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CancerNetwork, in a partnership with KidneyCAN

spoke with 2 genitourinary oncologists, Elizabeth P. Henske, MD, and Jason Muhitch, PhD, about how advocacy and funding through interdisciplinary collaboration between patient advocates, researchers, and physicians have resulted in numerous clinical breakthroughs in kidney cancer.

Henske is a professor of medicine at the Harvard Medical School, an associate member of the Broad Institute of MIT and Harvard, director of the Center for LAM Research and Clinical Care, and a physician at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. Muhitch is an associate professor of Oncology, co-chair of the Genitourinary Translational Research Group, deputy director of Graduate Studies, and a member of the Department of Immunology at Roswell Park Comprehensive Cancer Center at Roswell Park Comprehensive Cancer Center.

First, the state of kidney cancer advocacy was discussed, with Muhitch emphasizing multidisciplinary collaboration and the role of conferences, such as the 

 and the International Kidney Cancer Symposium, in bringing these groups together. Henske emphasized the strength of the advocacy network for kidney cancer, particularly as a mechanism for exchanging information, offering patient support and education, and facilitating research.

Next, funding was touched upon, with Henske expressing her interest in conveying the importance and urgency of kidney cancer research to Congress. Muhitch agreed, suggesting that the meetings with congressional offices offer opportunities to explain how funding can impact kidney cancer outcomes and scientist training, as well as the strength of patient advocacy in influencing Congress.

Muhitch and Henske then discussed the Kidney Cancer Research Program, which has enabled significant increases in funding for kidney cancer research, helped to facilitate clinical breakthroughs for common kidney cancer types, and set a foundation for exploring different kidney cancer variants. The discussion then turned to encouraging research for renal cell carcinoma , which Muhitch expressed can be attributed to partnership award recipients who went on to conduct research evaluating biomarkers predictive of patient responses to immunotherapies.

Regarding additional funding mechanisms, Henske and Muhitch discussed numerous private foundations providing smaller research grants. Henske explained that these smaller grants are instrumental in taking the first steps to explore rarer kidney cancer subtypes, with Muhitch explaining that the earlier funding can formulate research that leads to greater funding from the Kidney Cancer Research Program.

KidneyCAN is a nonprofit organization with a mission to accelerate cures for kidney cancer through education, advocacy, and research funding. Learn more about KidneyCAN’s mission and work 

Two oncologists discuss the impact of advocacy in kidney cancer research, highlighting collaboration between researchers, advocates, and physicians.

Highlighting Advocacy Impacts on Funding for Kidney Cancer Research

 at the 2024 Annual Oncology Clinical Practice and Research Summit, Andrew M. Evens, DO, MBA, MSc, spoke about a session he moderated at the meeting, in which he and other panelists highlighted ongoing efforts to improve the quality of care for cancer survivors at his institution.

Evens is the deputy director for Clinical Services at Rutgers Cancer Institute and the system director of Medical Oncology and the oncology lead at RWJBarnabas Health Medical Group. He is also the associate vice chancellor for Clinical Innovation and Data Analytics at Rutgers Biomedical and Health Sciences.

Evens contextualized the presentation by describing various gaps in care for survivors of cancer, particularly among adolescent and young adult populations or those who become “lost in transition” as they switch from pediatric to adulthood survivorship. He emphasized a growing effort to mitigate the risks of post-acute or late effects following prior anti-cancer therapy, which can include cardiac disease, lung disease, or increased infections associated with chemotherapy or radiation.

As part of elevating the level of care for cancer survivors, Evens described the collaborative efforts across different departments at his institution, including medical, surgical, and radiation oncologists; pharmacists; nurses; pathologists; and members of the clinical research team. Other international research projects, including those formed in association with the National Cancer Institute, aim to elucidate the granularity of treatment-related toxicity, which may help inform better survivorship care strategies.

“Survivorship includes many factors,” Evens said. “There are physical and emotional factors, and we want to do everything we can as a comprehensive cancer program, and to do what’s best for the patient in a holistic manner. [Beyond the] cancer, it also means the emotional factors and health behavior modifications. For the rest of their life, [we want to] help the patient in every way possible so they can live the most fruitful life. A high quality of life is what we strive for.”

Evens A, Cole P, Ligresti L, Manne S. Cancer survivorship: scale, scope, and partnerships for patient-centered care. Presented at the 2024 Annual Oncology Clinical Practice and Research Summit; November 15-16, 2024; New Brunswick, NJ.

Andrew M. Evens, DO, MBA, MSc, discusses the importance of meeting the emotional and physical needs of cancer survivors to help them lead fruitful lives.

Ensuring Holistic, Individualized Transitions of Care for Cancer Survivors

, CancerNetwork® spoke with Kelly A. Rone, DNP, RN, AGNP-c, about the current state of pancreatic cancer, emphasizing risk factors, diagnostic challenges, and treatment planning. Rone is an advanced practice nurse of gastrointestinal oncology at Mayo Clinic in Phoenix, Arizona.

Rone initially discussed patient counseling for risk factors, making a distinction between modifiable risk factors—such as smoking, drinking, and obesity—and nonmodifiable risk factors, which primarily include genetic syndromes. Rone then highlighted a need for more effective screening methods, highlighting a lack of screening tools that have been proven to be highly effective, as well as the tendency for pancreatic cancer to be identified at a later stage.

Rone then touched upon treatment-emergent adverse effects (AEs), as well as how her practice manages them. She particularly placed emphasis on appetite loss, which may prove difficult for patients attempting to recover from cancer treatment. Additionally, Rone suggested various methods to encourage food consumption in spite of appetite loss.

Rone expressed that she connects patients with pancreatic cancer to palliative care frequently, explaining that patients can benefit from involvement in terms of managing AEs and extending life expectancy. Furthermore, she stressed a need to correct misconceptions of palliative care as exclusively entailing pre-hospice care, highlighting benefit in all patients regardless of disease stage.

Rone iterated that addressing psychosocial needs for patients varies depending on a patient’s circumstances. Rone then suggested that viewing patients as individuals with lives beyond their cancer diagnosis can help humanize them and can help to foster more meaningful discussions regarding cancer treatment than electronic health records alone.

Then, Rone expressed a desire to find ways to detect pancreatic cancers sooner by developing biomarkers, highlighting how pancreatic cancer may be paired with several vague symptoms that make early detection difficult. Rone explained that early detection of pancreatic cancers can be associated with better outcomes.

She further expressed a need to elicit better treatment outcomes for pancreatic cancer based on low responsiveness to chemotherapy. Rone concluded by emphasizing a need for education regarding 2 distinct types of pancreatic cancer––pancreatic adenocarcinoma and pancreatic neuroendocrine cancer––to better manage patient expectations.

A nurse practitioner discussed risk factors, diagnostic challenges, and treatment planning in patients with pancreatic cancers.

Managing Risks, Planning Treatment, & Making Progress in Pancreatic Cancer 

 Tanios S. Bekaii-Saab, MD, spoke about various developments in the pancreatic cancer treatment field. Throughout the discussion, Bekaii-Saab weighed the benefits of currently available chemotherapeutic regimens for patients with metastatic disease, discussed research on the potential for precision medicine in those with 

wildtype pancreatic ductal adenocarcinoma (PDAC), and detailed ongoing initiatives to improve outcomes among those with 

mutations and other targetable genomic alterations.

Bekaii-Saab is the David F. and Margaret T. Grohne Professor of Novel Therapeutics for Cancer Research, chair and consultant in the Division of Hematology and Medical Oncology at Mayo Clinic in Arizona, and co-leader of Advanced Clinical and Translational Science at Mayo Clinic Cancer Center.

mutations and other alterations in patients with pancreatic cancer, Bekaii-Saab especially emphasized the use of genomic analysis to inform personalized treatment decision-making in the field. Screening patients to detect aberrations such as microsatellite instability-high tumors, 

fusions can open the door for the development and use of targeted agents, which may consequently improve patient outcomes.

Looking ahead, Bekaii-Saab noted the need to adapt the therapies that have shown activity in the later stages of the disease to earlier treatment settings. Although “great work” has been achieved with chemotherapy and surgical techniques, he highlighted the importance of bringing targeted agents to earlier lines of therapy to further increase the likelihood of positive outcomes for patients.

“I have never been more optimistic. I’m always the eternal optimist, but I’m even more optimistic today that we’re going to move the needle for our patients with pancreatic cancer and continue to enhance that likelihood of living longer, having a better quality of life, or even increasing the level of a cure for this cancer,” Bekaii-Sabb stated. “Certainly, the future looks bright. We’re chipping away, one drug at a time. We can now remove that whole concept of nihilism in pancreatic cancer and look quite optimistically on the future.”

Tanios S. Bekaii-Saab, MD, provides an overview of current therapy options and ongoing initiatives involving targetable alterations in those with pancreatic cancer.

Advancing Research and Targeting Genomic Alterations in Pancreatic Cancer

 spoke with Andrew M. Evens, DO, MBA, MSc, about developments in the treatment landscape for adolescents and young adults (AYA) with lymphoma. He highlighted collaboration between adult and pediatric oncologists that may better standardize treatment for this population.

Evens is the deputy director for clinical services at the Rutgers Cancer Institute and system director of medical oncology and oncology lead at RWJBarnabas Health Medical Group.

Of note, Evens discussed an effort to “harmonize” efforts between adult and pediatric oncologists in treating AYA patients who may receive different treatment regimens, despite being similar in age. Furthermore, he highlighted 2 prominent trials that illustrated collaborative efforts from both adult and pediatric oncologists: the phase 3 SWOG S1826 trial (NCT03907488) and the phase 3 AHOD2131 trial (NCT05675410).

Regarding the SWOG trial, Evens highlighted the greater efficacy and tolerability of nivolumab (Opdivo) with doxorubicin hydrochloride (Adriamycin), vinblastine sulfate, and dacarbazine (AVD) vs the standard of care brentuximab vedotin (Adcetris) plus AVD.

“You could say it was, generally speaking, a double winner. [The nivolumab combination] was more effective at 2 years; the progression-free survival [PFS] was greater than 90%, [which was] a remarkable output. When I say a double winner, it was also largely better tolerated. There was less neuropathy, [fewer] infections, and less sepsis [vs brentuximab vedotin plus AVD]. Surprisingly, to a certain extent, [there were] not many immune-related adverse events outside of thyroid [events],” Evens said.

Furthermore, Evens discussed how collaboration between adult and pediatric oncology has impacted developments in the AYA lymphoma sphere. He placed a particular emphasis on the efforts of the Lymphoma Research Foundation, which convened multiple AYA lymphoma symposiums and established an AYA consortium. He then outlined unmet needs for this patient population, which included mitigating late toxicities following treatment and addressing inconsistencies in guidelines for lymphoma treatment in the AYA group.

Evens then discussed mitigating disparities and addressing barriers to care, underscoring a need to navigate the complexities of treatment for a patient population with a myriad of stressors. He concluded by highlighting resources available to AYA lymphoma groups, which include educational, medical, and psychosocial resources to best educate patients and express to them that they are not alone.

“At the end of the day, be an advocate. Be an advocate for yourself. Be an advocate for others and know that there are [many] resources and people out there to help. We want to make sure nobody has to go through this alone, and that they have the medical and other psychosocial resources available to them,” Evens concluded.

Herrera AF, LeBlanc M, Castellino SM, et al. Nivolumab+AVD in advanced-stage classic Hodgkin’s lymphoma. 

 2024;391(15):1379-1389. doi:10.1056/NEJMoa2405888

Henderson TO, Hu B, Keller F, et al. AHOD2131: A randomized phase 3 response-adapted trial comparing standard therapy with immuno-oncology therapy for children and adults with newly diagnosed stage I and II classic Hodgkin lymphoma. 

. 2023;142(suppl 1):3084. doi:10.1182/blood-2023-189652

A leader from the adolescent and young adult lymphoma space discusses how collaboration between adult and pediatric oncologists has transformed the field.

Collaboration Fosters Treatment Advancements for Young Lymphoma Populations

 sat down with Kelley A. Rone, DNP, RN, AGNP-c, to discuss the importance of speaking compassionately and ensuring patient awareness when leading end-of-life discussions among those with gastrointestinal (GI) cancers. The discussion also focused on combating burnout in the clinic, using opioids to help manage pain and other symptoms, and educating all members of a multidisciplinary team on initiating end-of-life conversations with their patients.

Rone is an advanced practice nurse (APN) in GI oncology at the Mayo Clinic in Phoenix, Arizona.

As part of leading these end-of-life conversations, Rone emphasized the necessity of addressing the discomfort patients tend to feel when talking about the fact that they may die from their cancer. Speaking with these patients may involve being open about the possibility of terminating therapy early if treatment-related toxicity such as fevers, diarrhea, and pain outweigh any potential efficacy or diminish quality of life. Additionally, Rone highlighted how APNs may be more comfortable with speaking about death than other team members.

Rone also discussed the importance of managing fatigue and pain as patients near the end of their lives. In her role, she initiates education on pain management early in end-of-life care discussions to make patients feel more comfortable about receiving opioids for symptoms.

When working with other members of a multidisciplinary care team, Rone illustrated the challenge of having physicians understand that their treatments may fail in younger patients and helping other oncologists become more experienced in speaking about death with patients. Regarding the idea of mitigating burnout and maintaining one’s mental well-being, Rone described how her role has given her perspective on what is truly important about life.

“This [role] helps you appreciate the finality of life. You don’t get upset about [minor] things after you see a 39-year-old with metastatic cancer,” Rone stated. “You learn to have an appreciation for the good things and not dwell so much on the bad things.”

Kelley A. Rone, DNP, RN, AGNP-c, provides perspective on approaching end-of-life conversations with patients with GI cancers.

Educating Patients and Clinicians on End-of-Life Care and Discussions

CancerNetwork® spoke with John Paul Diaz, MD, about uterine transposition, a surgical technique aiming to preserve fertility in women undergoing radiotherapy for pelvic tumors. Diaz is the chief of gynecologic oncology, director of robotic surgery, director of the Center of Excellence in Minimally Invasive Gynecologic Surgery at Baptist Health, and lead physician for Clinical Trials in Gynecologic Oncology at Miami Cancer Institute.

Of note, Diaz discussed the outcomes associated with 2 procedures conducted at his practice, as well as challenges associated with the development and implementation of the procedure. Additionally, he spoke about the next steps in developing and raising awareness of the procedure.

Diaz foregrounded the discussion by highlighting the simplicity of the procedure, which he stated was similar to a hysterectomy. Unlike a hysterectomy, uterine transposition entails a temporary relocation of the uterus to the anterior abdominal wall, which preserves it for fertility while removing it from the radiation field.

Furthermore, Diaz described the collaboration between Baptist Health and Memorial Sloan Kettering Cancer Center, including a partnership with Mario M. Leitao, Jr., MD, FACOG, FACS, who holds the largest series in the United States in performing uterine transpositions. He explained that the collaboration was conducive for expanding patient populations that may benefit from this surgery.

Diaz then underlined outcomes related to 2 uterine transposition procedures he conducted at Baptist Health. He described a favorable outcome with one patient who had completed the procedure 3 months prior who may be able to become pregnant in the future. The second patient was undergoing radiotherapy, with plans to undergo the second stage of the surgery in following months.

Diaz then highlighted a distinction between uterine transposition and other fertility preservation measures in that it preserves the entire uterus so patients can still carry a child, whereas other radiation therapy techniques do not. He then highlighted patients who are eligible for this procedure, particularly among women who want to preserve their fertility with pelvic tumors requiring radiation that might otherwise sterilize the uterus.

Challenges related to the development and implementation of the procedure were discussed, with particular emphasis placed upon quality of life following treatment. Additionally, he emphasized the idea of patient-driven improvements in treatment outcomes, which he hoped could be applied to help more women preserve their fertility.

Diaz continued by emphasizing the novelty of the procedure, explaining that experiences with it are growing while surgery success rates increase with global collaboration and technique sharing. He followed by underscoring the primary goal of cancer eradication, stressing that treatment for progressing disease takes precedence over fertility, and in those situations, fertility may be compromised.

He further outlined key short-term outcomes in patients undergoing uterine transposition, particularly as they related to maintaining uterine perfusion and mitigating post-operative complications. For long-term outcomes, he highlighted the goal for patients to be disease-free and capable of carrying a live birth.

Additionally, Diaz underscored a challenge related to raising awareness for this procedure, highlighting efforts he has undertaken to inform surgeons in the colorectal cancer field about the availability of this procedure as an option for this patient population. He suggested that colleague identification of eligible patients, effective referral, and increased proliferation of procedure knowledge may be effective in overcoming this challenge.

Diaz concluded by highlighting next steps for the procedure as they relate to expanding access for patients, increasing knowledge of the procedure among physicians, and developing novel techniques for uterine preservation during radiotherapy. He highlighted the “exciting” development of this procedure, which he suggested might have been inconceivable a few years ago, in achieving better outcomes for young women diagnosed with pelvic tumors.

Uterine transposition, a surgical approach preserving fertility by moving the uterus out of the radiation field, may improve gynecologic cancer outcomes.

Uterine Transposition May Maintain Fertility Following Pelvic Radiotherapy

, Ginger J. Gardner, MD, FACOG, spoke about current research and advocacy efforts to improve clinical outcomes among patients with gynecological cancers. With diagnoses of gynecologic malignancies on the rise around the world, Gardner also highlighted the next steps for raising awareness in the field and addressing gaps in care.

Gardner is a gynecologic surgeon at Memorial Sloan Kettering Cancer Center, as well as the chair of the board for the Foundation for Women's Cancer (FWC).

According to Gardner, approximately 115,000 of those in the United States and 1 million patients across the world are diagnosed with gynecologic cancer. Additionally, she highlighted a growing incidence of uterine cancers, which included a 2-fold increase in mortality among patients who are Black in the United States compared with other populations.

As part of raising awareness in this patient population and advancing potential therapeutic solutions, Gardner described ongoing initiatives at FWC to facilitate collaboration among scientists, researchers, and gynecologic oncology providers to help improve outcomes. Regarding potential treatment innovations, she also highlighted clinical trials designed to assess various disease prevention methods and other therapies like targeted agents, PARP inhibitors, and antiangiogenic treatments.

Looking ahead, Gardner detailed other potential developments in the gynecologic cancer space that she is excited about. For example, she spoke about future efforts to further uncover the tumor biology and molecular heterogeneity associated with these malignancies, which may help providers optimize treatment plans for patients.

“We are seeing some impact in improvement for gynecologic cancers with innovation in many of our disciplines; that includes disease prevention and innovative modalities related to treatment, inclusive of surgical innovation, new targeted therapies, refining radiation treatment, and ultimately patient-reported outcomes. We need to keep our eye on the ball for where we’re going next,” Gardner stated. “It is hard to dial it into just 1 or 2 snapshots, but I am so thankful that we have this time together to talk about the importance of gynecologic health awareness and research because it is important that we raise this conversation.”

Ginger J. Gardner, MD, FACOG, highlights disease prevention innovations and other ongoing efforts to empower education in the gynecologic cancer field.

Empowering Awareness to Address Rising Gynecological Cancer Incidence

In a special co-branded episode between Oncology On the Go hosted by CancerNetwork

and the American Society for Transplantation and Cellular Therapy (ASTCT)’s program 

Alexis K. Kuhn, PharmD, BCOP, spoke with Katie Bruce, PharmD, BCPPS, and Susie Long, PharmD, about the use of approved cell-based gene therapies for patients with sickle cell disease, beta thalassemia, adrenoleukodystrophy (ALD), and metachromatic leukodystrophy (MLD). These panelists shared the pharmacist’s perspective on ensuring quality care with these 

 gene therapies across all treatment phases, including mobilization, conditioning, and infection prophylaxis.

Kuhn is an ambulatory Pediatric Hematology/Oncology/BMT Pharmacist at the Mayo Clinic in Rochester, Minnesota, and an assistant professor of Pharmacy at the Mayo Clinic College of Medicine. Bruce is a pediatric clinical pharmacy specialist at the Sarah Cannon Pediatric Hematology/Oncology & Cellular Therapy program of Tristar Centennial Medical Center in Nashville, Tennessee. Long is a pediatric clinical pharmacist in the Blood and Marrow Team at the University of Minnesota Masonic Children's Hospital.

Specifically, the panelists spoke about the use of agents like elivaldogene autotemcel (Skysona) and atidarsagene autotemcel (Lenmeldy), which are FDA-approved for ALD and MLD, respectively.

 They also discussed the use of exagamglogene autotemcel (Casgevy) and lovotibeglogene autotemcel (Lyfgenia), which the FDA approved for treating patients 12 years and older with sickle cell disease in December 2023.

 The conversation broke down each stage of treatment, detailing optimal strategies for the cell manufacturing and storing processes as well as the management of toxicities like cytopenias. They also reviewed key considerations during the post-infusion period that may help maximize the quality of life for patients after they complete their therapy.

“It has been so amazing to be able to be a part of gene therapy and gene editing,” Bruce stated regarding the potential long-term impacts of these treatments. “We have patients who are able to hold full-time jobs they never were able to have before. We have patients who are climbing mountains and backpacking through Europe, which would have never been an option before because their sickle cell disease would have prevented them from [doing] that…. It’s not an easy process, and it has a lot of steps for the patient to go through, but the reward at the end of it all is worth it.”

bluebird bio receives FDA accelerated approval for SKYSONA® gene therapy for early, active cerebral adrenoleukodystrophy (CALD). News release. bluebird bio, Inc. September 16, 2022. Accessed October 7, 2024.https://tinyurl.com/mp8crxes

A panel of expert pharmacists provides their perspectives on gene therapy agents such as exagamglogene autotemcel in the management of sickle cell disease.

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