COR2ED - Oncology Medical Conversation

Prof. Thomas Powles, a Medical Oncologist from Barts Cancer Centre in the UK and Prof. Georg Hutterer, a Urologist from the Medical University of Graz, Austria, discuss the role of VEGFR-TKIs in the treatment of advanced renal cell carcinoma (RCC) alone or in combination with immunotherapy.

In this podcast, by COR2ED Medical Education, the two experts discuss key trials (CHECKMATE 214, KEYNOTE 426, CHECKMATE 9ER and CLEAR) which have led to recent updates to the ESMO and EAU treatment guidelines for RCC. Combination treatment with either VEGFR targeted therapy plus a PD-1 or CTLA-4 inhibitor in the first-line setting is discussed as well as VEGFR-TKI monotherapy options at the time of disease progression.

They also focus on how to manage treatment toxicity whilst trying to optimise treatment outcomes and preserving patients’ quality of life as well as the use of biomarkers and risk stratification models.

In this podcast series, Dr. Jenny Seligmann (University of Leeds, UK), Dr. Autumn McRee (University of North Carolina, USA) and Dr. Dominik Modest (Charité University of Medicine, Germany) discuss the different therapeutic options available in colorectal and gastric cancer.

In this third episode, the experts turn their focus to earlier stage disease and consider how lessons learnt in the treatment of metastatic disease can be applied in the neo adjuvant setting for colorectal cancer by discussing data from the FOXTROT and NICHE trials and the adjuvant setting for gastric cancer by discussing data from CheckMate 577. Finally, the experts consider new promising data on targeting KRAS compared to the MEK and the ERK inhibitors.

In this podcast series, Dr. Jenny Seligmann (University of Leeds, UK), Dr. Autumn McRee (University of North Carolina, USA) and Dr. Dominik Modest (Charité University of Medicine, Germany) discuss the different therapeutic options available in colorectal and gastric cancer.

This second episode focuses on recent developments in immunotherapy approaches in metastatic colorectal and gastric cancer – specifically whether immunotherapy should be used alone, in combination with other treatments or with chemotherapy. Data from several clinical trials are discussed such as KEYNOTE-177, CheckMate 142, CheckMate 649, KEYNOTE 062, and NICHE. The experts also consider the appropriate treatment regimens for MSI-high and MSS colorectal and gastric cancer patients and whether CPS is an appropriate biomarker for gastric cancer.

In this podcast series, Dr. Jenny Seligmann (University of Leeds, UK), Dr. Autumn McRee (University of North Carolina, USA) and Dr. Dominik Modest (Charité University of Medicine, Germany) discuss the different therapeutic options available in colorectal and gastric cancer.

In this first episode the experts discuss novel targeted approaches in metastatic colorectal and gastric cancer. They discuss practice changing drug targets including BRAF and HER2 with reference to data from recent clinical trials such as DESTINY and HERACLES. They also discuss molecular testing and differences in approaches between the USA and Europe and review recommendations in the guidelines for colorectal and gastric cancer.

In this medical education podcast series, myeloma experts Dr. Karthik Ramasamy (Haematologist and Associate Professor of Haematology at the Oxford University Hospitals in London, UK) and Dr. Joshua Richter (Assistant Professor of Medicine and Director of Myeloma at the Tisch Cancer Institute at the Icahn School of Medicine and the Blavatnik Family Chelsea Medical Center at Mount Sinai in New York, USA) discuss their experience and views on choosing the best treatment every time in multiple myeloma.

In this second episode, Dr. Richter and Dr. Ramasamy explore how to select the best treatment approach in the second-line setting and beyond. Firstly, they discuss at what point they consider a patient to actually be in relapse. They both believe that it’s important to stay on top of this incurable illness and act when there is a suspicion of relapse. However, the need to treat must be balanced with quality of life. They also take potential enrolment into a clinical trial into account in the treatment decision.

The decision on which treatment option to select in the second line and beyond mostly depends on refractoriness to other drugs. With an increasing number of novel treatment options becoming available, choosing a regimen that does not contain a drug the patient is refractory to is becoming easier. Dr. Richter and Dr. Ramasamy discuss the challenges around these treatment decisions.

Furthermore, they share their experiences with CAR-T and other T cell redirection therapies, and when to use it in the treatment sequence. The speakers conclude with a look into the future of myeloma treatment.

Prof. Josep Llovet and Prof. Stephen L. Chan discuss a very interesting topic about the use of the VEGFR TKIs monotherapy in the treatment of unresectable or advanced HCC in the first-line setting. They will go into details about who can benefit from monotherapy and will share the current guidance on the implementation of the dosing strategies for the management of toxicity in the clinical practice. They discuss first line monotherapy with TKI (lenvatinib or sorafenib) for patients who are not suitable for the treatment with atezo-bev combination (around 20% of the patients) which is the current standard of care. They summarise the HCC patients who are not ideal for this I/O combination such as HCC patients with liver transplantation, high bleeding risk, impaired liver function or severe autoimmune disease. The experts discuss about which patients can benefit from TKI and provide a summary of efficacy data and safety profile from various pivotal clinical studies (including SHARP, REFLECT, IMbrave150) as well as real-world data. Dosing-strategies for VEGFR-TKIs and management of AEs are discussed as well as guideline recommendations. Finally, the experts discuss key developments over the next few years focusing on the new immunotherapy combinations approach that could become new standard of care.

In this medical education podcast series, myeloma experts Dr. Joshua Richter (Assistant Professor of Medicine and Director of Myeloma at the Tisch Cancer Institute at the Icahn School of Medicine and the Blavatnik Family Chelsea Medical Center at Mount Sinai in New York, USA) and Dr. Karthik Ramasamy (Haematologist and Associate Professor of Haematology at the Oxford University Hospitals in London, UK) discuss their experience and views on choosing the best treatment every time in multiple myeloma.

In this first episode, Dr. Richter and Dr. Ramasamy discuss how to select the best approach in newly diagnosed patients with multiple myeloma. The experts look at transplant eligibility as one of the key factors in deciding which treatment to start with in the front-line setting. They discuss the potential for personalising therapy in newly diagnosed patients, both in the transplant setting as well as in patients who are not eligible for transplantation.

They also comment on the impact of MRD negativity in clinical practice and agree that the goal of treatment is to induce deep remissions. However, which patient needs triple or quadruplet therapy to achieve this goal is still unclear and the risk-benefit profile needs to be considered for each individual patient.

The final topic that the experts share their points of view on is continuous vs fixed-duration maintenance therapy.

Professor Matthias Pinter, medical hepatologist from the medical University of Vienna in Austria shares some insights from key abstracts and topics discussed at ILCA 2021 and ESMO 2021 in hepatocellular carcinoma.

One main topic included discussions about treatment options in first-line systemic therapy and managing patients who still may need to receive a TKI in first-line instead. Another topic covered is how to proceed with immunotherapy in HCC, in particular the rationale for triplet immunotherapy combination.

There were two studies data presented on atezolizumab plus bevacizumab, the new reference standard of care in systemic front-line HCC treatment.

Another interesting topic was the combination of TACE with immune checkpoint blockade in intermediate stage HCC.

Regarding monotherapy TKI in first-line setting, Prof Pinter points out that around 15 to 20% of HCC patients are not ideal candidates for atezolizumab plus bevacizumab, and these are mainly patients with HCC recurrence of the liver transplantations, patients with severe autoimmune disease, or those with a high bleeding risk.

He discusses several real-world evidence studies including lenvatinib, sorafenib and regorafenib in special populations that are usually excluded from clinical trials.

 Prof Pinter also discusses data presented covering predictive and prognostic biomarkers such as cachexia, the growing role of AI, multibipolar radiofrequency ablation and the potential role of underlying etiology as a predictor of the efficacy of immunotherapy.

In this podcast, PO CONNECT members Prof Frédérique Penault-Llorca (University of Clermont-Ferrand, France) and Prof Andrea Sartore-Bianchi (Niguarda Cancer Centre, Milan, Italy) provide both a pathologist and medical oncologist perspective about the detection and treatment of TRK fusion-positive GI cancers, with a particular focus on colorectal cancer.

Penault-Llorca and Sartore-Bianchi start by explaining TRK fusion biology, the role as oncogenic drivers and briefly describe the two approved TRK inhibitors. They then discuss the challenges of finding patients harboring these fusions, referring to how enrichment strategies and predictors can aid identification in patients with GI cancers. Finally, they discuss key efficacy and safety data for larotrectinib and entrectinib, as well as mentioning second-generation products in development to tackle mechanisms of resistance.

In this podcast, Veerle Lamotte, an oncology nurse practitioner at Antwerp University Hospital and Paola Belardi, nurse chief at San Donato Hospital in Arezzo, Italy discuss the role of the nurse in the management of adverse events in patients receiving VEGFR-TKI treatment. Their discussion focuses specifically on patients with hepatocellular cancer (HCC), differentiated thyroid cancer and advanced renal cell carcinoma (RCC).

VEGFR-TKIs are widely used treatments for these solid tumours but are associated with substantial toxicity which needs early recognition and management in order to help patients stay on optimal treatment.

The most common adverse events related to these treatments are discussed together with recommendations for their management. Veerle and Paola discuss the key role of the nurse as part of the multi-disciplinary team involved in the patient’s care, and the role they have in providing close support and guidance to the patient. Education of patients regarding potential side effects and early identification and management of adverse events is key in terms of trying to keep patients on the optimum dose so that they can achieve the best outcomes.