Oncology On The Go

During the 2024 Oncology Nursing Society Congress, CancerNetwork® spoke with multiple registered nurses about research they presented on safely administering treatment options such as CAR T-cell therapy and bispecific T-cell engager (BiTE) therapy in patients with multiple myeloma and other malignancies.

Ishmael Applewhite, BSN, RN-BC, OCN, a registered nurse at the University of Rochester Medical Center, highlighted the management of adverse effects including peripheral neuropathy in patients with multiple myeloma undergoing treatment with ciltacabtagene autoleucel (cilta-cel; Carvykti). He discussed these treatment strategies in the context of a presentation he gave on findings from the phase 3 CARDITUDE-4 trial (NCT04181827), in which investigators assessed treatment with cilta-cel in those who were refractory to lenalidomide (Revlimid).1


According to Applewhite, cilta-cel may offer “another path” aside from standard treatment options such as chemotherapy and give “more time” to patients with multiple myeloma.


Additionally, Leslie Bennett, MSN, RN, a nurse coordinator at Stanford Healthcare, highlighted the importance of identifying and mitigating cranial nerve palsy (CNP) in patients with multiple myeloma who are treated with cilta-cel. At the conference, Bennett presented data on CNP outcomes across various studies, which included the phase 1/2 CARTITUDE-1 trial (NCT03548207), phase 2 CARTITUDE-2 trial (NCT04133636), and phase 3 CARTITUDE-4 trial (NCT04181827).2


According to findings from this presentation, patients had CNP onset at a median of approximately 3 weeks after beginning treatment with cilta-cel. Most cases of CNP tended to occur in male patients.

Kathy Mooney, MSN, RN, ACNS-BC, BMTCN®, OCN®,clinical program director at Johns Hopkins Hospital and Johns Hopkins Health System, spoke about a study designed to evaluate the feasibility and safety of using BiTE therapy to treat those with cancer in an outpatient setting.3 Mooney emphasized multidisciplinary collaboration among nurses, pharmacy providers, and social workers as part of monitoring patients for toxicity as they undergo treatment with BiTE agents.

References


1.        Applewhite I, Elfrink G, Esselmann J, Lonardi C, Florendo E, Sidiqi MH. Efficacy and adverse events after ciltacabtagene autoleucel treatment in the CARTITUDE-4 as-treated population consisting of patients with lenalidomide-refractory multiple myeloma who received 1-3 prior lines of therapy. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

2.        Bennett L, Kruyswijk S, Sidana S, et al. Incidence and management of cranial nerve impairments in patients with multiple myeloma treated with ciltacabtagene autoleucel in CARTITUDE studies. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

3.        Mooney K, Allen N, Anderson K, Zukas A. Taking a BiTE out of hospital admission days using a team approach to managing patients at risk for treatment related toxicities. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC. 
 

In a conversation with CancerNetwork® at John Theurer Cancer Center, Timothy Chen, MD, highlighted various novel treatment strategies that have impacted his care of patients with brain tumors and other types of cancer. 


Chen, a board-certified radiation oncologist and medical director of the Central Nervous System Program at Jersey Shore University Medical Center and the director of Proton Therapy in the Department of Radiation Oncology at Hackensack Meridian Health, first discussed his use of the novel stereotactic radiosurgery modality ZAP-X for patients with brain tumors. According to Chen, this tool may allow for practices to administer radiation at submillimeter precision, which can spare normal tissue from receiving excess radiation.


Another technology that Chen highlighted included GammaTile, a radiation treatment that was developed for the management of brain tumors. He said that this collagen tile may help with administering strong radiation to precisely where the tumor is located, while also protecting healthy tissues to minimize the adverse effects from radiation therapy. Specifically, Chen stated that GammaTile may be beneficial for those with larger, difficult-to-treat tumors.


Finally, Chen discussed the potential applications of proton therapy and how it may improve outcomes in patients compared with standard radiotherapy. According to Chen, proton therapy serves a “great purpose” with what he described as a precise depth charge that can minimize toxicity during treatment. 


Additionally, Chen described how proton therapy may help reduce the probability of developing mutations or secondary cancers among pediatric patients. He highlighted the potential benefit of this modality based on a specific case in which a pediatric patient with myxopapillary ependymoma experienced improvements in pain and urinary control following proton therapy.


Regarding these novel forms of therapy, Chen emphasized the notion of multidisciplinary care and said that practices should “work together as a team” when operating these technologies.


“[With] all this technology, it's not just used as it is; the technology brings us to work together,” Chen said. “I think multidisciplinary care is the future. People are no longer siloed…. We all work together.” 

The robotic-assisted biopsy platform Ion is a “game-changer” for patients with lung cancer, as it provides a quicker, less invasive surgical method for conducting a lung biopsy, according to Richard Lazzaro, MD.


In a conversation with CancerNetwork, Lazzaro, the chief of Thoracic Surgery at the Southern Region of RWJBarnabas Health, spoke about his experience with adopting the Ion robotic bronchoscopy platform for the early detection of lung cancer at Monmouth Medical Center. He highlighted how the tool may enable practices to acquire tissue and perform disease staging with fewer complications, which may particularly benefit those who plan to undergo induction chemotherapy or immunotherapy.


In terms of other potential advancements in the lung cancer surgery field, Lazzaro discussed how he anticipates the use of video-assisted thoracoscopic (VATS) surgery to evolve. Specifically, he mentioned the development of technologies such as augmented reality as tools that may help minimize the variability of surgical procedures.


Regarding his practice, Lazzaro highlighted how a multidisciplinary thoracic tumor board—including medical oncologists, radiologists, pathologists, and pulmonary physicians, among others—has helped in producing long-term survival improvements. He emphasized collective discussions and shared decision-making as part of determining appropriate courses of care for his patients. When it comes to a multidisciplinary approach, Lazzaro stated that “you want to take care of patients” like they were part of “your family.”


Overall, Lazzaro noted how the lung cancer treatment landscape has changed over time. He emphasized referring patients for CT scans as well as evaluations at nodule or thoracic oncology clinics as part of a multidisciplinary strategy.


“The management of lung cancer is different than it was even 5 years ago. If we can detect lung cancer early, we have options for treating patients today that we never had before,” Lazzaro said. “This is the time where we really need to make a huge difference in lung cancer.”

Reference


Latest most advanced treatments for lung cancer now available at Monmouth Medical Center. News release. RWJBarnabas Health. January 22, 2024. Accessed April 17, 2024. https://tinyurl.com/ty8st3hm

During the 2024 Society of Surgical Oncology Annual Meeting (SSO), CancerNetwork® spoke with a variety of surgical oncology experts regarding the topline data they presented. Each conversation also expanded upon how these results can be implemented into the clinical space and the next research steps. 


First, Adrienne Bruce Shannon, MD, a complex general surgical oncology fellow at Moffitt Cancer Center, discussed findings from her presentation highlighting responses to neoadjuvant immune checkpoint inhibitors among select patients with mismatch repair deficient (dMMR) gastroesophageal cancer.1 


Looking ahead, Shannon described her aim to optimize treatment strategies for this patient population, which may include assessing whether single-agent treatment can be efficacious while avoiding toxicity associated with combination regimens. 


Next, Sean Dineen, MD, an associate member in the Gastrointestinal Department, section leader for Peritoneal Disease, and the program director for the Complex General Surgical Oncology Fellowship at Moffitt Cancer Center, spoke about his session, which was aimed at determining appropriate conditions for using cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) for those with colorectal cancer (CRC) and peritoneal metastases.2 


Dineen highlighted that there is “good evidence” in support of HIPEC as a “valid treatment option” and emphasized the need to encourage medical oncologists to refer patients for consideration of surgery. Additionally, he spoke about other advancements he hopes to see in this patient population, including the development of markers of various disease volumes that can help identify potential recurrence in those who receive surgery. 


Finally, Muhammad Talha Waheed, MD, a research fellow in the Department of Surgical Oncology at City of Hope National Medical Center in Duarte, California, detailed findings from a retrospective analysis indicating disparate treatment access and cancer-related mortality based on racial-economic segregation.3 


Specifically, data showed that those who lived in Black and poor majority areas were less likely to receive care that was in accordance with various treatment guidelines while having worse overall survival outcomes. Regarding the next steps, Waheed described his intentions of sharing his findings with policymakers who may create legislature intended to mitigate the disparities observed in the analysis.

References


1.        Shannon AB, Mehta RJ, Mok SR, et al. Pathologic response to neoadjuvant immunotherapy in DNA mismatch repair protein-deficient gastroesophageal cancers. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA. Abstract 94.

2.        Dineen S. Optimal tumor burden for CRS/HIPEC in colorectal cancer. Presented at the Society of Surgical Oncology 2024 Annual Meeting; March 20-23, 2024; Atlanta, GA.

3.        Waheed MT, Sullivan KM, Haye S, et al. Impact of racialized residential segregation on guideline concordant cancer care and survival. Presented at the Society of Surgical Oncology (SSO) 2024 Annual Meeting; March 20 – 23, 2024; Atlanta, GA; abstract E126.

As part of Breaking Barriers: Women in Oncology, Maha H. Hussain, MD, and Sarah E. Fenton, MD, PhD, spoke with CancerNetwork® about developments in their careers and the evolution of research in the genitourinary oncology (GU) field. Additionally, they discussed their personal experiences in the field, which ranged from applying key pieces of advice from former mentors, handling challenges, and maintaining a healthy work/life balance.


Hussain is a Genevieve E. Teuton Professor of Medicine at Northwestern Medicine, and her mentee and fellow colleague, Fenton, is an assistant professor of Medicine at Northwestern Medicine.


The conversation partly focused on how the GU oncology landscape has evolved over time. According to Hussain, funding for new research and clinical trials has grown due to partnerships with pharmaceutical companies, which has accompanied a growth in median survival for patients with metastatic castration-resistant and metastatic hormone-sensitive prostate cancer. Looking ahead, Fenton said she hopes to see a greater proportion of patients achieve improved disease control, thereby leading to more treatment discontinuations or longer treatment-free intervals. 


Additionally, Fenton described some of the advice she received that impacted the trajectory of her career and helped her decide to specialize in GU oncology.


“You need to stick with things that are important to you, worth your time, and are going to help people,” Fenton said. “That is the best piece of advice that Maha has given me as I’ve been moving through and thinking about what projects I’m going to start and where I am going to work hard.”


Hussain and Fenton also spoke about some of the personal challenges they have encountered in genitourinary oncology, including the difficulty of balancing their personal lives with professional aspirations. Both spoke to the importance and possibility of caring for their families while establishing priorities for their work.


“You can parallel-track your career and your personal life. I would say motherhood is wonderful; it’s a wonderful opportunity to be a mother,” Hussain said. “At the same time, it was a wonderful opportunity to be a physician and move the field there and work hard. Don’t forget that your personal life is very important because a happy personal life also reflects on your work life.”

In a conversation with CancerNetwork®, Rian M. Hasson Charles, MD, MPH, FACS, spoke about her career in thoracic surgery and her visions for increasing equitable care in the field as part of a new, first-of-its-kind role at Brigham and Women’s Hospital. She will serve as the inaugural vice chair for Diversity, Equity, and Inclusion (DEI) in the Department of Surgery as well as an associate surgeon in the Division of Thoracic Surgery.


Hasson contextualized the acceptance of her new role by highlighting her previous experiences in lung cancer surgery, which included pursuing a psychology major at University of California, Berkeley and working as an attending physician at Dartmouth Hitchcock Hospital. At Dartmouth, she formed a DEI program for the public health school and pursued initiatives designed to spread access to care for patients with lung cancer.


As part of her new role at Brigham and Women’s Hospital, Hasson aims to reduce significant disparities in care across areas surrounding the academic center, grow a diverse workforce, and form connections with members in the community. 


Hasson also described some of the barriers she experienced and overcame as a woman in oncology. She offered advice to other aspiring surgeons in the field, emphasizing the importance of paying attention to the family, friends, and partners who can support them during their journey.


“The world is your oyster. This position is a dream position for me because it’s bringing together everything that I love to do,” Hasson said.


“I encourage people to find their focus, find their passion, find the thing that keeps them up at night or that wakes them up in the morning. You can do whatever you set your mind to. With today’s resources, there should be nothing that limits you. There may be things that seem like they’re discouraging, but you have the power to overcome those and collaborate with people that will help generate success,” she added.

In a conversation with CancerNetwork®, Gregory Peter Kalemkerian, MD, spoke about the publication of updated guidelines for managing small cell lung cancer (SCLC) with systemic therapy, which was developed by the American Society of Clinical Oncology (ASCO) in collaboration with Ontario Health (Cancer Care Ontario).1


Kalemkerian, a clinical professor at The University of Michigan and senior author of the guidelines, discussed developments in the SCLC field that inspired the creation of the revised guidelines since the last publication from ASCO in 2015.2 Although the latest guidelines contained recommendations concerning treatment modalities such as surgery and radiotherapy, Kalemkerian said that the biggest advances related to the integration of immunotherapy into frontline treatment for patients with extensive-stage SCLC (ES-SCLC).


Specifically, Kalemkerian highlighted the use of immunotherapeutic agents such as durvalumab (Imfinzi) and atezolizumab (Tecentriq), which have demonstrated long-term improvements in survival of those with ES-SCLC. The guideline authors issued a strong recommendation backed by high-quality evidence for the frontline use of carboplatin plus etoposide or cisplatin plus atezolizumab or durvalumab followed by maintenance immunotherapy in patients with ES-SCLC who have no contraindications to immunotherapy.1 Additionally, there was no evidence supporting the continuation of immunotherapy for those with relapsed SCLC and progressive disease following maintenance immunotherapy based on an informal consensus.


With respect to other updates in the guidelines, Kalemkerian spoke about optimal treatment strategies for patients with poorer performance statuses as well as the potential role of biomarkers in SCLC. Although there are currently no validated biomarkers that have demonstrated utility in the management of SCLC, he stated that it was necessary to overhaul how practices understand how diseases like SCLC develop and grow to help improve patient outcomes.


“I would like people to pay attention to SCLC a little bit,” Kalemkerian said. “Non–small cell lung cancer has gotten a lot of the press and hype over the last 20 years or so since targeted therapy came out for that disease. Before that, we all thought SCLC was where we were going to be making advances, and we were wrong. We’re on the cusp of understanding the disease better and utilizing that understanding to advance newer strategies for trying to treat these patients.”

References


1.        Khurshid H, Ismaila N, Bian J, et al. Systemic therapy for small-cell lung cancer: ASCO-Ontario Health (Cancer Care Ontario) guideline. J Clin Oncol. 2023;41(35):5448-5472. doi:10.1200/JCO.23.01435

2.        Rudin CM, Ismaila N, Hann CL, et al. Treatment of small-cell lung cancer: American Society of Clinical Oncology endorsement of the American College of Chest Physicians Guideline. J Clin Oncol. 2015;33(34):4106-4111. doi:10.1200/JCO.2015.63.7918.

CancerNetwork® collaborated with OncLive® to speak with Edward S. Kim, MD, MBA, and Richard T. Lee, MD, about ongoing initiatives to expand integrative oncology for patients with cancer at City of Hope.


Kim is the physician-in-chief and senior vice president at City of Hope Orange County as well as the Construction Industries Alliance City of Hope Orange County physician-in-chief chair. Lee is the Cherng Family Director’s Chair of the Center for Integrative Oncology and a medical director of Supportive & Integrative Medicine in the Department of Supportive Care Medicine as well as a clinical professor of Supportive & Integrative Medicine at City of Hope.


The discussion partly focused on how integrative oncology is practiced at City of Hope. The institution’s style of integrative care derives inspiration from traditional Eastern medicine and encompasses modalities such as acupuncture, meditation, yoga, and massages to help treat patients with cancer more holistically. Lee cited updates in integrative therapy guidelines published by the Society for Integrative Oncology (SIO) in partnership with the American Society of Clinical Oncology (ASCO) to illustrate how integrative care can benefit patient quality of life.1 For example, he highlighted that there was strong evidence in support of implementing mindfulness-based interventions to help reduce anxiety and stress among patients.


“These types of integrative therapies are a great way to complement many of the standard-of-care options that we have and provide even further benefit in controlling these symptoms and allowing patients to have a better quality of life as they go through treatment and as they head into survivorship,” Lee said.


The conversation also pertained to the institution’s efforts to expand the Cherng Family Center for Integrative Oncology, a first-of-its-kind national integrative oncology program, following receipt of a $100 million gift from Andrew and Peggy Cherng, co-founders and co-chief executive officers at Panda Express, supporting its creation.2 This initiative will include conducting rigorous research in a clinical program that may inform future integrative oncology guidelines, pursuing natural product drug development, and instituting educational programs that may train future integrative oncologists.


"The only way we're going to be able to increase access to these important programs to more people is to do the rigorous, level 1 research that’s needed in order to prove that there is a benefit of any particular area,” Kim said. “Because if we’re rigorous and we show the results are positive, then we would expect them to be on the guidelines like the National Comprehensive Cancer Network, and then payers would then provide support to patients who want to have these services.”

References


1.        Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. J Clin Oncol. 2023;41(28):4562-4591. doi:10.1200/JCO.23.00857

2.        Logsdon Z. City of Hope receives $100 million gift to create first-of-its-kind national integrative oncology program. News release. City of Hope. September 12, 2023. Accessed March 13, 2024. https://tinyurl.com/26y3xj87

Monique Gary, DO, MSc, FACS spoke with CancerNetwork® about estimated increases in cancer burden across the world and the potential rises in cancer inequities among underserved populations, and discussed mitigating these disparities from an oncology and primary care perspective.


Gary, a board-certified breast surgical oncologist and medical director of the Grand View Health/Penn Cancer Network cancer program, talked about growing cancer burden in the context of a World Health Organization (WHO) survey that projected future cancer risks. According to findings from the survey, there was an estimated 20 million new cancer cases and 9.7 million deaths from cancer in 2022. Authors estimated that 1 in 5 people will develop cancer, with 1 in 9 men and 1 in 12 women estimated to die from their disease. Additionally, more than 35 million new cancer cases were projected in 2050, representing a 77% increase from the estimated 20 million cases in 2022.


In particular, Gary highlighted a rise in cancer diagnoses among younger patients, including those without family history or hereditary mutations. In addition to environmental factors such as poor air quality and health conditions like obesity, she emphasized health system inequities in certain countries as obstacles that may contribute to rising cancer burden. Due to a lack of financial protection, some patients may lack adequate access to early detection and therapy for cancer. 


Part of addressing these inequities, Gary said, requires primary care physicians redefining their perspective of cancer and not dismissing younger people who present with cancer symptoms. In addition to increasing screening for younger populations, she stated that it was necessary for oncologists to lean into available research and encourage patients to enroll on clinical trials.


“It's not just the job of advocacy groups and societies; it's the job of every clinician,” Gary said regarding what needed to be done to address the growth in cancer incidence and disparities. “The individuals who have been disadvantaged already, those [patients] who have a higher mortality and are diagnosed at a later stage of disease…don't have the access. This disparity is going to get wider and wider; we'll do something about it. And that should inspire everyone because there's something for everyone to do.”

Reference


World Health Organization. Global cancer burden growing, amidst mounting need for services. February 1, 2024. Accessed March 5, 2024. https://shorturl.at/pLNU7

In a conversation with CancerNetwork®, Robert A. Winn, MD, spoke about current obstacles in achieving equitable care for patients with cancer and discussed how initiatives from community health centers and federal bodies alike may help increase access to anti-cancer therapy.


Winn, director and Lipman Chair in Oncology at Virginia Commonwealth University (VCU) Massey Comprehensive Cancer Center, senior associate for Cancer Innovation, and professor of pulmonary disease and critical cancer medicine at VCU School of Medicine, began the discussion by defining health equity as a principle. By eliminating disparities that impact access to treatment for certain populations, it may be possible for all patients to receive the same kind of care and potentially experience the same outcomes as part of an “even playing field.”


According to Winn, initiatives that may promote health equity in oncology include the ruling from the Centers for Medicare & Medicaid Services (CMS) allowing for the reimbursing of navigation services to help patients and their families access treatment for cancer and other serious diseases.1 Although Winn said that the field was trending towards the goal of health equity, he stated that more progress was necessary for biomarker testing in lung cancer and other malignancies. Additionally, increasing access to new treatments, technologies, and screening mechanisms across different communities represented another challenge concerning progress. 


Winn also spoke about educating others on cancer-related disparities, including his colleagues and other resourceful groups in cancer care. He detailed his experiences with working on the yearly American Association for Cancer Research (AACR) Cancer Disparities Progress Reports since the first was published in 2020, which he described as an element that he hopes will educate people and spread awareness. In addition to collaboration among professional bodies including the Association of American Cancer Institutes and the American Society of Clinical Oncology, Winn highlighted local efforts in spreading awareness and improving progress towards health equity.


“By not sitting on our heels and waiting for the community to come to us, but by going out to the community and talking about the importance of screening, talking about the importance of finding a new drug and what that means, and talking about these new technologies, we've actually gotten a very robust group of community members who are actually by our sides and actually making other people aware out in the community,” Winn said regarding Facts & Faith Fridays, an initiative from Massey Comprehensive Cancer Center in collaboration with local faith-based leaders designed to spread awareness of anti-cancer treatment.2 “That has resulted in very positive outcomes for us.”

References


1.        CMS finalizes physician payment rule that advances health equity. News release. Centers for Medicare & Medicaid Services. November 2, 2023. Accessed February 27, 2024. http://tinyurl.com/4p7dhr7h

2.        Facts & Faith Fridays. VCU Massey Comprehensive Cancer Center. Accessed February 27, 2024. http://tinyurl.com/5wetmdyz