Oncologists reflect on innovations, challenges, ‘eye-opening’ experiences of past year
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From innovations in therapy and telehealth to greater recognition of structural barriers to care and the need for community outreach, developments in oncology over the past year will have a lasting impact, experts said.
Tiffany A. Traina, MD, associate professor of medicine at Weill Cornell Medicine and vice chair of oncology care at Memorial Sloan Kettering Cancer Center, asked a panel of oncologists at Chemotherapy Foundation Symposium to describe the most significant changes in the field in 2021.
Joseph A. Sparano, MD, Ezra M. Greenspan MD professor in clinical cancer therapeutics at Icahn School of Medicine at Mount Sinai, cited new agents for the treatment of metastatic breast cancer, including CDK 4/6 inhibitors and antibody-drug conjugates, as well as the role of genomic assays for personalizing therapy.
Ramaswamy Govindan, MD, Anheuser Busch endowed chair in medical oncology at Washington University School of Medicine in St. Louis, noted the impact of immune checkpoint inhibitors, particularly PD-1/PD-L1 inhibitors, on survival outcomes not only of patients with advanced non-small cell lung cancer, but also those with early-stage disease.
For community oncologist Amit A. Patel, MD, AACP, vice president of medical-dental staff for RWJBarnabas Health, adapting to innovation in treatment with newer drugs and dealing with various authorization levels was both “challenging and enlightening.”
Patrick I. Borgen, MD, chair of the department of surgery at Maimonides Medical Center in Brooklyn, New York, said from a surgical oncologist’s perspective, four key challenges today are early tumor class prediction and early profiling of both the tumor and patient; treatment sequencing; managing residual cancer burden after neoadjuvant therapy; and locoregional control in patients who achieve durable remission.
Karen M. Winkfield, MD, PhD, executive director of Meharry-Vanderbilt Alliance in Nashville, Tennessee, said innovations in digital health have been revolutionary in their ability to improve care of patients in a patient-centered manner.
“Although it’s been challenging, one of the values to [telemedicine] is actually seeing patients in their homes, in their residence, meeting their family that otherwise couldn’t have taken the time to come into clinical practice,” Traina said. “I think it’s been an eye-opening experience to understand the context in which we’re treating our patients.”
Winkfield said the greatest takeaway of the past year and a half is the understanding that diversity, equity and inclusion are everyone’s responsibility.
“Black men [and] Black women get killed in this country all the time, but it was because of COVID that people had to stop when George Floyd got murdered and it was recorded,” she said. “People are now starting to understand that circumstance goes beyond just people making things up. There are clear structural barriers that we need to identify.”
Health equity is one of four strategic areas at City of Hope’s Comprehensive Cancer Center, according to its director, Steven T. Rosen, MD. The other areas are precision medicine, cellular therapeutics and community networks.
“We have 35 community sites and we want to bring the care to the community — and we all recognize it’s essential,” he said.
Winkfield said infrastructure is needed to bring clinical trials to the community. In addition, Govindan said the burdensome requirements for clinical trials must be eased to enable community participation.
“I sign far more papers in a day related to clinical trials than anything else I do,” he said. “This is so daunting, even for people like us card-carrying members of the trial community.”
The past year has brought positive changes in the conduct of clinical trials, Traina said, proving that shipment of oral medications to patients and remote monitoring could be conducted safely.
“We need to make sure we keep some of these benefits and change policy so that we don’t slide back to where we were before,” she said.
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Traina TA, et al. Experiences and lessons learned in oncology in 2021. Presented at: 39th Annual Chemotherapy Foundation Symposium: Innovative Cancer Therapy for Tomorrow; Nov. 3-5, 2021.
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