Oncology On The Go

Starting April 1, 2024, Diane M. Simeone, MD will start her new position as director of the University of California San Diego (UCSD) Health Moores Cancer Center.1 


In a conversation with CancerNetwork®, Simeone highlighted her excitement to be working with an institution that she said aligns with her goals and values. During her time as director, she said that she wants to focus more on early detection of pancreatic cancer, which may help save many patients. Additionally, some of her short- and long-term goals include submitting a Cancer Center Support Grant to the National Institutes of Health and expanding clinical trial efforts at UCSD. She also discussed ongoing projects she will aim to work on, such as the UC Pancreatic Cancer (UCPCC) Consortium and the Pancreatic Cancer Early Detection (PRECEDE) Consortium.2,3


Prior to beginning her new position at UCSD, Simeone has been the Laura and Isaac Perlmutter Professor of Surgery, director of the Pancreatic Cancer Center, and the associate director of translational research at Perlmutter Cancer Center at New York University Langone Health. Additionally, she was previously the chair of the scientific and medical advisory board of the Pancreatic Cancer Action Network and a member of the scientific advisory board for the Let’s Win Pancreatic Cancer online community. 


“It was clear that everybody is aligned with this mission and understands the importance of how we care for patients with cancer and do research at the cancer center,” Simeone said during the interview. “There seems to be a clear commonality of thinking on their vision of being at the forefront of advancing science and, most importantly, how we apply to take care of patients. Patients are always the driving force. That's always the center of what we need to be thinking about.”

References


1.     World-renowned surgeon named new director of Moores Cancer Center at UC San Diego Health. News release. University of California San Diego. January 8, 2024. Accessed January 25, 2024. http://tinyurl.com/4986f4cb

2.     UC Pancreatic Cancer Consortium. University of California Health. Accessed January 25, 2024. http://tinyurl.com/3szdvyxv

3.     PanCAN’s Precision Promise adaptive clinical trial platform –. Pancreatic Cancer Action Network. Published April 27, 2016. Accessed January 25, 2024. http://tinyurl.com/fpax5hhd

After the 2024 Gastrointestinal Cancers Symposium, Jun Gong, MD, and Daneng Li, MD, sat down to discuss the most relevant trial data to have come from the conference. They convened for a live X Space hosted by CancerNetwork®.


During the discussion, they covered different trials across the gastrointestinal space, which included those evaluating different disease states from hepatocellular carcinoma (HCC) to colorectal cancer (CRC), and those assessing circulating tumor DNA (ctDNA) dynamics.


Gong, a hematologic oncologist focusing on gastrointestinal and genitourinary cancers at Cedars-Sinai Medical Center, and Li, an associate professor in the Department of Medical Oncology and Therapeutics Research at City of Hope, each gave their perspective on the clinical trial data and discussed if they had implemented any of these study treatments into clinical practice. 


The studies they covered included: 


1.        Phase 3 NETTER-2 Trial (NCT03972488)1:

- Investigated lutetium Lu 177 dotatate (Lutathera) plus octreotide vs octreotide alone for advanced gastroenteropancreatic neuroendocrine tumors (GEP-NETs).

- Lutetium Lu 177 significantly improved progression-free survival (PFS) and overall response rate (ORR) compared with octreotide alone.

- The agent may be considered for patients with high-grade GEP-NETs who desire significant tumor shrinkage.

2.        Phase 3 EMERALD-1 Trial (NCT03778957)2:

- Studied transarterial chemoembolization (TACE) plus durvalumab (Imfinzi) with or without bevacizumab (Avastin) for unresectable HCC.

- Durvalumab/bevacizumab plus TACE improved PFS compared with placebo plus TACE.

- TACE may be preferred over transarterial radioembolization (TARE) due to faster patient recovery.

3.        Phase 3 CheckMate-8HW Trial3:

- Evaluated nivolumab (Opdivo) plus ipilimumab (Yervoy) vs chemotherapy for first-line treatment of microsatellite instability-high/mismatch repair deficient metastatic CRC.

- Nivolumab/ipilimumab demonstrated superior PFS compared with chemotherapy.

- Chemotherapy may no longer be the standard first-line treatment for this patient population.

4.        BESPOKE Study (NCT04264702)4:

- Assessed the impact of minimal residual disease (MRD) detected by ctDNA on disease recurrence in patients with stage II and III CRC receiving adjuvant chemotherapy.

- MRD positivity was associated with worse disease-free survival (DFS).

- ctDNA clearance at 12 weeks indicated improved DFS. 

5.        GALAXY Trial5:

- ctDNA is a promising biomarker that can be used to predict recurrence in patients with CRC.

- Patients with ctDNA-positive disease had a worse DFS than patients with ctDNA-negative disease.

- This suggests that ctDNA may be useful for making treatment decisions, but more research is needed before it can be used in clinical practice.

6.        Phase 3 FRESCO-2 Trial (NCT04322539)6:

- Fruquintinib (Fruzaqla) improved the quality of life in patients with metastatic CRC when combined with best supportive care and significantly improved quality-adjusted time without symptoms of disease or toxicity compared with placebo and best supportive care.

- The study showed positive effects on PFS, response rate, disease control, and duration of response with the fruquintinib combination.

- The findings from this trial supported the FDA approval of fruquintinib for metastatic CRC in November 2023.7


References


1.        Singh S, Halperin D, Myrehaug S, et al. [177Lu]Lu-DOTA-TATE in newly diagnosed patients with advanced grade 2 and grade 3, well-differentiated gastroenteropancreatic neuroendocrine tumors: primary analysis of the phase 3 randomized NETTER-2 study. J Clin Oncol. 2024(suppl 3):LBA588. doi:10.1200/JCO.2024.42.3_suppl.LBA588

2.        Lencioni R, Kudo M, Erinjeri J, et al. EMERALD-1: a phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization. J Clin Oncol. 2024;42(suppl 3):LBA432. doi.10.1200/JCO.2024.42.3_suppl.LBA432

3.        Andre T, Elez E, Van Cutsem E, et al. Nivolumab (NIVO) plus ipilimumab (IPI) vs chemotherapy (chemo) as first-line (1L) treatment for microsatellite instability-high/mismatch repair-deficient (MSI-H/dMMR) metastatic colorectal cancer (mCRC): First results of the CheckMate 8HW study. J Clin Oncol. 2024;42(suppl_3):LBA768. doi.10.1200/JCO.2024.42.3_suppl.LBA768

4.        Kasi P, Aushev V, Ensor J, et al. Circulating tumor DNA (ctDNA) for informing adjuvant chemotherapy (ACT) in stage II/III colorectal cancer (CRC): interim analysis of BESPOKE CRC study. J Clin Oncol. 2024;42 (suppl _3):9. doi:10.1200/JCO.2024.42.3_suppl.9

5.        Yukami H, Nakamura Y, Mishima S, et al. Circulating tumor DNA (ctDNA) dynamics in patients with colorectal cancer (CRC) with molecular residual disease: Updated analysis from GALAXY study in the CIRCULATE-JAPAN. J Clin Oncol. 2024;42(suppl_3):6. doi:10.1200/JCO.2024.42.3_suppl.6

6.        Stintzing S, Tabernero J, Satoh T, et al. Quality-adjusted time without symptoms of disease or toxicity (Q-TWiST) analysis of fruquintinib + best supportive care (BSC) compared with placebo + BSC in metastatic colorectal cancer (mCRC): results from the FRESCO-2 trial. J Clin Oncol. 2024;42(suppl 3):116. doi:10.1200/JCO.2024.42.3_suppl.116

7.        FDA approves fruquintinib in refractory metastatic colorectal cancer. FDA. News release. November 8, 2023. Accessed February 7, 2024. https://shorturl.at/isJW2

In a conversation with CancerNetwork®, Lisa Carter-Bawa PhD, MPH, APRN, ANP-C, FAAN, spoke about factors that may contribute to feelings of stigmatization surrounding a lung cancer diagnosis, which may impact an individual’s decision to undergo screening for potential disease.


Specifically, Carter-Bawa, director of the Cancer Prevention Precision Control Institute at the Hackensack Meridian Health Center for Discovery and Innovation, detailed the stigmatization related to smoking and how public discourse in the context of lung cancer may impart feelings of shame or blame surrounding the development of one’s disease. As part of an effort to combat the stigmatization that at-risk populations may experience, she discussed the use of a digital, public-facing health communication and decision support tool named LungTalk. The tool was designed to provide an individually tailored experience that can help people understand more about lung health and lung cancer screening while encouraging shared decision-making with an informed clinician.


According to findings published in JTO Clinical Research and Reports, applying the Lung Cancer Stigma Communications Assessment Tool to LungTalk as part of a language, imagery, and context audit led to a revision of the digital tool in which potentially stigmatizing terms such as “smoker” were replaced with person-first language. Authors of the report concluded that adjusting public messaging surrounding at-risk individuals to be more empathic in conjunction with outreach and education efforts from clinicians may play a role in destigmatizing lung cancer.


Carter-Bawa also spoke about ongoing initiatives intended to address the low rates of lung cancer screening among screening-eligible African-American patients. Efforts such as community advisory councils and interactions with churches and other faith-based organizations aim to spread knowledge about lung cancer even beyond screening-eligible individuals.


“I would love for my colleagues to take away envisioning a world where stigma in lung cancer doesn't exist—that it's just a historical blip that we look back on—and that we are treating people equitably across the board,” Carter-Bawa said. “[A world where] we're using person-first language and not referring to people as smoker and nonsmoker in our scientific communication, our medical communication, or layman communications.”


Reference


Carter-Bawa L, Ostroff JS, Hoover K, Studts JL. Effective communication about lung cancer screening without iatrogenic stigma: a brief report case study using the lung cancer stigma communications assessment tool of LungTalk. JTO Clin Res Rep. 2023;4(11):100585. doi:10.1016/j.jtocrr.2023.100585

Although strides have been made with Bruton tyrosine kinase (BTK) inhibitors and CAR-T cell therapy, relapse and resistance remain significant hurdles in treating patients with mantle cell lymphoma (MCL). The Lymphoma Research Foundation's 2023 MCL Scientific Consortium and Workshop addressed these complexities, aiming to dissect the intricate biology of MCL and propel progress towards a cure.


CancerNetwork® spoke with leaders in the MCL field to better understand the aim of the consortium and the advancements they hope to see in the space. The journal ONCOLOGY® published these findings in the February 2024 issue. The interviews included Elias Campo, MD, PhD, research director and professor of anatomic pathology at the Hospital Clinic of the University of Barcelona; Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at The University of Texas, MD Anderson Cancer Center; Martin Dreyling, MD, PhD, professor of Medicine in the Department of Medicine and head of the Medical Clinic 3 at the University of Munich-Grosshadern in Germany; and Julie M. Vose, MD, MBA, Neumann M. and Mildred E. Harris Professor and division chief in the Division of Hematology at the University of Nebraska Medical Center and coeditor in chief of ONCOLOGY. 


The consortium touched on t(11;14), which dysregulates cyclin D1 and fuels uncontrolled cell growth. Additionally, research presented at the consortium revealed other molecular pathways contributing to treatment resistance and relapse, highlighting the heterogeneous nature of the disease. This heterogeneity underscored the need for personalized treatment strategies and biomarker-based prognostics, a notion further emphasized by multiple findings on the predictive value of specific gene mutations.


Beyond understanding the inner workings of MCL, presentations also focused on novel therapeutic avenues. Specifically, there were encouraging data on the potential of next-generation BTK inhibitors including acalabrutinib (Calquence) to overcome resistance.


Challenges such as the limitations of current risk stratification models remain, underscoring the need for robust biomarkers to guide early interventions and optimize treatment selection. Additionally, the consortium featured a discussion on addressing a lack of diversity in clinical trial populations, which may help increase treatment access for those with various medical conditions.


“…The patient population that has a disease is not always [represented] in the clinical trials. That’s why it’s important to be able to have a diversity of patients in clinical trials: to test these new therapies because [patients] may have other medical conditions that would change the outcome of trials and not be necessarily representative of the entire patient population with that disease,” Vose said. “It’s important to try to advance the treatment of a very diverse patient population through these clinical trial mechanisms.”

Integrative therapies have been proven to help reduce the adverse effects (AEs) of anxiety and depression in patients with cancer, according to Linda E. Carlson, PhD, RPsych. 

Carlson, Enbridge Research Chair in Psychosocial Oncology and a professor in the Department of Oncology, Cumming School of Medicine at the University of Calgary, explained how different therapies such as mindfulness-based interventions, yoga, and relaxation could work to manage anxiety and depression in patients with cancer. Specifically, she talked about the new recommendations published by The Society for Integrative Oncology (SIO) in collaboration with the American Society of Clinical Oncology (ASCO), which highlighted integrative approaches to managing AEs related to anxiety and depression.1

During the interview, Carlson spoke about the current guidelines, which recommendations clinicians can begin to use in their everyday practices, and what aspects future research should focus on. Specifically, she highlighted the benefits of yoga, tai chi, and relaxation as possible therapies that can help mitigate the AEs of anxiety and depression.

“For the clinician, [it’s important to understand] that these options are available and that they’re evidence-based,” Carlson said. 

“Then, [it’s important to figure] out where in your local area these kinds of treatments are available. Many comprehensive cancer centers have integrative therapies; they have yoga, tai chi, mindfulness-based interventions, relaxation, and imagery. Many counselors can offer those kinds of services and cognitive behavioral therapy. Being aware that [these options are] effective and that they are first-line treatments, finding out where they’re available, knowing how patients can access them, facilitating the treatments in whatever way [clinicians] can, and advocating for more of these programs within cancer treatment centers will be important.”

 Carlson is also the past president of SIO and a current editorial advisory board member of ONCOLOGY®.

Reference
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

In a conversation with CancerNetwork® prior to the FDA approval of pembrolizumab (Keytruda) plus chemoradiotherapy in FIGO stage III to IVA cervical cancer, Jyoti S. Mayadev, MD, spoke about how the regimen’s approval would be a “major step” for the aforementioned population and how she planned to integrate it into her care.1 


Mayadev, a board-certified radiation oncologist and professor of radiation medicine and applied sciences at the University of California, San Diego School of Medicine, stated that the approval would be a “huge win” with respect to progression-free survival (PFS) based on supporting findings from the phase 3 KEYNOTE-A18 trial (NCT04221945). According to data presented at the 2023 Annual Global Meeting of the International Gynecologic Cancer Society (IGCS), treatment with pembrolizumab plus chemoradiotherapy produced a significant PFS benefit compared with chemoradiation alone (HR, 0.70; 95% CI, 0.55-0.89; P = .0020).2 Additionally, findings from a subgroup analysis highlighted that the PFS benefit with the pembrolizumab-based combination extended to those with FIGO stage III to IVA disease (HR, 0.58; 95% CI, 0.42-0.80).1


Mayadev also described the tolerability and quality-of-life benefits associated with the pembrolizumab combination in the KEYNOTE-A18 trial. Additionally, she stated that potential next steps for research may involve integrating adaptive technology to potentially reduce toxicity following chemoradiation among patients with cervical cancer. 


“Uptake of any new agent requires a multidisciplinary team approach. It requires workflows,” Mayadev said regarding her strategy for adopting the newly approved regimen in her clinic. “For our particular institution, we would somewhat seamlessly go into the FDA approval. At the same time, we would try to help others in the community. We, as a scientific global community for gynecologic oncology and radiation oncology, will come together and start to incorporate how we can move forward with the FDA approval.”

References


1.     FDA approves pembrolizumab with chemoradiotherapy for FIGO 2014 stage III-IVA cervical cancer. News release. January 12, 2024. Accessed January 15, 2024. https://bit.ly/3NZNGPb

2.     Lorusso D, Xiang Y, Hasegawa K, et al. ENGOT-cx11/GOG-3047/KEYNOTE-A18: A randomized, double-blind, phase 3 study of pembrolizumab plus chemoradiotherapy for high-risk locally advanced cervical cancer. Presented at 2023 Annual Global Meeting of the International Gynecologic Cancer Society; November 5-7, 2023; Seoul, South Korea. Abstract SE004/1614.

In a conversation with CancerNetwork®, Sarah Donahue, MPH, NP, discussed strategies for managing adverse effects (AEs) associated with different drug classes for patients with metastatic breast cancer, ranging from antibody drug conjugates (ADCs) to CDK4/6 inhibitors.


With respect to ADCs, Donahue, a nurse practitioner at University of California, San Francisco, and member of the Oncology Nursing Society, highlighted common AEs following treatment with trastuzumab deruxtecan (T-DXd; Enhertu) and sacituzumab govitecan-hziy (Trodelvy). In particular, she spoke about the necessity of managing nausea associated with T-DXd by helping patients schedule doses with antiemetic drugs, as well as mitigating fatigue and improving quality of life in the process. For those who are treated with sacituzumab govitecan, Donahue spoke about mitigating abdominal cramping at her infusion center and administering loperamide to help patients manage acute diarrhea.


Donahue also discussed her methods for managing toxicity related to CDK4/6 inhibitors including palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenios). Among patients with hormone receptor (HR)–positive breast cancer, treatment with palbociclib and ribociclib, when given in combination with hormonal therapy, may result in fatigue, hot flashes, and arthralgia. According to Donahue, encouraging patients to exercise often may combat fatigue while mitigating arthralgia associated with an aromatase inhibitor. Moreover, she stated that loperamide may help manage potential diarrhea following treatment with abemaciclib. 


Overall, Donahue underscored the importance of keeping patients on treatments with CDK4/6 inhibitors and other treatments by being communicative with them regarding the potential to alleviate AEs. She suggested that such openness may give patients the confidence to ask providers for guidance on how to manage their disease.  


“The main thing that I find most helpful for my patients is to explain the potential [adverse] effects, explain that there’s something that we can do about them—that we can intervene. If they reach out to us sooner, we can help them more,” Donahue concluded. “I hope that the providers who are listening to this now can help to empower their patients to reach out and to ask for advice. That’s the best thing that they can do to keep them on these medications longer. They can work well; we can show that in studies. But if we can’t keep [patients] on the medications, then what are we doing?”

In a recent conversation with CancerNetwork®, Sara A. Hurvitz, MD, FACP, senior vice president and director of the Clinical Research Division at Fred Hutch Cancer Center and head of the Division of Hematology and Oncology at the University of Washington Department of Medicine, discussed new treatment options for patients with metastatic HER2-positive breast cancer. 

In the discussion, Hurvitz highlighted findings from the phase 3 HER2CLIMB-02 trial (NCT03975647), which assessed the efficacy and safety of tucatinib (Tukysa) plus ado-trastuzumab emtansine (Kadcyla; T-DM1) in patients with HER2-positive breast cancer, specifically those with brain metastases. 

Patients enrolled in this trial experienced a significant improvement in progression-free survival (PFS) with the tucatinib-based regimen. Data presented at the 2023 San Antonio Breast Cancer Symposium (SABCS) highlighted that the median time to disease progression or death was 9.5 months (95% CI, 7.4-10.9) and 7.4 months (95% CI, 5.6-8.1 in the experimental arm and placebo arm, respectively (HR, 0.76; 95% CI, 0.61-0.95; P = .0163). In patients with brain metastases, the median time to disease progression or death was 7.8 months (95% CI, 6.7-10.0) and 5.7 months (95% CI, 4.6-7.5) in the experimental arm and placebo arm, respectively (HR, 0.64; 95% CI, 0.46-0.89). Investigators reported that toxicity in the experimental arm was generally manageable and reversible.

“This was a study that only enrolled patients who were naive to trastuzumab deruxtecan [T-DXd; Enhertu],” Huvitz said. “We know that T-DXd has substantial improvements in PFS and survival, so having so many patients receive this [agent] after progression is certainly going to impact our ability to observe survival differences. About 15% of patients in each arm also went on to receive tucatinib. These are pretty exciting results for our patients, especially those with brain metastases. This study did enroll, as I said, patients with brain metastases, who comprised 44% or so of the entire population enrolled in this study. These are interesting data, and we'll see if this regimen is ultimately approved.”

Reference

Hurvitz SA, Loi S, O’Shaughnessy J, et al. HER2CLIMB-02: randomized, double-blind phase 3 trial of tucatinib and trastuzumab emtansine for previously treated HER2-positive metastatic breast cancer. Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX. Session GS01-10.

In a conversation with CancerNetwork®, Amy Tiersten, MD, spoke about how findings from the phase 1/2 ASPIRE trial (NCT03304080) may support anastrozole (Arimidex) plus palbociclib (Ibrance), trastuzumab (Herceptin), and pertuzumab (Perjeta) as a first-line treatment for patients with hormone receptor (HR)–positive, HER2-positive metastatic breast cancer.


Data presented at the 2023 San Antonio Breast Cancer Symposium (SABCS)highlighted a clinical benefit rate of 97% (95% CI, 83%-100%; P <.0001) and an objective response rate of 73% (95% CI, 54%-88%) in patients who received the experimental regimen. Moreover, investigators reported a median time to overall response of 2.8 months (95% CI, 2.7-5.2) and a median duration of response of 37.8 months (95% CI, 14.0-not estimable).


The anastrozole-based combination produced a median progression-free survival (PFS) of 21.2 months (95% CI, 18.4-57.2), with PFS rates of 46.1% (95% CI, 30.2%-70.4%) at 24 months and 24.6% (95% CI, 10.4%-58.3%) at 48 months. Additionally, the median overall survival had not been reached at the time of the analysis; only 1 of 30 patients died after more than 2 years of study treatment.


Based on these findings, Tiersten, a professor of Medicine and clinical director of Breast Medical Oncology at Mount Sinai Hospital, spoke to the importance of having an alternative treatment option outside of chemotherapy in this patient population. She stated how administering this study regimen in the frontline may help patients avoid some of the common toxicities associated with chemotherapy, thus benefitting their quality of life.


“It’s hugely important if we can have that kind of clinical benefit rate and the duration of the response and have patients avoid the toxicities of chemotherapy such as hair loss, neutropenia, fever, and nausea—all the known [adverse] effects that come with chemotherapy,” Tiersten said. “Quality of life is always important, but it’s especially important in a group of patients in whom we’re not treating with curative intent and have many lines of therapy ahead of them. If we can delay more toxic therapy by as much as we can, that would only be a win for the patients.”

Reference


Patel R, Cascetta K, Klein P, et al. A multicenter, phase I/II trial of anastrozole, palbociclib, trastuzumab, and pertuzumab in hormone receptor (HR)-positive, HER2-positive metastatic breast cancer (ASPIRE). Presented at the 2023 San Antonio Breast Cancer Symposium; December 5-9, 2023; San Antonio, TX; abstract RF02-01.

In a conversation with CancerNetwork®, Rakshanda Rahman, MD, FRCS, FACS, discussed a wide range of surgical therapy strategies and other developments in the breast cancer space, ranging from factors that should be considered for surgical decision-making to the evolution of artificial intelligence (AI) in the field.


Rahman, a professor of Breast Surgical Oncology at Texas Tech University Health Sciences Center and the medical director of UMC Cancer Center, spoke about challenges associated with barriers to treatment, stating how some patients, particularly those residing in rural counties, may not have sufficient access to the latest technologically advanced care as those in other communities. She also emphasized the value of giving early breast cancer screenings to patients to match them with appropriate systemic therapies.


“We need to keep increasing the advocacy towards screening for patients,” Rahman said. “There are still a lot of misgivings in people’s minds. They may be scared of radiation or do not have time; there are lots of reasons why people choose to not have a screening. Nothing makes a bigger difference to mortality from breast cancer like screening does. All these advancements are great, but if patients do one thing, they should get screened.”


Rahman also discussed her adoption of a genomic profiling test at her clinic to more accurately predict patients who may benefit from treatment with chemotherapy or endocrine therapy. Additionally, she spoke to the use of advanced screening technologies that allow for the detection of tiny tumors, although this may present some logistical challenges for surgically removing a tumor of that size. She also highlighted her use of MOLLI®, a magnetic device that she said has produced quicker operating times compared with a standard wire-based procedure.


With respect to AI, Rahman said that processing blood tests with an algorithm may help identify genes that could affect a patient’s disease, thereby allowing practices to discern what makes a tumor develop resistance. Additionally, certain AI tools may reduce the number of imaging tests needed for a patient, thus reducing health care costs in the process. However, Rahman cautioned that these AI programs should be used responsibly, as to not replace the “human connection” that underscores the doctor/patient relationship. 

Reference


MOLLI: precision surgery made simpler. MOLLI Surgical Inc. Accessed December 13, 2023. https://shorturl.at/mvCM6