations than those patients without the BRCA alterations or the homologous recombination repair mutations.

Dr. Pal: Excellent. Excellent summary. I think that's about all that we've got time for today. New paradigms in prostate cancer and bladder cancer potentially and a massive amount of new data in kidney cancer to things going forward with clinical practice from ESMO 2022. Tian, thanks so much for joining me today, and I hope everyone listening enjoyed this as well.

Dr. Zhang: Thanks, Monty. Take care.

ASCO: Thank you, Dr. Pal and Dr. Zhang.

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

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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, Ms. Walker 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.

View disclosures for Ms. Walker and Dr. Patel at Cancer.Net.

Dr. Manali Patel: Hello, I'm Manali Patel. I'm a thoracic lung cancer doctor at Stanford University and the VA in Palo Alto. And I'm a researcher that's focused on trying to improve and overcome health disparities and really trying to achieve health equity. I'm also the Cancer.Net Associate Editor for Health Equity. And today it's my great pleasure to talk with Ms. Stephanie Walker. Stephanie is a registered nurse, a survivor of metastatic breast cancer, and a leading patient advocate. She's the lead author of the BECOME Research Project on increasing Black patient participation in metastatic breast cancer clinical trials, which she presented beautifully at the 2022 ASCO Annual Meeting. Stephanie, we can't thank you enough for talking with us today. I'm going to first start off by saying that I am from North Carolina. And Stephanie, I read so much about you over the past few years and noticed that you are living in Tarboro, North Carolina. Is that correct?

Stephanie Walker: That is correct. I currently live there. We moved here originally in 2012, but this is my, I think, third or even fourth time living in North Carolina, moving back and forth between Thomasville and Durham and now permanently in Tarboro.

Dr. Manali Patel: Well, I love that we share our Tar Heel roots. I am a Tar Heel born, Tar Heel bred. When I die, I'm a Tar Heel dead. So I can't thank you enough for sharing those roots and then also for sharing your story with us today. You were first diagnosed with metastatic breast cancer in 2015. Can you tell us a little bit about your experience with that diagnosis and what it was like to be diagnosed?

Stephanie Walker: Well, actually the diagnosis in 2015 was my first diagnosis. I was not an early stager that had a recurrence, so I guess I could say breast cancer was never on my radar regarding family history. I thought maybe kidney disease or hypertension or those kind of things, but never breast cancer. So to say my life derailed at that time, it had. And I don't know if I ever grieved when I was told that I had metastatic breast cancer, I took it and just ran with it. I did not really fall off until many years later when I had to stop working. At the time I was diagnosed, I was working as an on-call nurse for a hospice company. So I was working 7 days on, 7 days off. So on my 7 days on is when I received a call and during my nap time. But yeah, it was very hard.

But like I said, I didn't think bad of it. When I did finally look it up and see that the life expectancy was like 36 months, that kind of kicks your butt into gear to do things. But I didn't do anything. I just continued to work. [laughter] I didn't stop working. So yeah, it went through the basic standard of care treatment of Adriamycin, Cytoxan, and Taxol. But I didn't get through my whole series of Taxol due to neuropathy and increased falls. So I stopped at 9 out of 12.

Dr. Manali Patel: Still 9 out of 12, it's difficult. And that's a difficult therapy and difficult regimen. You talked about how it derailed your life. And I know I've had the pleasure of reading your story online. I think what's also really interesting is that you had a role as a hospice nurse and over 40 years as a hospice nurse.

Stephanie Walker: No, most of my years of nursing was critical care. The last 14 years were hospice care, palliative life care. But, yeah, I just rolled with that. Even taking care of patients that had the same diagnosis kind of brought-- seeing death and dying every day. But then to see somebody with metastatic breast cancer dying was really hard.

Dr. Manali Patel: Yeah. And I'm sure that your experience at nursing on the other side and the flip side, and then when you became a patient, is quite different and maybe challenging in and of its own.

Stephanie Walker: A lot of people expected or said that. I think I got left out of a lot of things that could have helped my journey in the beginning, like a patient navigation and that kind of thing was kind of not given to me. And I guess it was because being a nurse. But I had no experience other than pediatric oncology. I knew what those children went through. And actually, it actually did help going through my treatment because I would remember this one little girl that was going through chemo, and she got up one morning and her pigtails started falling out, and then she wanted to get on the IV pole and go to the playroom. And I'm thinking to myself, if she can do it-- and I called her by name, if she can do it, what the hell am I complaining about? So it's like, just get up and go to the playroom. [laughter]

So I kept going back to that, you know what I mean? These kids that are innocent and have not even started to live their life going through this, and they never complained. So being an old lady at 56, being diagnosed, hell, who was I to complain about it? So just pick your hair up and keep going.

[laughter]

Dr. Manali Patel: That's right. Get your IV pole and go to the playroom.

Stephanie Walker: That's right.

Dr. Manali Patel: It's interesting that you mentioned that being from the nursing field and from the medical field kind of excluded you from a lot of what we hope other people receive, which is good education about their diagnosis. And like you mentioned, a patient navigator. Do you think that being a Black woman in any way, shape, or form shaped your experience with cancer, and if so, how?

Stephanie Walker: It didn't in the beginning. Like I said, from 2015 up until 2018 when I found myself suddenly without a job or insurance, I had no idea. I didn't know anybody else with metastatic breast cancer. I didn't know what was out there. I guess I didn't have a need that was not met. I had insurance that was paying the bills. I had a husband that helped care for me, 2 adult children that looked in on me, a job that I didn't consider a job, it was a calling, and I had no needs at that time that weren't met. So I didn't have the desire or the need to look outside my little tiny world, I guess, until I found myself in 2018. In 2017, we moved late in the year back to North Carolina from Louisiana and started a new job as a hospice nurse, same kind of a schedule and was out shopping with my husband one day, and I kept saying, "I'm really short of breath." And I said, "All this weight I've gained since treatment, it's horrible. I'm just fat and can't breathe." And he just kind of laughed at me and said, "No, you're fine, you're fine." Well, then I started experiencing chest pain and I said, "I think I need to go to the ER."

And for me to say I need to go to the ER, then my husband kicked it into gear and thinking, "Oh gosh, maybe so." Went to the ER, thought I was having an MI [myocardial infarction, a heart attack], ruled that out, and sat back in the lobby for a couple of hours and then they came and got me again and, in a hurry, said that they'd seen that I had a blood clot in my left lung. So it's like, great, here I am now with the PE [pumonary embolism] and having to be on blood thinners. And then I had a TIA [transient ischemic attack, sometimes called a ministroke] on an oral blood thinner. So obviously that failed me. So that's when I had to stop work. And then that's when I went into a deep depression. And people say it's like just because you have to stop work, you get depressed and it's like, yeah, I mean, I had always told myself in the very beginning of my diagnosis, I'm going to work up until the very end. And then not to have that-- and I felt like if I don't do anything, I'm going to die quicker. So I did not know what I didn't know until I found myself trying to figure out how I was going to live, pay bills, eat, pay for treatment.

You know, when you don't have that comfort, then I started looking for ways to help provide until I could figure out a plan. And that's when I found the world of metastatic breast cancer and advocacy that I went to my first metastatic breast cancer conference: Living Beyond Breast Cancer, actually in April of 2018. And I don't remember the weekend because I was just in awe that all these women around me had metastatic breast cancer and were thriving. And more than that is I've seen a whole lot of Black people that were like me. So I wanted to know more, learn more, do more. So that's when my whole-- I tell people that was my coming out party of metastatic breast cancer. So I did research trying to find funding and I spent 8 hours a day, 5 days a week looking for that since I didn't have a job, I didn't know what else to do. And luckily, I found enough resources to stop the bridge until I got my first disability check. Nobody told me there was a 5-month waiting period, right? And I found the insurance, thank you to my cancer center, provided ways for me to continue treatment because I made an appointment to tell them I'm going to stop treatment. I can't afford to pay you. But they came through, and I'm thankful for that. So that's when the world of advocacy opened up. It was in 2018, about 3 years after my diagnosis.

Dr. Manali Patel: I love that you think and were part of the calling and your identity of being a nurse, and then of course as a hospice nurse, especially, but losing that identity, but then channeling and refocusing and helping other people and really advocating has given me a lot of inspiration as a daughter of a mother that also faced similar challenges.

Stephanie Walker: I'm so sorry.

Dr. Manali Patel: I really want to thank you for all that you've done on behalf of all women with breast cancer, and especially for Black and Brown community members who have breast cancer. We've read your story and know about you and so are really just thankful for you and the research that you've been doing, especially the research that you presented this past summer at our ASCO Annual Meeting 2022, where you presented the results of the BECOME Research Project. I was hoping that you could give us some background on the study and why you wanted to do research in this particular area?

Stephanie Walker: First and foremost, I'm not a researcher. I don't like research, [laughter] and I didn't plan on doing research. So with that being out of the way, I am a nurse. I am a critical care nurse. I am a hospice nurse. I am an advocate. Researcher, not. So actually, it was done because there was another metastatic breast cancer huge advocate, Marina Kaplan, who is no longer with us. I met her at the San Antonio Breast Cancer Symposium in 2019, and she had done a poster presentation regarding patient-centered outcomes as well. And she noticed that the Black respondents to her survey was less than optimal. She only had like 8% return. And she said, "Stephanie, I don't understand, why so low?" And it was like, "Marina, I don't know. I did your survey, so I can't tell you." So she said, "There's got to be a reason." And she said, "Let's delve into trying to find out why." And she said, "How about this? You do the survey. You gear it to the Black population, men and women with metastatic breast cancer, and I'll help you."

And I said, "You're definitely going to have to help me. I'm not a researcher. I don't do statistics either. I found that I didn't need that when calculating medication doses." Anyway, so with that being said, she said, "I'll do it. I'll do that part for you." And I thought, me being simplistic, how hard can it be to do a survey, right? You have questions, you put them on a piece of paper, you print them off, you make 100 million copies, and you send them out to people or you ask people in one of your Facebook groups or something, and you just write down the answers. That is not how it's done in the research world. So, unfortunately, before we could get it off the ground, she passed away. And actually, she was very sick at the conference. So she passed away actually the following January-- February. So I kind of put it on the shelf in the back of my mind because I just assumed that was just between me and her. Nobody else knew. She had told somebody else, and they came back to me. It was actually someone at Living Beyond Breast Cancer, Janine.

She came back to me. She said, "Hey, do you remember when Marina talked to you about X, Y, Z?" And it's like, "Here it comes." And I said, "Yeah, sure." And I told her I would get it done. I told her I would do it. I told her I would do it. And people said, "She's gone. You don't have to do it." And it's like, "My word is my word." So she introduced me to a group at the Metastatic Breast Cancer Alliance, the information task force, and they looked at it and thought it was a great idea and picked it up as one of their projects. And there I was starting my research problem with being the project lead of people that I didn't know, with an idea that I didn't know how it was going to be done. So I am thankful for a bunch of people, man, I am telling you. So it got done. It was partnered with a marketing and strategic group, CB White, and they actually got it off the ground to which way it needed to go. I didn't realize it cost a lot of money either. [laughter]

It started off, we did literature search. We found some ASCO literature that would support our survey. Then we did interviews with the patients, the clinicians, researchers, payers, and they asked the questions -- we formulated questions because we had a subcommittee and someone else did the interviews. And after those were all done, that's how the survey was formed. And the survey went out-- it basically went out via social media. And the subcommittee, it was a bunch of patients and industry people and from the Alliance that pushed us out and was supportive of it and really believed in it. And my goal was to get 500 respondents.

I wanted 250 Black and 250 of everybody else. I didn't care who, but I say I didn't reach my mark, and it was a little disappointing. I only had like 420-some people that responded. But everybody said that was really good because I didn't offer them anything. I didn't offer you money. I didn't offer you a gift card. I didn't offer you a cup of coffee. But it was done, and I'm proud of the responses. It was all done -- this whole project was done during the pandemic. And you have to realize that a lot of people in the subcommittee that I had that actually worked really hard, I had never met. So this is a group of people that you only know a face like on Zoom or something. So the results were some of them were -- I kind of expected that. But the biggest shocker for me was -- the number one thing that we're focusing on is a general ask, right? No one asked us, as Black men and women with metastatic breast cancer, talked to us about clinical trials.

Dr. Manali Patel: I think that that finding, can you briefly tell us the numbers for the readers? I've read through and also saw the presentation kind of what you found in terms of that being the biggest and then some of the other outcomes that you looked at.

Stephanie Walker: Well, some of the other outcomes were like, other than the 4 that we're focusing on, is to better inform, you know what I mean? We need Black patients to know about and to get the information to make informed decisions about clinical trials. That's first. Then the second one was to inspire trust. We all know about all the stuff in the past and the distrust of the Black community with health care providers. So we need to build that, and it has to start in a community in which the person lives. And we also found that more Black than non-Black, when questioned, would try a clinical trial only if they were asked to, but they weren't. So to ensure access -- there were barriers, obviously, to people wanting to participate in a clinical trial. And some of those were the travel time, the difficulty in finding the trials, worrying about the financial burden.

And a lot were like, if I go to another facility, is my insurance going to cover it? So that's a big thing. And the final was to address the concerns, legitimate concerns. We need the health care provider to communicate in a clear language that we understand, and also understand the reasons that motivate us to participate in a clinical trial. So with those 4 things, we came up with some actions to do. But those were the 4 big ones that I found out that needed to be addressed. Because when doing this, I didn't do it just to be doing it. I wanted to do it to find out what the barriers were and then to come up with actionable steps. And as a physician or anybody, there's all those surveys people want you to do, and then they stop there. They don't go on. And I'm one of these people, like, don't waste my time. Let's do something that's actionable that we can act upon or help other people to act upon.

Dr. Manali Patel: I think those of us in the health equity space, right, are not surprised that a lot of what you found does really play in terms of what the health care provider and what the health system can do. The health system can do things to engender trust rather than putting the blame on the patient, saying that patients don't enroll in clinical trials. Well, maybe we aren't asking patients equitably if they're enrolling. And we need to take a hard look at our own selves and our own practices and think about what we can do similar to a checklist, right? When a patient comes in, how can we make this part of standard of care to make sure that everybody gets asked, and we've got all these fancy decision support tools and our electronic health record that turn up poppers of, "Did you ask the patient about this?" But making this part of the rubric of what we do, I think was really nicely highlighted in your study and your findings.

Stephanie Walker: Yeah. And I truly agree. Rubric metric, however you want to say it, people are like, "Well, how are you going to get them to change it?" Like, first of all, with education, and second of all, man, if I could figure out a way to attach a dollar sign to that rubric or that metric, it would be great.

Dr. Manali Patel: I think for our readers, you and I know and really want to get the messaging out for equitable and accessible clinical trials. Can you explain from your perspective why it's so important to be inclusive and to have clinical trials that are accessible and equitable for all patients with cancer?

Stephanie Walker: Well, the statistics speak for themselves. Only like 6% of participants in a clinical trial for a metastatic breast cancer are, like 6%. But it's important that the clinical trials are inclusive for everybody, all people, because you want the medications to work for quote-unquote "all people." And we find that, speaking from just my experience and what I know and have heard, that there are treatments out there that don't actually work on Black people. And one of the big general ones is one of the blood pressure meds we have found recently that does not work or do not work very well with people of color. So we have to include everybody in these clinical trials to be able to have effective treatments to work for everybody, no matter where they are, where they live, who their doctor is, what hospital they go to. All people need to be included. And we find that 80% of the patients are treated in community cancer centers, and those are the patients that are usually left out just due to the fact they're not associated with a teaching medical institution/NCI facility.

Dr. Manali Patel: I think this is so important and really appreciate you highlighting that important fact is that making sure that our treatments are effective and feasibly can be provided to all patients in our quest for achieving health equity. What work is currently being done to make clinical trials more inclusive?

Stephanie Walker: Everybody is working on that. Even Stephanie is working on that. With a new subcommittee, a little branch out from BECOME, we found that -- we had just spoken of education. And so we came up with an idea of an actionable step. How do we do that, and how do we educate the health care providers regarding all of these facts that we found? And we are going to have a symposium. We came up with a symposium, a 1-day event. And we are going to attach it to the San Antonio Breast Cancer Symposium. We're actually going to have it the day before the symposium starts and hopefully, that will attract health care providers who we're targeting this to come and just listen to see what the patient has to say. We have it broken into 3 sections. The first section is about the health care provider, how to communicate with your patients.

What does it look like on the other side? And then the other is broken down into the pharmacy or pharma industry section. What are they doing to help include all people in clinical trials? And a lot of them have jumped on that bandwagon to be inclusive. But really, what are you working on? I want to know. So that's the second session. And the third session is about the patient and the caregiver. From the patient's point of view, how they did with clinical trials, and also a clinical navigator, what their role is to help patients find out about the trials and be that support person and as well the caregiver. A lot of people forget the caregiver goes through this as well. And to get the view of what the caregiver had, what they had, what they needed, what they didn't receive, to find out that so we can provide those things for them, hopefully. But yeah, that's what we're doing now. We're still in the planning phase.

Dr. Manali Patel: That's amazing. I love the action-orientedness of really moving to the next step, taking the findings that you found, moving towards really action, and bringing all of the partners together. I know that all the industry partners and really holding people accountable for what they are planning on doing. I love that. What actually are you doing and coming up with a plan for moving forward?

Stephanie Walker: Yeah, you have to start holding people accountable, get rid of the biases. And I've been blessed that I had not experienced any kind of biases in my care until the pandemic. And that was when I wanted to get my cancer treatment at a community center closer to home because it was a simple treatment of fulvestrant injection, and I wanted to get it closer to home. And we all agreed. We found a physician that would accept me closer to home. And it was going great until I started having complications, and he totally blew me off, actually. He told me that I needed psychiatric help, but he didn't know I was already getting it. But anyway, after contacting several patients that see this physician, they experienced the same thing. So that's the first time I had experienced anything based on my race and who I am. And that happens when a physician walks into a patient's room, sometimes that's what they see. They don't see Stephanie, they see a Black woman, and they start thinking in their head ticking off things like, "Oh, she's Black. She doesn't understand. She doesn't even know what a clinical trial is. She's going to be non-compliant. She's going to quit. And then she's going to become this angry Black woman that I'm going to have to deal with." So all of that before it is, "Hi, my name is." So, yeah. That experience made me want to do a little bit more to try to get rid of the biases that patients experience.

Dr. Manali Patel: Yeah, I think what you're doing to advocating, not only us clinicians, I'm so sorry that you have to experience that. Unfortunately, we've heard and know that it's sometimes the norm of what people experience or the systemic biases that then play into the role with implicit biases and then, unfortunately, lead to delays in care and also mistreatment or even lack of evidence-based treatment for people just based off of their skin color or from what community they may be from, or even how much income they may have or education level. I think what you said about what the work that you're doing and educating us clinicians, number one, first and foremost, what we can do with the health care system and looking at our own practices and our own policies and trying to reduce and remove some of the biases that are baked into the system. But then also what you're doing on the ground with other patients and advocating for patients. I want to close with 1 last question, and you've highlighted some of it, but if you were to give advice to people with cancer who are faced with needing to advocate for themselves, be it for care like you described, or for clinical trials, what advice would you give them?

Stephanie Walker: It's almost like having to put burden on the patient to learn. But you do. You have to become Ph.D.-certified with your own illness. You got to go out there and know what you got and know what you need, what the standard of care is, and that is the truth. When you get that diagnosis, I believe you should, first of all, take somebody with you with a notepad to be able to write down things. When you hear the word "cancer," you don't hear nothing after that. And you're only going to probably absorb a fourth of what you're told at the office. So have somebody to write down what the doctor says, suggestions, and research your plan of care. Find out what the standard of care is. I tell people, don't go to Dr. Google, but you're going to have to Google some things. But try to find vetted sites, reputable sites to do that. And there's lots of organizations out there that you can get the information from. And I don't want to say use Facebook, but believe it or not, there are great groups on Facebook that offer support, information, suggestions, "Hey, I'm getting ready to start this treatment. What happened to you? Or what do you think?" So always arm yourself with questions when you go in.

Ask the questions. Don't be afraid to ask. If that doesn't work, of course, with the pandemic, I would have people that want to go with me, and I couldn't go, but I could sit out in the lobby on my cell phone and listen in and encourage them to ask this question or ask the doctor a question. Of course, that has to be given with permission from the physician as well. But arm yourself with as much information as you can. And if you are finding that you're not getting that feeling of, "This doctor has my best interest," seek a second opinion, third opinion, a fourth opinion. Don't let a doctor railroad you into doing something that you don't understand. If you don't understand, speak up. I tell people all the time, they may know about cancer, but you know about yourself, so hold firm to that. I've told several doctors. I've fired several. So, I mean, they're out there. And I tell people all the time, don't be scared. Be comfortable and always know there's somebody out there. You're not alone to talk to. And being depressed or down sometimes, it's normal. You go there, but don't live there. If you find yourself living there, reach out for help. Because I'm one that thought that nurses don't reach out for help, but I finally did. So don't be afraid to ask for help and know that there's somebody out there with you. Call me. I'm available.

Dr. Manali Patel: Ms. Walker, I can't thank you enough for sharing your story with us and telling us more about your experiences and the work that you've been doing-- the important work you've been doing in this area. It was really wonderful to have you, and I hope that we get to meet in person at some point.

Stephanie Walker: I really thank you for the opportunity to share and hopefully the information that we both have provided, people will get it and understand it, and it will help somebody, because the work you done while you were at ASCO was amazing, too. So read that. [laughter] So I really do, and I really appreciate the opportunity.

Dr. Manali Patel: We are very grateful. And thank you for Cancer.Net, for hopefully being that source of trust and source of information for all of our patients.

ASCO: Thank you, Ms. Walker and Dr. Patel. 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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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 interim of 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.

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, Dr. Maryam Lustberg discusses highlights from the Multinational Association of Supportive Care in Cancer's 2022 Annual Meeting, held June 23-25 in Toronto.

Dr. Lustberg is the Director of the Center for Breast Cancer at Smilow Cancer Hospital and Yale Cancer Center; Chief of Breast Medical Oncology at Yale Cancer Center; Associate Professor of Medicine at Yale School of Medicine; and the 2022 President of the Multinational Association of Supportive Care in Cancer. She is also a member of the Cancer.Net Editorial Board.

View Dr. Lustberg's disclosures at Cancer.Net.

Dr. Lustberg: Hello, everyone. I'm Dr. Maryam Lustberg. I am chief of breast oncology at Yale Cancer Center, co-chair of Symptom Intervention Committee for Alliance Clinical Trials, and the new president of the international society of Multinational Association of Cancer Supportive Care, or MASCC. And I'm here to talk to you about updates from the meeting that happened in Toronto in June of 2022. I have no relationships to disclose relevant to the topics that I will be talking about today.

And there were 3 broad themes in the meeting that I would like to highlight for you. One theme was a global focus on disparities in the delivery of cancer supportive care. So we do know that even in North America, patients with different socioeconomic backgrounds, different races, different cultural backgrounds, may not have as full access to cancer supportive care services, and that can include access to symptom management, survivorship care, palliative care. The umbrella of cancer supportive care is quite broad, and it's really focused on supporting patients and their families throughout the care continuum in a very multidisciplinary, holistic way. And so what we're finding, unfortunately, similar to cancer treatment, access to the best supportive care in cancer can also face certain disparities in the U.S. and North America. And this is something that we talked quite a bit about in the meeting in terms of recognizing this as well as finding solutions for it. And similarly, globally, we know that access to symptom management strategies, access to palliative care, access to oncology rehab, all of these can be quite restricted in different regions of the world. So the meeting in Toronto was really a call to action to recognize this as a pressing issue for our global community. And we will be forming several task forces to really look towards solutions. And so we look forward in terms of looking at low-hanging fruit interventions that we can both provide in North America as well as globally so that really patients and families could have access to such an important part of cancer care.

The second theme of the meeting focused on digital technologies as well as the impact of COVID-19 on the delivery of cancer supportive care. We know that the pandemic certainly shook the world, and it also impacted patients' access to supportive care services. These were often the services that were put on hold, understandably, during the resource-lean times and restricted access to services during the pandemic. So this was something that we absolutely recognize that this happened. It impacted many patients and families, but we also, as a community, really came together to come up with innovative solutions. And one of these innovative solutions, what people have called maybe the silver lining in what happened during COVID, is that there was an increase in telehealth services, including telehealth care delivery of some of these supportive care services. So a lot of the meeting focused on how this was implemented, what access may have looked like. There's certainly disparities even here in terms of access to telehealth services. And also patient preferences and caregiver preferences also plays a great role here, where some patients really find telehealth to be a really comfortable solution for them. They don't have to leave their home, find parking, but others may find it less personal. So really, if we're thinking about personalizing cancer supportive care, I think there was a lot of discussion about making sure that we kind of understand which clinical situations may benefit from telehealth care delivery, which situations may do better with face-to-face, and ultimately to really involve patients and families in that decision and to make sure that we're engaging and not dictating policies without their full engagement. So this is something that we absolutely care deeply about.

The third theme focused on burnout. There was a lot of focus on clinician burnout, which we know was also something that was a tremendous issue during the pandemic due to workforce shortage across all health care disciplines. People have talked quite a bit about the great resignation, where many health care workers as well as people in other sectors actually resigned or could not work in the conditions that the pandemic necessitated. So there was a lot of focus on recognizing burnout in clinicians because that directly impacts how well we can take care of patients. So recognizing it and thinking about proactive solutions, including there was a wonderful speaker, Dr. Benjamin Corn, who has done quite a bit of research on hopefulness and really feeling hope, whether you're a caregiver, whether you're a clinician or a patient, was found to be a key measure or predictor of burnout. And this is not meant to minimize system issues or anything like that. But I think there was a lot of focus on self-management and self-efficacy, kind of recognizing burnout and trying to foster things that we can do ourselves to keep ourselves healthy mentally, emotionally, and spiritually so that we can continue to function in the health care setting and take the best care of our patients, which is ultimately our goal as an entire scientific oncologic community is to be more present, to be more engaged, to deliver the best evidence care whether it be in the realm of cancer treatments or cancer supportive care, I do feel it's all part of that full package. Thank you so much for listening to this podcast.

ASCO: Thank you, Dr. Lustberg. 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.