Targeted Talks

Gynecologic cancer incidence is moving in 3 different directions at once, and clinicians outside gynecologic oncology are often the first to see the warning signs. Ovarian cancer incidence is falling as genetic testing and risk-reducing surgery catch more high-risk women before diagnosis, even as its prevalence climbs because patients are living longer on treatment. Cervical cancer incidence continues to decline thanks to Pap and HPV co-testing plus vaccination, though it has not been eliminated. Endometrial cancer is the outlier: incidence is rising, driven largely by aggressive, high-grade subtypes that disproportionately affect Black women.¹

In this episode of Targeted Talks, Sabrina Serani, managing editor of Targeted Oncology, spoke with Noelle Gillette Cloven, MD, a gynecologic oncologist at Texas Oncology's Fort Worth Cancer Center and executive chair of the GYN Research Committee at Sarah Cannon Research Institute, to discuss how these shifting patterns should inform testing, screening, and referral decisions in everyday practice. The conversation is timed to Gynecologic Cancer Awareness Month, observed each September to raise awareness of cervical, ovarian, uterine, vaginal, and vulvar cancers.

A recurring theme was the distinction between germline and somatic testing in ovarian cancer. Germline testing, done via blood or cheek swab, identifies inherited mutations in genes such as BRCA1 and BRCA2, present in roughly 20% of ovarian cancers, and carries implications for the patient's relatives. Somatic testing of the tumor itself, including homologous recombination deficiency (HRD) status, is a separate question that determines which patients are likely to benefit from PARP inhibitor maintenance therapy after chemotherapy. Cloven emphasized that an adequate core biopsy, not a fine-needle aspiration, is essential to secure enough tissue for HRD testing and to distinguish high-grade from low-grade serous disease, since treatment approaches for the two differ substantially.

Screening gaps surfaced repeatedly. Extended Pap and HPV testing intervals, while evidence-based, make it harder for patients to track when they are due, and Cloven pushed back on guidance to stop cervical cancer screening at 65, noting that more than a third of cervical cancer cases are diagnosed after that age. In endometrial cancer, postmenopausal bleeding is rarely missed, but irregular bleeding in women under 40 is often attributed to obesity or PCOS and treated with oral contraceptives without a biopsy, delaying diagnosis in a population where the disease is less common but not absent. Cloven also flagged a persistent misconception among patients and some clinicians: a Pap test screens only for cervical cancer, not for ovarian, endometrial, or vulvar disease, and a well-woman exam does not automatically include one.

On the treatment horizon, Cloven pointed to antibody-drug conjugates producing response rates in platinum-resistant ovarian cancer that she described as the best she has seen in her career, immunotherapy's role in extending survival in metastatic cervical cancer, and early movement toward non-chemotherapy, receptor-targeted options for advanced endometrial cancer guided by molecular profiling.

For clinicians outside gynecologic oncology, Cloven's practical takeaways were straightforward: take a thorough family history, since it is often the entry point to genetic testing; do not substitute imaging or a prescription for a pelvic exam when a patient has persistent symptoms; and consider a clinical trial referral at diagnosis rather than as a last resort, since it may offer earlier access to newer therapies.

REFERENCE
1. Gaber C, Meza R, Ruterbusch JJ, Cote ML. Endometrial cancer trends by race and histology in the USA: projecting the number of new cases from 2015 to 2040. J Racial Ethn Health Disparities. 2017;4:895-903. doi:10.1007/s40615-016-0292-2

In part 2 of this conversation, oncologists discuss how they help both patients and trainees navigate an overwhelming volume of medical information. The speakers describe encouraging patients to consult reliable resources like NCCN's patient site rather than turning solely to AI chatbots, while also acknowledging patients will inevitably seek outside information and clarification from family.

For fellows, the panel emphasizes using training time intentionally: reading about patients in depth before appointments, focusing on core algorithms during subspecialty rotations, and building relationships with mentors who can be lifelong resources. Dr Demel highlights curated tools like condensed literature summaries and topic-specific podcasts as more efficient than reading full journals, especially given the explosive growth in oncology trials and publications over the past two decades alongside rising retraction rates. Dr Mehta describes using voice-based AI during a daily commute to get updated on relevant papers, a habit some fellows have since adopted.

The discussion turns to varying attitudes toward AI among colleagues, with speakers describing a spectrum from enthusiastic adopters to skeptics wary of hallucinations. Dr Ji stresses recognizing "good enough" knowledge limits, using AI to stay current on standard-of-care changes and practice-changing trials, while emphasizing that human collaboration and communication remain essential when navigating complex cases beyond one's expertise.

The conversation closes with reflections on reading outside one's specialty to address patients' broader health needs, including medication interactions and comorbidities. Panelists describe current AI use as still in its "infancy," with promising applications emerging in patient monitoring, wearable data, and predictive analytics. Take-home messages include "cautious optimism" about AI's power and a prediction that oncologists who learn to use AI effectively will have a distinct advantage in the field's future.

In this episode of Treating Together, host Dr Pallav Mehta sits down with Dr Kurt Demel and Dr Yan Ji, 2 community-based medical oncologists practicing in the Twin Cities, to tackle a problem every oncologist feels but few have named clearly: information overload.

The conversation opens with a deceptively simple question: When does learning become overload? The group traces the line from the genuine joy of working in a constantly evolving field to the point where the sheer volume of trial data, survival end points, and subgroup analyses makes it hard to land on a clear recommendation for the patient in the room. Dr Ji offers a memorable framing for this: the "memory battery" that drains over the course of a clinic day, leaving even thorough research feeling unresolved when conflicting trials point in different directions.

From there, the discussion moves into how oncologists actually cope by leaning on colleagues through email threads and group chats, the growing divide between generalist and subspecialist practice, and how increasingly informed patients (armed with their own ChatGPT printouts) are reshaping the visit itself. The back half of the episode digs into AI's expanding role in oncology: ambient note-taking, evidence-summarization tools like OpenEvidence, and AI-assisted clinical trial matching, alongside real concerns about hallucinated summaries, erosion of foundational clinical reasoning in trainees, and the risk of applying trial data to patients who don't resemble the trial population. The episode closes on a note of cautious optimism—AI as a tool to clear away noise, not a replacement for the clinical judgment and human connection that the panel agrees remains the real value an oncologist brings to a patient.

In this episode, managing editor Sabrina Serani sits down with 3 experts at the intersection of oncology pharmacy, health informatics, and drug distribution to unpack the 505(b)(2) regulatory pathway and what it means for cancer centers navigating today's complex drug landscape.

Guests:

What We Cover:

The 505(b)(2) Pathway Explained — Jessica breaks down how the 505(b)(2) new drug application differs from a traditional NDA, allowing drug developers to build on existing FDA-recognized data through bridging studies. The result: faster approvals, lower development costs, and drugs that improve on — rather than simply duplicate — what's already on the market.

Why Oncology, Why Now — Nick explains how 505(b)(2) drugs address a critical pain point in oncology practice: supply disruption. When reference products go on allocation or become unavailable, these drugs provide a meaningful alternative — and in some cases, meaningful clinical improvements like reduced toxicity, modified dosage forms, or improved adherence.

The Real Friction Points — Derek identifies where practices actually get stuck: not at the clinical level, but in operations. Launching without a brand name, missing J-codes, absent ASP data, and gaps in the CMS NDC crosswalk all create hesitation in revenue cycle teams. The underlying problem, he argues, is almost never resistance to innovation — it's undefined coverage, coding, and workflow clarity at launch.

Who Needs to Be at the Table — Nick walks through Carti's internal adoption process, emphasizing that economic evaluation must run in parallel with patient impact assessment. A cross-functional team — pre-certification, pharmacy (both infusion and dispensing), billing and coding, and claims monitoring — needs to move together, with a single source of truth so that no one on the front lines is working from conflicting information.

Practical Strategies for Adoption — The group converges on two key approaches: front-load organizational alignment before the first dose is given, and start narrow with a defined pilot population before any broad rollout. Derek and Jessica also stress the value of a designated practice champion who can coordinate across departments and pressure-test coverage and economics in advance.

The Patient at the Center — When everything is working, patients experience seamless transitions between products, fewer delays, and — in some cases — therapies that are easier to tolerate and stay on. The panel emphasizes that a well-integrated 505(b)(2) strategy should be invisible to the patient while delivering real downstream clinical and economic benefit.

Safety Considerations — Derek underscores that practices managing multiple agents within the same drug category face real risks around dispensing, billing, and administration if labeling and workflows aren't airtight. Jessica notes that the industry is correcting course, with more manufacturers now launching 505(b)(2) products with distinct brand names — reducing the risk of misidentification.

Where the Pipeline Is Headed — Jessica closes with a look at the road ahead: more branded manufacturers entering the 505(b)(2) space, a growing pipeline from traditional generic manufacturers focused on oncology, and a strategic emphasis on supply redundancy and clinical improvements for older, well-established agents that have experienced drug shortages.

Key Takeaways:

Ahead of the 2026 ASCO Annual Meeting, Sabrina Serani, managing editor of Targeted Oncology, previews the late-breaking abstracts most likely to influence clinical practice across breast, colorectal, prostate, and lung cancer, as well as in metastatic uveal melanoma, a disease that has gone without an effective systemic therapy for decades. From VIKTORIA-1 in PIK3CA-mutant metastatic breast cancer to BREAKWATER's first look at overall survival in BRAF V600E-mutant colorectal cancer, this episode breaks down the science, the clinical context, and the questions that full data will need to answer.

In this episode of the Treating Together podcast, host Pallav Mehta, MD, medical oncologist at MD Anderson Cancer Center at Cooper University Health Care and medical director of Reimagine Care, speaks with E. Anders (Andy) Kolb, MD, president and chief executive officer of Blood Cancer United (formerly The Leukemia & Lymphoma Society; LLS). Together, they unpack the major forces shaping change in pediatric hematologic malignancies—from biology to treatment/care delivery and advocacy—and how they converge to rapidly translate research into practice.

The conversation explores the momentum in pediatric blood cancer research and treatment, highlighting how genomics, clinical trials, and large-scale initiatives are reshaping care. Highlights include:

In this episode of Treating Together, host Marc Braunstein, MD, PhD, associate professor of medicine at the NYU Perlmutter Cancer Center, sits down with Adam Kittai, MD, associate professor and director of the CLL and Lymphoma programs at NYU Perlmutter Cancer Center, for a deep dive into the rapidly evolving frontline treatment landscape in chronic lymphocytic leukemia (CLL). As chemotherapy continues to give way to targeted and time-limited therapies, clinicians face an increasingly complex array of choices, each influenced by disease biology, patient preferences, and emerging clinical trial data. 

The episode focuses on the evolving frontline management of CLL and how clinicians can individualize therapy in an era of expanding options. Highlights include:

In this episode of Targeted Oncology’s Treating Together podcast, Dr Pallav Mehta sits down with Dr Sanjay Juneja, aka The Onc Doc, a medical oncologist known for his social media presence and his work in medical informatics. The duo explores how the landscape of cancer care is shifting from a "paucity of information" to a challenge of "information overload," and how technology can bridge the gap between clinical expertise and patient understanding.

The Rise of the "Social" Oncologist
Dr Juneja shares his transition from creating "theatrical" social media content to using his platform for democratizing medical information.

Dr Gabriel Mannis from Stanford University and Dr Gail Roboz from Weill Cornell Medicine discussed the evolving treatment landscape for relapsed/refractory NPM1-mutant acute myeloid leukemia (AML). The conversation highlighted the dramatic transformation of relapsed/refractory AML management from a space where "drugs went to die" to one with multiple targeted therapeutic options.

Dr Roboz emphasized the importance of comprehensive mutational reassessment at relapse, as co-mutation profiles can change from initial diagnosis. She distinguished between mutational profiling for treatment selection versus minimal residual disease (MRD) monitoring, noting that NPM1 was previously considered undruggable but now has two FDA-approved menin inhibitors: revumenib and ziftomenib.