The ASCO Daily News Podcast features oncologists discussing the latest research and therapies in their areas of expertise.
Developing the Next Generation of Prostate Cancer Researchers
Dr. Charles Ryan, president and CEO of the Prostate Cancer Foundation (PCF), joins ASCO Daily News Editor-in-Chief Dr. Neeraj Agarwal, of the University of Utah Huntsman Cancer Institute, to assess impactful prostate cancer research from the PCF’s recent conference and discuss Dr. Ryan’s vision for the future, including increasing access to cutting-edge care.
Dr. Neeraj Agarwal: Welcome, to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, the editor-in-chief of the ASCO Daily News, and director of the Genitourinary Cancers Program at the University of Utah Huntsman Cancer Institute.
Today, we'll be discussing compelling research that was featured at the recent Prostate Cancer Foundation Scientific Retreat, and I'm very pleased to welcome Dr. Charles Ryan, the president, and CEO of the Prostate Cancer Foundation.
Our full disclosures are available on the transcript of this episode, and disclosures relating to all episodes of the ASCO Daily News Podcast are available on our transcripts at: asco.org/podcasts.
Dr. Ryan, thank you for taking the time to be with us today.
Dr. Charles Ryan: Dr. Agarwal, thank you. It's my pleasure to be with you.
Dr. Neeraj Agarwal: So, Dr. Ryan, before I discuss the PCF meeting, I would like to ask you, what made you move to the PCF as the president and CEO when you had a flourishing career as a division chief of a large academic program, and as one of the top and internationally recognized investigators in prostate cancer?
Dr. Charles Ryan: Well, thanks. That's a fair question, I guess. And it took me about three minutes to make the decision when I was offered the position, simply because the Prostate Cancer Foundation has been one of my intellectual homes for my entire career. I've been at the University of Wisconsin, Memorial Sloan Kettering Cancer Center, UCSF, and the University of Minnesota, and all those institutions were affected by the Prostate Cancer Foundation, or previously, CaP CURE. So, I was involved in their research during my time at all those institutions.
In addition to my own personal legacy with the PCF, but more importantly, is the fact that it is an organization that funds the deepest scientific inquiry into prostate cancer and the ways that it can cause suffering and death for men with the disease and has made tremendous progress in identifying factors that lead to that lethality. It's also a community of scholars, a community of researchers, that is a platform really for collaboration. And it's also an organization with a world reach - we fund research in 28 countries around the world, and we fund research going from the scope of very basic research to correlative research, to quality of life, and health services research.
Dr. Neeraj Agarwal: That is truly impressive and inspiring. So, what is the mission of the Prostate Cancer Foundation formally?
Dr. Charles Ryan: Formally, it's pretty simple. The mission of the Prostate Cancer Foundation is to reduce the death and suffering from prostate cancer.
Dr. Neeraj Agarwal: So, the 29th PCF Scientific Retreat was recently held on October 27 to October 29th in Carlsbad, California. What were the goals and objectives of this meeting?
Dr. Charles Ryan: The meeting, we call it the retreat, it's an annual event and it always has several goals. One is, it's where we announce and hand out, if you will, our awardees of our various awards that we give. It's also a reporting-in process where those who have been using PCF funding are called to come and discuss their work. We also want it to be an open forum for individuals to come and interact - it's really a collaboration and an interaction vehicle as much as anything.
So, when you come to our scientific retreat, we all stay at the same hotel, we all share meals together, nobody goes out for dinner. You don't leave the campus, essentially, of the hotel where we are. We have many, many round tables set out, it's designed to be interactive. We have a big ro
Novel Therapies Targeting KRAS in Lung Cancer & RAS-Altered Tumors
Dr. Vamsi Velcheti and Dr. Benjamin Neel, of the NYU Langone Perlmutter Cancer Center, and Dr. John Heymach, of MD Anderson Cancer Center, discuss new therapeutic approaches for KRAS-mutant lung cancers and therapy options for RAS-altered tumors.
Dr. Vamsidhar Velcheti: Hello, I'm Dr. Vamsidhar Velcheti, your guest host for the ASCO Daily News podcast today. I'm the medical director of the Thoracic Oncology Program at Perlmutter Cancer Center at NYU Langone Health.
I'm delighted to welcome two internationally renowned physician-scientists, Dr. John Heymach, the chair of Thoracic-Head & Neck Medical Oncology at the MD Anderson Cancer Center, and my colleague, Dr. Benjamin Neel, the director of the Perlmutter Cancer Center at NYU Langone Health, and professor of Medicine at NYU Grossman School of Medicine.
So, we'll be discussing new therapeutic approaches today for KRAS-mutant lung cancers, and we will talk about emerging new targeted therapy options for RAS-altered tumors.
Our full disclosures are available in the show notes, and the disclosures of all the guests of the podcast can be found on our transcript at: asco.org/podcast.
Dr. Heymach and Dr. Neel, it's such a great pleasure to have you here for the podcast today.
Dr. John Heymach: My pleasure to be here.
Dr. Benjamin Neel: Same here.
Dr. Vamsidhar Velcheti: Dr. Neel, let's start off with you. As you know, RAS oncogenes were first discovered nearly four decades ago. Why is RAS such a challenging therapeutic target? Why has it taken so long to develop therapeutic options for these patients?
Dr. Benjamin Neel: Well, I think a good analogy is the difference between kinase inhibitors and RAS inhibitors. So, kinase inhibitors basically took advantage of an ATP-binding pocket that's present in all kinases, but is different from kinase to kinase, and can be accessed by small molecule inhibitors. So, the standard approach that one would've thought of taking, would be to go after the GTP-binding pocket. The only problem is that the affinity for binding GTP by KRAS is three to four orders of magnitude higher. So, actually getting inhibitors that are GTP-binding inhibitors is pretty much very difficult.
And then, until recently, it was felt that RAS was a very flat molecule and there weren't any surfaces that you could stick a small molecule inhibitor in. So, from a variety of biochemical and medicinal-pharmacological reasons, RAS was thought to be impervious to small molecule development. But as is often the case, a singular and seminal insight from a scientist, Kevan Shokat, really broke the field open, and now there's a whole host of new approaches to trying to drug RAS.
Dr. Vamsidhar Velcheti: So, Dr. Neel, can you describe those recent advances in drug design that have enabled these novel new treatments for KRAS-targeted therapies?
Dr. Benjamin Neel: So, it starts actually with the recognition that for many years, people were going after the wrong RAS. And by the wrong RAS, the overwhelming majority of the earlier studies on the structure, and for that matter, the function of RAS centered on HRAS or Harvey RAS. We just mutated in some cancers, most prominently, bladder cancer, and head & neck cancer, but not on KRAS, which is the really major player in terms of oncogenes in human cancer. So, first of all, we were studying the wrong RAS.
The second thing is that we were sort of thinking that all RAS mutants were the same. And even from the earliest days, back in the late eighties, it was pretty clear that there were different biochemical properties in all different RAS mutants. But this sort of got lost in the cause and in the intervening time, and as a result, people thought all RASes were the same and they were just studying mainly G12V and G12D, which are more difficult to drug.
And then, the third and most fundamental insight was the idea of trying to take advantage of a particular mutation in KRAS, which is present in a large fraction of l
Advancing Equity and Quality Cancer Care at #ASCOQLTY22
Dr. Cardinale Smith, of the Mt. Sinai Health System, and Dr. Stephanie Wheeler, of the UNC Lineberger Comprehensive Cancer Center, discuss key research featured at the 2022 ASCO Quality Care Symposium, including practical solutions to advance equity, new trends in cancer care delivery, and novel approaches in palliative and supportive care.
Dr. Cardinale Smith: Welcome to the ASCO Daily News podcast. I'm Dr. Cardinale Smith, a professor in the division of Hematology and Medical Oncology and Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York, and the chair-elect of the 2022 ASCO Quality Care Symposium.
I'm your guest host today and delighted to welcome the chair of the Symposium, Dr. Stephanie Wheeler. Dr. Wheeler is a professor in the Department of Health Policy and Management and associate director of Community Outreach and Engagement at the University of North Carolina Leinberger Comprehensive Cancer Center.
We'll be discussing practical solutions and key research to advance equity and quality in cancer care, new trends in cancer care in the home and local community, novel approaches in palliative and supportive care, and other key takeaways from the meeting.
Our full disclosures are available in the transcript of this episode, and disclosures relating to all episodes of the ASCO Daily News podcast are available on our transcripts at: asco.org/podcasts.
Dr. Wheeler, it's great to be speaking with you today.
Dr. Stephanie Wheeler: Thank you, Dr. Smith. I'm excited to be here.
Dr. Cardinale Smith: Well, I'm super excited that I just got to see you, and it was fantastic that we had a hybrid event that really allowed our participants to meet in person and allowed folks who couldn't be in person to participate virtually.
Cancer health equity was a major theme this year with sessions that explored how to incorporate equity into our work. Can you highlight a few takeaways for us?
Dr. Stephanie Wheeler: Absolutely. And yes, it was such a delight to see you in person. And I'll just note that at this 10th anniversary of the Quality Care Symposium, we had record attendance - over 700 participants. So, I was really excited to have that level of engagement in this meeting.
So, you know that as a planning committee, we really prioritized centering equity in our content this year, and I think it was reflected in every session at the meeting. Our very first educational session featured Drs. Chanita Hughes Halbert, Meera Vimala Ragavan, Victoria Blinder, and Sam Cykert, as well as community advocate, Terrence Muhammad, from the Greensboro Health Disparities Collaborative.
Together, they provided important foundational and conceptual context to really set the stage for the rest of the meeting. Most importantly, they discussed specific evidence-based interventions designed to improve racial, socioeconomic, and rural health equity. These included the Accure Realtime Health Alerts Intervention with Navigation and Bias Training and Financial Hardship screening.
Later in the meeting, we heard from Dr. Joannie Ivory presenting Abstract 68, who shared that we really need to take our trials where minoritized and historically disadvantaged populations live. In that study, geographic areas with greater numbers of black residents did a better job recruiting black participants to clinical trials, and the trial itself built in structural factors designed to ensure that at least 30% black participants were accrued.
I also want to shine a light on the wonderful abstracts that were presented by Drs. Qasim Hussaini and Qinjin Fan, Abstract 69 and 3, which focused on association between historical housing discrimination and modern-day mortgage discrimination in colon and lung cancer treatments and outcomes respectively. I think this work just further underscores that racism is structural and societal and that we need to be paying attention to not only how we deliver o
The Impact of Hurricane Ian on Cancer Care
Host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, and Dr. Eduardo Sotomayor, director of the cancer institute at Tampa General Hospital, discuss the impact of Hurricane Ian on cancer care in Florida, and the importance of disaster preparedness to protect patients and clinicians in regions prone to natural disasters.
Dr. John Sweetenham: Hello, I'm Dr. John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center, and host of the ASCO Daily News podcast.
Hurricane Ian, a large and destructive Category 4 hurricane, has caused fatalities and widespread damage in Florida after causing huge destruction in Cuba. Communities in the hardest-hit areas have been destroyed, and hospitals across the state have been forced to evacuate patients.
Today, I will be speaking with Dr. Eduardo Sotomayor, the director of the Cancer Institute at Tampa General Hospital, about the impact of the hurricane on cancer care.
Our full disclosures are available on the transcript of this episode, and disclosures relating to all episodes of the ASCO Daily News podcast are available on our transcripts at asco.org/podcasts.
Dr. Sotomayor, thanks for being on the podcast today.
Dr. Eduardo Sotomayor: Thank you, John, and the ASCO Daily News Podcast, for having me.
Dr. John Sweetenham: To begin with, Dr. Sotomayor, could you tell us a little about how Hurricane Ian impacted cancer care at your institution, and how soon do you think you'll have all of your cancer services restored?
Dr. Eduardo Sotomayor: Thank you for the opportunity to talk to you about the effect of Hurricane Ian on the state of Florida. But before we start, I would like to say that our thoughts and our prayers are for those Florida citizens who were severely affected by this hurricane, in particular, our cancer patients and their caregivers. So, Tampa General Hospital is located on Davis Islands. So, we were at high risk for having inundation, major destruction, and disruptions in cancer care if the hurricane hit us directly.
We were blessed that at the last minute, the hurricane changed its path. But it's important to emphasize all of the preparation that took place, starting seven days before the potential landfall of the hurricane in the state of Florida. This started at the highest levels of the hospital, with the senior leaders getting together as well as the leaders of the cancer institute. We have different scenarios that we call scenario A, B, and C. So, scenario A was the worst-case scenario that we would have a direct hit, then one or two floors of the cancer institute and the hospital would be under water. So, for that scenario, we knew that we needed to be ready to move cancer care to other facilities that Tampa General has inland in areas called Riverview and Brandon.
So, scenario C is the scenario that fortunately for us, was the scenario that we dealt with during the storm. We didn't have a direct hit; we had only minimal damage, and we were able to reopen our doors 48 hours after the storm hit Florida. Important to mention also is that during those 48 hours, there was significant disruption in cancer care. In the inpatient service, we had to decrease the number of inpatients to keep those patients that really needed to be in the hospital. We closed all our outpatient facilities and therefore needed to call every patient to let them know about the cancellation of appointments, but also re-scheduling those appointments for the days after the storm has passed.
As I said, again, we were among the lucky cancer centers in the state of Florida, but south of us, there were hospitals and community oncology practices that were severely affected by Hurricane Ian.
Dr. John Sweetenham: So, it sounds to some extent, Dr. Sotomayor, as if your institution kind of dodged a bullet, although clearly people south of you were very badly affected. But I'm assu
How Primary Tumor Sidedness Impacts Treatment and Other Advances in Colorectal Cancer
Gastrointestinal cancer experts Dr. Aparna Parikh and Dr. Kristin Ciombor discuss the treatment implications of the phase 3 PARADIGM trial and other advances in colorectal cancer with guest host and ASCO Daily News Associate Editor, Dr. Shaalan Beg.
Dr. Shaalan Beg: Hello, and welcome to the ASCO Daily News Podcast. I'm Dr. Shaalan Beg, your guest host of the ASCO Daily News Podcast today. I'm an adjunct associate professor at UT Southwestern's Simmons Comprehensive Center and vice president of Oncology at Science 37. I'm delighted to welcome Dr. Aparna Parikh, and Dr. Kristen Ciombor to the podcast today.
Dr. Parikh is an assistant professor of Medicine at Harvard University and a GI medical oncologist at the Mass General Hospital Cancer Center. Dr. Ciombor is an associate professor of Medicine and GI medical oncologist at the Vanderbilt University Medical Center.
Today, we'll be discussing exciting new approaches using EGFR inhibitors as frontline therapy in colorectal cancer, and promising advances with immune therapy in the treatment of rectal cancer. Our full disclosures are available in the show notes, and disclosures of all guests on the podcast can be found in our transcripts at: asco.org/podcasts. Dr. Parikh, and Dr. Ciombor, it's great to have you on the podcast today.
Dr. Aparna Parikh: Thanks so much.
Dr. Kristen Ciombor: Thanks so much for having us.
Dr. Shaalan Beg: We've seen some exciting advances in GI oncology this year. Let's start with colorectal cancer. Dr. Parikh, there have been many trials looking to compare EGFR and VEGF inhibitors in colorectal cancer. We've heard about the IDEA studies, the FIRE trials, and CALGB 80405. At the 2022 ASCO Annual Meeting, we heard the results of the PARADIGM trial. Have we finally answered the question of when to use EGFR inhibitors as frontline therapy for colorectal cancer?
Dr. Aparna Parikh: Thanks so much, Dr. Beg, for this great question. It has been a really exciting year for colorectal cancer across the board. So, the anti-EGFR story is really interesting and has evolved. And maybe just for a little bit of background, we know that colorectal cancer originating from both the right and left side of the colon differ. So, they differ embryologically, and epidemiologically; there are different genetic and molecular aspects to right and left sides of colon cancers. And we have learned over time that in the era of targeted therapy, the primary tumor location has been found to play a very important role, not only in the prognosis of patients but to predict treatment response.
We know that patients that have left-sided colon cancers-- and when we think about left-sided colon cancers, we think about cancers that originate from the splenic flexure and descending colon, sigmoid colon, rectosigmoid junction, and sometimes include the rectum in this as well. The rectals have slightly different molecular features than distal colons.
And we know that these left-sided patients, overall, have better survival benefits than patients that have right-sided CRC. And that includes again, cecum, ascending colon, hepatic flexure, and transverse colon. So, we know that that had prognostic implications, but what about the predictive implications?
And with ASCO, we saw some really exciting data with the PARADIGM study, as Dr. Beg highlighted. We have seen many examples in the past showing the predictive power of anti-EGFR therapy, and anti-EGFR therapy showing a detriment for patients on the right side of the colon. But all these results historically have been obtained by retrospective analysis.
So, retrospective analysis of the pivotal CALGB 80405 study, which is the first-line biologic trial. FIRE-3, which is a similar study, but done out of Europe, and KRYSTAL. So all these studies show the same finding but were all obtained basically by retrospective analysis.
And what we saw with PARADIGM this year, which is exciting to see, is that this was the first pro
Update from Poland: Cancer Care for Ukrainian Refugees
Professor Piotr Rutkowski, of the Maria-Sklodowska-Curie National Research Institute, discusses how Poland is managing the influx of 5 million Ukrainian refugees since the war began and tells host Dr. John Sweetenham, of the UT Southwestern Harold C. Simmons Comprehensive Cancer Center, about the future health needs of Ukrainian refugees with cancer.
Dr. John Sweetenham: Hello. I’m Dr. John Sweetenham, the associate director for Clinical Affairs at UT Southwestern's Harold C. Simmons Comprehensive Cancer Center and host of the ASCO Daily News podcast. My guest today is Professor Piotr Rutkowski, who leads the department of Soft Tissue and Bone Sarcoma and Melanoma at the Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Poland. Prof. Rutkowski is also the deputy director for the National Oncological Strategy and Clinical Trials, and serves as president of the Polish Oncological Society. Prof. Rutkowski spoke with us earlier this year as millions of people were fleeing the war in Ukraine, and he described the really remarkable response from both the Polish government and his institution to this crisis.
He's back on the podcast today to tell us about cancer care for Ukrainian refugees 5 months into the conflict, and how health systems are coping with the influx of millions of refugees. He will also share his insights on the kind of support that will be needed long-term to care for these patients in the future.
Our full disclosures are available in the show notes and disclosures relating to all guests on the podcast can be found on our transcripts at asco.org/podcasts.
Professor Rutkowski, thank you for being on the podcast today. It's been about 4 months since we last spoke. How are you doing?
Dr. Piotr Rutkowski: I'm very privileged that we can speak again. I'm talking probably on behalf of many Polish physicians and citizens involved with this dramatic situation of war in Ukraine and helping our patients and citizens from Ukraine. And I feel okay, but of course, the situation is still dramatic, and we don't know what will happen during the next months. What we can tell, first, is what has been changed for these last 4 months, it is the number. So as of now, almost 5 million people from Ukraine crossed the border between Ukraine and Poland. And we can estimate that about 3 million refugees stay temporary or maybe even permanently in our country. This is a completely new situation because it means that it's about 10% of our citizens now.
And what didn't change but still the cancer care for Ukrainian patients is the extension of regular cancer care within our national oncology network and our national health fund with this Polish insurance system. And this is the same for patients in Poland. And so all refugees from Ukraine are entitled to receive the same care as citizens of Poland.
Still, this extraordinary legislation, which was adopted by the Polish parliament, covers all the refugees of war, social security, and health insurance. And we have a better situation because all comprehensive cancer centers or major cancer centers organize the help with a hotline, not only on the level of the whole country but also on the center level in the Ukrainian language. And the majority of these centers have staff speaking the Ukrainian language.
Moreover, what I can say as a president of Polish Oncological Society, recently, with the help of an educational grant, we bought electronic translators for major oncological cancer centers. So they can help in the situation, like in the emergency situation, when we have access to live talk. So they can be used in that situation. And in my opinion, it is very, very helpful. So this is the current situation. And of course, I will present further the structure of oncological patients from Ukraine in Poland now and what's been done.
Dr. John Sweetenham: Thank you. It's really quite extraordinary to grasp that your patient population almost overnigh
Love the new host!
Great resource for a more intimate understanding of cancer and the evolving treatments