From compelling data presented at the San Antonio Breast Cancer Symposium to the recent U.S. Food and Drug Administration approval of capivasertib, 2023 saw numerous key advances in breast cancer care. Aditya Bardia, MD, MPH, director of the breast cancer research program at Massachusetts General Hospital and associate professor at Harvard Medical School in Boston, and Robert A. Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, discuss how several notable developments are already impacting practice. Dr. Bardia explains why genotyping is essential, provided it is available and affordable, and what recent changes have meant for the “roadmap” he presents to patients with metastatic disease. He also considers what 2024 may have on tap for this rapidly changing field.

From the use of prostate-specific membrane antigen (PSMA) positron-emission tomography (PET) to advancements in targeted treatments, prostate cancer care is quickly evolving. Edwin M. Posadas, MD, director of the Experimental Therapeutics Program and director of the Center for Urologic Oncology Research Excellence at Cedars-Sinai in Los Angeles, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai, about how he is already implementing promising new data into practice. Although Dr. Posadas notes that although immunotherapy approaches in prostate cancer have been “a bit of a disappointment” so far, he sees “a lot of exciting research going on.” He explains why he doesn’t “like to wait” when expanding his therapeutic armamentarium and why he prefers to be “proactive rather than reactive” when it comes to molecular profiling and other approaches.

Results of the recent EMBARK study show that both enzalutamide plus leuprolide and enzalutamide monotherapy significantly improved metastasis-free survival compared with leuprolide alone in patients with prostate cancer who have high-risk biochemical recurrence. Lead author Stephen Freedland, MD, associate director for education and training and director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Cancer Center in Los Angeles, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai, about how these findings should be applied in practice. Although the data represent a significant advance, Dr. Freedland suggests even more progress ahead, asking "This is the new standard, but for those [who] are really high-risk, how can we do even better?”

Studies involving high-risk, early-stage ER-positive breast cancer are among the most eagerly anticipated at this year’s San Antonio Breast Cancer Symposium (SABCS), to be held Dec. 5-9. Virginia Kaklamani, MD, professor of medicine in the division of hematology and medical oncology at the University of Texas Health Sciences Center San Antonio and leader of the breast cancer program at the Mays Cancer Center, discusses which data she thinks has the best chance of changing practice soon. She also speaks with Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about key research into HER2-positive disease, brain metastases, and local therapy to watch for at this year’s conference.

Last month, a U.S. Food and Drug Administration (FDA) Oncologic Drugs Advisory Committee (ODAC) determined that progression-free survival (PFS) could not be reliably interpreted in a confirmatory clinical trial for sotorasib (Lumakras) used to treat KRAS G12C–mutated locally advanced or metastatic non-small cell lung cancer (NSCLC). Ravi A. Madan, MD, senior clinician at the National Cancer Institute’s Center for Cancer Research and chair of the ODAC, speaks with Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles, about broader implications from the 2-10 vote against the sotorasib data. They discuss the specific rationale behind the decision, as well as what this means for clinical practice in the short term and big picture solutions to help improve future trials.

How should results of the FLAURA2 clinical trial be applied in practice? The study examined the use of osimertinib plus chemotherapy in the first-line treatment of EGFR-mutated advanced non-small cell lung cancer (NSCLC) compared with osimertinib alone and found that progression-free survival was significantly improved with the combination treatment. Pasi A. Jänne, MD, PhD, director of three cancer centers at the Dana-Farber Cancer Institute in Boston, including the Lowe Center for Thoracic Oncology, shares his team’s findings with Bob Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles. They discuss toxicity concerns, best practices for treatment assessment, and how to identify patients for whom the new strategy may yield the best results.

“Therapies are improving dramatically” in mantle cell lymphoma (MCL), according to Michael Wang, MD, professor in the department of lymphoma/myeloma, division of cancer medicine at the University of Texas MD Anderson Cancer Center in Houston. Dr. Wang presented updates on major advances in MCL at the recent Society of Hematologic Oncology (SOHO) annual meeting. Here, he speaks with Bob Figlin, MD, the Steven Spielberg family chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about which promising regimens from recent studies are most appropriate for certain age groups. Dr. Wang and Dr. Figlin also discuss common challenges when approaching newly diagnosed patients, as well as how to process the “explosion” of new information in MCL.

Recent advances have provided new options for when and how best to treat patients with chronic lymphocytic leukemia (CLL). Trials of combination strategies have shown promise in providing patients the potential for unmaintained remissions. Marco Ruella, MD, an assistant professor of medicine in hematology-oncology at the Perlman School of Medicine at the University of Pennsylvania and scientific director of the lymphoma program, speaks with Robert Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about the current state of CLL care and what changes are likely in the near future. Although satisfied in many ways with recent progress, Dr. Ruella argues in favor of moving past simply “maintaining the disease at long-term” and, instead, pushing for a cure.   Dr. Ruella reports relationships with AbClon, BMS, Bayer, NanoString, and UPenn/Novartis.   Dr. Figlin has reported relationships with numerous companies.

The World Conference on Lung Cancer (World Lung) will be held in Singapore, September 9–12. The current president of International Association for the Study of Lung Cancer (IASLC), Heather A. Wakelee, MD, division chief of medical oncology at the Stanford Cancer Institute in California, shares which presentations and findings she is most looking forward to at this year’s event. She speaks with Robert Figlin, MD, the Steven Spielberg Family Chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles, about steps being taken to ensure that key information from the conference is communicated quickly, clearly, and effectively to community oncologists around the world. They also discuss specific issues that will be addressed in Singapore, including a focus on lung cancer screening and why overcoming obstacles to more widespread uptake is crucial.

Updates to the American Society for Clinical Oncology’s (ASCO’s) living guidelines for therapy in patients with stage IV non-small cell lung cancer (NSCLC) with driver alterations were recently released. Dwight H. Owen, MD, MS, from The Ohio State University Comprehensive Cancer Center – James, examines the new recommendations that he and his team introduced with Bob Figlin, MD, the Steven Spielberg family chair in hematology-oncology at Cedars-Sinai Cancer Center in Los Angeles. They discuss how the living guidelines are updated and the rationale for what gets included, a process Dr. Figlin notes is “critical to the practicing oncologist.” Dr. Owen describes three new additions that are “really impactful” and his hopes for how these will directly improve patient care.