The ASCO Daily News Podcast features oncologists discussing the latest research and therapies in their areas of expertise.
The ASCO Daily News Podcast features oncologists discussing the latest research and therapies in their areas of expertise.
Dr. Jeanny Aragon-Ching Highlights Key Research in Genitourinary Cancers
Transcription Welcome to the ASCO Daily News podcast. I'm Lauren Davis, and joining me today is Dr. Jeanny Aragon-Ching, a medical oncologist who serves as the clinical program director of genitourinary cancers at Inova Schar Cancer Center in Fairfax, Virginia. She treats patients with genitourinary cancers. Dr. Aragon-Ching, welcome to the podcast. Dr. Jeanny Aragon-Ching: Thank you very much, Lauren, glad to be here. We're glad you're here. Today we're talking about new treatment options for patients with prostate cancer and renal cell carcinoma. There are new therapies available, but I wonder how do you decide which combination of drugs to use for a particular patient? Dr. Jeanny Aragon-Ching: Yes, Lauren, so there has been a lot of exciting challenges and changes actually in both prostate and advanced kidney cancer treatment, so let me first start off with advanced kidney cancers. There has been several recent approvals with a combination of immuno-oncology drugs-- so that's what they're called, I-O drugs-- and VEGF TKIs, which have paved the way for better treatment outcomes. But it is very crucial to pay attention to potential side effects, as we decide to choose between different treatment options. Dr. Jeanny Aragon-Ching: So for first-line metastatic kidney cancer treatment, the options have always included TKIs alone. So for instance, we've always had sunitinib and pazopanib, although cabozantinib soon joined the first-line TKI therapy, since about late December 2017. So more recently, combination I-Os using nivolumab and ipilimumab, as well as I-O plus TKI combinations, such as pembrolizumab and axitinib, or avelumab and axitinib, have been approved and are currently available commercially. Dr. Jeanny Aragon-Ching: So one way to distinguish these different regimens would be to evaluate what to call the IMDC criteria. So that stands for international Metastatic RCC Database Consortium criteria. So these are six different factors that the clinician can evaluate for each of their patients. So any time they have presence of anemia, leukocytosis, thrombocytosis, hypercalcemia, and a poor performance status, and if their time from diagnosis to systemic treatment is less than a year, they get a point for each. Dr. Jeanny Aragon-Ching: So if a patient has none of these factors, they would be considered to have favorable risk disease. And if they have one to two factors, then they are considered to have intermediate risk disease. If they have three or more of these, they're considered poor risk. And that's important because we want to be able to distinguish between these different categories of patients. Dr. Jeanny Aragon-Ching: So for instance, if we think about intermediate or a poor-risk disease patient, they benefit a lot from the combination of nivolumab and ipilimumab. And this is based on what you call the CheckMate 214 trial. And they reported the 30-month update at ASCO GU earlier this year. So the results showed 11.3% complete response rate compared to sunitinib, which only yielded 1.2% complete response rate. So if we look at the overall response rates for all the patients, 42% versus only 29% in the sunitinib arm. Dr. Jeanny Aragon-Ching: Now, on the other hand, pembrolizumab and axitinib with the KEYNOTE-426 Trial, also showed remarkable objective responses at around 59% versus only 35% for the sunitinib arm. And the complete responses was also impressive, occurring in about 5.8% in the combination arm. Dr. Jeanny Aragon-Ching: Now, if we look at the risk of death, it was 47% lower in the pembro/axitinib group compared to the sunitinib group. And the 18-month overall survival was 82% compared to 72% in the sunitinib arm. Now, there's another trial that looked at combination of avelumab and axitinib. This was called the JAVELIN Renal 101 Trial. And it also showed an impressive objective response rate of 55% in th
Dr. Megan Kruse Discusses a New Treatment for Metastatic Breast Cancer
ASCO Daily News: Welcome to the ASCO Daily News Podcast. I'm Lauren Davis, and joining me today is Dr. Megan Cruz, a medical oncologist at the Cleveland Clinic who treats patients with breast cancer. ASCO Daily News: Today we're talking about a new therapeutic option for patients with metastatic breast cancer who carry the PIC3CA mutation. Dr. Cruz, welcome to the podcast. Dr. Megan Cruz: Good morning. Thank you for having me. ASCO Daily News: We're glad you're here. ASCO Daily News: So the PIK3CA is a commonly mutated gene in HR positive and HER2 negative advanced breast cancer. What kind of tests are used to detect this mutation? Dr. Megan Cruz: Yes, so that's correct. The PI3 kinase mutation is found in about 40% of hormone receptor positive HER2 negative advanced breast cancer cases. And this mutation can actually be detected by a variety of tests, many of which are convenient for our patients. Dr. Megan Cruz: Most commonly, we use tissue-based testing. And that can be samples of tissue that have been archived from either a patient's initial breast cancer diagnosis or a newer biopsy from a metastatic site. If neither of those places can be accessed or that tissue sample is no longer available, patients can have testing run on a blood-based sample. And this is often very helpful for patients who potentially have bone-only metastatic disease. ASCO Daily News: Are new agents are available to treat this form of cancer? Dr. Megan Cruz: Yes. So earlier this year, we had FDA approval of a new medication called alpelisib, which is used in combination with endocrine-based therapy in the form of fulvestrant in order to treat patients with the PI3 kinase mutated breast cancer. ASCO Daily News: And how effective is this treatment in terms of survival or overall survival? Dr. Megan Cruz: So this treatment was studied in the SOLAR-1 trial. And in that trial, it was found that there was a progression-free survival advantage for patients who received the combination of alpelisib and fulvestrant compared to placebo and fulvestrant. And that difference at 20 months was approximately from 11 months with alpelisib and fulvestrant from 5.7 months for the placebo fulvestrant combination. ASCO Daily News: And what do clinicians need to know about side effects? Dr. Megan Cruz: So there are some unique side effects with this medication, alpelisib, that clinicians will need to pay attention to. The most common ones are hypoglycemia and rash, which are generally pretty easily managed, but we have to be aware of them. Dr. Megan Cruz: When starting a patient on this medication, they need to have fasting blood sugar testing as well as hemoglobin A1C testing done prior to starting as a baseline. And then shortly after initiation of the medication, we recheck these labs to make sure that they're staying stable. Dr. Megan Cruz: If the blood sugar is rising, it's recommended to do more frequent monitoring and consideration of starting a medication like metformin to help control the blood sugars. In terms of the rash, that can actually be dealt with in a preventative way, where patients can be started on prophylactic antihistamine medications along with the start of alpelisib. And then if the rash does happen once they're on the medication, we often use either topical steroids or oral steroids to help control it. Dr. Megan Cruz: The last toxicity that I think that the clinicians should be aware of his diarrhea, which is one that we're more familiar with managing from other chemotherapies and targeted agents. So typically, use of our common anti-diarrheal medications will help to control that. ASCO Daily News: What do you think's on the horizon for metastatic breast cancer treatment? Dr. Megan Cruz: I think that we will continue to see medications like this that are targeted for specific mutations that we find in a patient's breast cancer. And then along wi
Dr. Julie Vose Discusses the ABIM/ASCO Medical Oncology: Learning & Assessment
ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Lauren Davis. And joining me today is ASCO's past president, Dr. Julie Vose, world renowned expert in the treatment of hematologic malignancies. Dr. Vose is the chair of the Hematologic Malignancies Exam Subcommittee, which determine the blueprint and testing points for the hematologic malignancies assessment. ASCO Daily News: And we'll review the overall exam forms and their associated educational materials. She has been integral to ASCO's work to reimage maintenance of certification. Today, we're talking about the ABIM/ASCO Medical Oncology Learning & Assessment that offers physicians the choice of medical oncology assessments, a general oncology assessment, or disease-specific medical oncology assessments. ASCO Daily News: Starting in 2020, diplomates can choose from three assessment options-- general oncology, breast cancer, and hematologic malignancies. Dr. Vose welcome to the podcast. Dr. Julie Vose: Thank you very much. A great privilege to be here today. We're glad you're here. The new MLLA begins in 2020. How is it different from prior years? Dr. Julie Vose: Well, this is very important, as we've been working with ABM for quite a few years now to shape the future of education and our ongoing learning process. Way back when I was president several years ago, I started working with ABM to kind of remold or re-examine the MLC process, as it was found to be really quite burdensome, especially for people like myself who specialize in one specific area and haven't seen many of these different types of cancers for many years in practice. It's difficult to keep current. And then once you learn it, it's really not ever used. So it's kind of a waste, unfortunately. Dr. Julie Vose: So ASCO's reimagination is tried to reflect and make it more of an ongoing learning process as opposed to a memorization and a process that wasn't very helpful to the participants. And I think that we've accomplished that with the new MLLA process to start in 2020. ASCO Daily News: That's great. And what was the reason for the change from every 10 years to every two years? Dr. Julie Vose: Well, every 10 years was really just to memorize a lot of things that have changed over a 10-year period. And it wasn't necessarily a learning process, an ongoing way. So every 10 years, things do change quite a bit. And we want to have ASCO members continuing on ongoing learning process as opposed to just a memorization process every 10 years. Dr. Julie Vose: And I think that this really accomplishes that, as well as helps the people that specialize in specific areas to try to focus just on their area and still retaining knowledge of some of the general oncology principles that we all use every day. ASCO Daily News: Absolutely. What has been ASCO's role in these changes? Dr. Julie Vose: So ASCO's worked very closely with ABM in trying to mold these changes to the every two-year learning assessment that it can be done online with the assistance of some support as we would do in every day practice, such as up to date. And also that it wasn't so burdensome. Dr. Julie Vose: You didn't have to go to a testing facility, didn't have to take a lot of time off work to do this or to necessarily memorize or study things that you don't use on a everyday basis. So we've worked very closely with ABM to try to have this process and an ongoing learning process. And I think that we've accomplished that. ASCO Daily News: That's great. And how important is it that oncologists keep up with certifications? Dr. Julie Vose: Well, certification is very important for us to maintain knowledge, to learn, to make sure that we can take the best care of our patients. It really shouldn't be used as a certification. And ASCO did not support it as a use of certification for conditions of licensure, insurance, or privileging processes. An
Dr. Fumiko Chino Tells Her Personal Story About Financial Toxicity
Dr. Fumiko Chino was the art director at a television production company engaged to a young PhD candidate. Today, she's a radiation oncologist at Memorial Sloan Kettering Cancer Center, studying the effects of financial strain patients with cancer and their loved ones.
Dr. Andrew S. Epstein Highlights Key Sessions from the 2019 Supportive Care Symposium
Dr. Gilberto Lopes Highlights Key Presentations from ASCO Breakthrough
At the inaugural ASCO Breakthrough Summit, attendees experienced the cutting edge of oncology and how rapidly-evolving science, technology, and research are transforming cancer care with remarkable new treatments and therapies. ASCO will return to Asia in 2021.
Customer ReviewsSee All
Love the new host!
Great resource for a more intimate understanding of cancer and the evolving treatments