Oncology On The Go

As part of a CancerNetwork® Frontline Forum program, Alexander I. Spira, MD, PhD, FACP; Millie Das, MD; Joshua K. Sabari, MD; and Misako Nagasaka, MD, PhD, reviewed updates in the management of EGFR exon 20 non–small cell lung cancer (NSCLC), and how these findings may apply to clinical practice. 


Spira, codirector of the Virginia Cancer Specialists Research Institute and director of the Thoracic and Phase I Program, and Das, a clinical associate professor of Medicine and Oncology at Stanford Health, led one part of the discussion regarding the evolution of molecular profiling and next-generation sequencing in the NSCLC space. Moreover, they spoke to clinical and non-clinical factors informing treatment decision-making in the second-line setting. Additionally, they reviewed data from the phase 1 CHRYSALIS trial (NCT02609776) assessing amivantamab as a treatment for patients with disease progression following chemotherapy.


According to data from the CHRYSALIS trial, amivantamab elicited an objective response rate of 40% (95% CI, 29%-51%), and a median duration of response of 11.1 months (95% CI, 6.9-not reached). Additionally, the clinical benefit rate was 74% (95% CI, 63%-83%). Common any-grade adverse effects (AEs) in the study’s safety population that were associated with EGFR inhibition included rash (86%), paronychia (45%), stomatitis (21%), pruritus (17%), and diarrhea (12%).


Sabari, a thoracic medical oncologist at Perlmutter Cancer Center of NYU Langone Health, and Nagasaka, a thoracic oncologist at the University of California, Irvine, also discussed clinical updates in the EGFR exon 20 NSCLC population. They spoke about potential novel treatment options including mobocertinib (Exkivity), as well as potential next steps in research such as moving drugs to earlier lines of treatment and obtaining a better understanding of mechanisms of acquired resistance to treatment.


According to findings from a phase 1/2 trial (NCT02716116), mobocertinib produced an ORR of 28% (95% CI, 20%-37%) by independent-review committee assessment and 35% (95% CI, 26%-45%) per investigator assessment in a cohort of platinum-pretreated patients with EGFR exon 20 insertion mutations. Common AEs reported in the trial included diarrhea and rash.


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As part of a CancerNetwork® Frontline Forum program, Joselle Cook, MBBS; Matthew James Pianko, MD; Luciano Costa, MD, PhD; and Timothy Schmidt, MD, reviewed key data updates and real-world practice findings in newly diagnosed multiple myeloma (NDMM), and how they may impact patient subgroups including those with transplant-ineligible NDMM.


Cook, a hematologist specializing in the management of patients with multiple myeloma at the Mayo Clinic in Rochester, Minnesota; and Pianko, a hematologist in the Division of Hematology and Oncology at The University of Michigan-Ann Arbor, led one part of the discussion. They discussed efficacy results from studies including the phase 3 MAIA study (NCT02252172), which assessed daratumumab (Darzalex) plus lenalidomide (Revlimid) and dexamethasone vs lenalidomide plus dexamethasone in previously untreated multiple myeloma. They also spoke about the selection of patients with transplant ineligible multiple myeloma for triplet vs doublet induction therapy regimens and potential disparities in care for patients of racial and ethnic minorities.


“We need trials to accommodate patients who are working [and patients] who are unpartnered, [and] we need to do more to understand the biologic drivers [of multiple myeloma] in Black patients,” Cook said. “Even though we have this explosion of [new] therapies onto the scene, we still have so much to do to make access to these novel treatments accessible and more equitable for everyone.”


Costa, a professor of Medicine and director of the Multiple Myeloma Program at The University of Alabama at Birmingham, and Schmidt, assistant professor in the Division of Hematology, Medical Oncology, and Palliative Care within the Division of Medicine at The University of Wisconsin, also discussed updates in the multiple myeloma space, which included a review of findings from the phase 2 GRIFFIN trial (NCT02874742). In this trial, investigators assessed daratumumab plus lenalidomide, bortezomib (Velcade), and dexamethasone as a treatment for patients with transplant-ineligible NDMM. Costa and Schmidt also spoke about approaching consolidation and maintenance therapy for patients with transplant-ineligible NDMM.


“As we’re trying to move treatments into earlier lines of therapy—particularly things like bispecifics and CAR T—improving access is [something] that we as a field and as a community need to address,” Schmidt said. 


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In a Twitter Spaces edition of the Oncology-On-The-Go podcast, Rafael Fonseca, MD and Krina Patel, MD, MSc spoke with CancerNetwork® about how key findings from multiple myeloma trials presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meetingmay impact the treatment paradigm. 


Fonseca, director of Innovation and Transformation Relationships at the Mayo Clinic in Phoenix, Arizona and Patel, an associate professor in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, detailed results from the phase 1b RedirecTT-1 trial (NCT04586426) assessing teclistamab-cqyv (Tecvayli) plus talquetamab in those with relapsed/refractory multiple myeloma.


In the RedirectTT-1 trial, investigators reported an objective response rate (ORR) of 86.6% across all dose levels and 96.3% at the recommended phase 2 dose. Additionally, the combined complete response (CR) or stringent CR rate was 40.2% and 40.7% at each respective dose level.


Another trial of interest that Fonseca and Patel discussed included the phase 2 LINKER-MM1 trial (NCT03761108), evaluating linvoseltamab (REGN5458) in relapsed/refractory multiple myeloma. In the study, the agent elicited an ORR of 71% at the 200 mg dose level. Moreover, the CR rate was 14%, the very good partial response (PR) rate was 29%, and the PR rate was 12%. The estimated 6-month progression-free survival (PFS) rate among patients receiving the regimen was 72.7%.


Fonseca and Patel also discussed results from the phase 3 CARTITUDE-4 trial (NCT04181827), comparing ciltacabtagene autoleucel (cilta-cel; Carvykti) with standard of care in lenalidomide (Revlimid)-refractory multiple myeloma. In patients receiving cilta-cel, the median PFS was not reached (NR, 95% CI, 22.8 months-not estimable [NE]) vs 11.8 months (95% CI, 9.7-13.8) among those receiving standard of care. The 12-month PFS rate in each respective arm was 76% vs 49%.


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In a conversation with CancerNetwork® during July’s Sarcoma Awareness Month 2023, Brian Van Tine, MD, PhD, spoke about developments in the sarcoma research space and discussed where future research needs to be focused in order to push the needle forward in the treatment of this patient across numerous sarcoma subgroups.


Van Tine, a professor of medicine in the Division of Oncology, Section of Medical Oncology at Washington University School of Medicine’s Siteman Cancer Center, discussed his research on nirogacestat as a treatment for desmoid tumors as part of the phase 3 DeFi trial (NCT03785964) as well as sitravatinib for managing well-differentiated or dedifferentiated liposarcoma. 


He also spoke about other areas of interest in the sarcoma space, including the development of an adoptive T-cell therapy for patients with synovial sarcoma in a phase 1 trial (NCT03132922). Moreover, in the advanced leiomyosarcoma space, he indicated that investigators are assessing unesbulin in combination with dacarbazine as part of another phase 3 trial (NCT05269355).


Concerning the potential next steps in the sarcoma space, Van Tine highlighted several possible developments including research centered on circulating tumor DNA, metabolic therapies, and immunotherapies. He also voiced his hope of advancing vaccine-based technologies in the field within the next 5 years with the hope of delivering individualized neoantigens via injection to sarcomas. 


“The best part is when, all of a sudden, you see that look in a patient's face when you get to tell them that they tried something that was ultra-new, and it worked,” Van Tine commented when discussing the development of new treatment options for patients with sarcomas. “We don't do this for us. We do this because we're dedicated to this community. When you actually get the opportunity to see it work, it's almost as exciting for us as it is for the patient.”


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In a conversation with CancerNetwork® during June’s National Cancer Survivor Month, Lindsay Morton, PhD, spoke about her research on the long-term risks of developing second cancers among cancer survivors.


Morton, director of the Radiation Epidemiology Branch and head of the Cancer Survivorship Research Unit at the National Cancer Institute and member of the Lymphoma Research Foundation’s Scientific Advisory Board, discussed treatment exposure, genetics, and lifestyle elements including smoking as factors that may confer a risk for secondary cancers. She also detailed findings from her studies on second cancer risk factors across several disease types and treatment options, including potential risks associated with immunosuppression for solid organ transplant recipients. 


Don’t forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Ritu Salani, MD, and Tanios S. Bekaii-Saab, MD, FACP, spoke with CancerNetwork® about key findings presented at the 2023 American Society of Clinical Oncology (ASCO) Annual Meeting, and how they may affect clinical practice for gynecologic cancer and gastrointestinal cancer.


Salani, the Gynecologic Oncology Fellowship Director at University of California Los Angeles (UCLA) Health and the Gynecologic Oncology editorial board member for the journal ONCOLOGY®, discussed presentations on the treatment of ovarian cancer and other gynecologic malignancies. These included data on dostarlimab-gxly (Jemperli) in advanced or recurrent endometrial cancer in the phase 3 RUBY trial (NCT03981796), mirvetuximab soravtansine-gynx (Elahere) in folate receptor alpha–high platinum-resistant ovarian cancer in the phase 3 MIRASOL trial (NCT04209855), and a bevacizumab (Avastin)-based regimen in newly diagnosed ovarian cancer in the phase 3 DUO-O trial (NCT03737643).


Bekaii-Saab, leader of the Gastrointestinal Cancer Program at the Mayo Clinic Comprehensive Cancer Center; medical director of the Cancer Clinical Research Office; vice chair/section chief for Medical Oncology, Department of Internal Medicine, at Mayo Clinic, Phoenix, Arizona; and the Gastrointestinal Cancer chair for the ONCOLOGY® tumor board, detailed findings from presentations in the gastrointestinal cancer space. He discussed data on fam-trastuzumab deruxtecan-nxki (Enhertu) in HER2-positive metastatic colorectal cancer (CRC) in the phase 2 DESTINY-CRC02 study (NCT04744831), sotorasib (Lumakras) in advanced solid tumors with KRAS G12C mutations in the phase 1b/2 CodeBreaK 101 trial (NCT04185883), and bevacizumab plus atezolizumab (Tecentriq) in metastatic CRC in the phase 2 AtezoTRIBE trial (NCT03721653).


Don’t forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Margaret Rosenzweig, PhD, CRNP-C, AOCNP, FAAN, spoke with CancerNetwork® about findings from the CONNECT study (NCT02712229), a study she authored that aimed to assess the benefit of palliative care intervention in patients with advanced cancer.


Rosenzweig, the distinguished service professor of nursing and a professor of medicine at the Hillman Cancer Center Acute & Tertiary Care, University of Pittsburgh, described the potential benefits of more frequently involving oncology nurses in discussions on advanced care planning, and helping patients make decisions on what treatment options best suit them. She also addressed some of the logistical challenges, including provider shortages and implementing training for infusion room nurses.


Don’t forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Rakhshanda Rahman, MD, FRCS, FACS, interviewed with CancerNetwork® regarding advancements in the systemic and surgical de-escalation of breast cancer treatment, which include wire-free markers that help define the extent of a tumor during surgery.


Rahman, a professor of Breast Surgical Oncology at Texas Tech University Health Sciences Center and the medical director of UMC Cancer Center, discussed de-escalation techniques including cryoablation that may aid with de-escalation beyond surgery as well as challenges surrounding physicians’ understanding of how to use new technology and educating patients on the safety and benefits of treatment options. 


Don’t forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

Javier Orozco-Mera, MD, FACS, MSc, a neurosurgeon in the Department of Neurosurgery at Hospital Universitario del Valle “Evaristo García,” University of Valle, spoke with CancerNetwork® about his study titled, Signaling Pathways in the Relapse of Glioblastoma, which was published in the journal ONCOLOGY®.


In his study, Orozco-Mera and his colleagues identified a several signaling pathways and molecular processes that are involved in glioblastoma relapse, including markers such as O-6-methylguanine-DNA methyltransferase, micro-RNA, EGFR, and P53.


Don’t forget to subscribe to the “Oncology On-The-Go” podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

In a Twitter Spaces edition of the Oncology On-The-Go podcast, Ritu Salani, MD, and Dana Chase, MD, spoke with CancerNetwork® about findings presented at the Society of Gynecologic Oncology (SGO) 2023 Annual Meeting on Women’s Cancer,and how they may impact clinical practice.


Salani, the Gynecologic Oncology Fellowship Director at University of California Los Angeles (UCLA) Health and the Gynecologic Oncology editorial board member for the journal ONCOLOGY®, and Chase, associate professor of UCLA Obstetrics and Gynecology in the Division of Gynecologic Oncology, reviewed data from trials including the phase 3 NRG GY018 trial (NCT03914612),the phase 3 RUBY trial (NCT03981796), and the phase 3 ENGOT-OV16/NOVA study (NCT01847274).



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