Dr. Premal Thaker, gynecologic cancer care expert from Washington University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. The ATHENA monotherapy trial demonstrated efficacy as primary maintenance post adjuvant chemotherapy in which of the following groups of advanced ovarian cancer patients: 1.       BRCA mutant 2.       BRCA wt/LOH high 3.       BRCA wt/LOH low 4.       BRCA wt/LOH inde 5.       All of the above Correct Answer: 5) All of the Above Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Ravi Vij, leukemia expert from Washington University, reviews BCMA directed therapies in development from the 2022 ASCO annual conference that have changed the standard of care. Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. David VanderWeele, prostate cancer care expert, reviews an update from the VISION trial on the benefit of Lu-PSMA from the 2022 ASCO Annual Conference. He explains that benefit from Lu-PSMA is independent of prior and concomitant therapies. Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Russell Pachynski, genitourinary cancer care expert from Washington University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. 71 yo female with right renal lesion discovered incidentally on imaging for abdominal pain. She has a history of interstitial lung disease (ILD) for which she had received high dose steroids in the past. Staging reveals no pathologically enlarged lymph nodes or other suspicious lesions. Patient undergoes a R nephrectomy with pathology showing clear cell RCC, pT3a N0 grade 3. Post operative imaging shows surgical changes with no new lesions. She is interested in adjuvant treatment. Which would you recommend? a. Pazopanib b. Everolimus c. Pembrolizumab d. Axitinib/Pembrolizumab e. Surveillance   Answer: E) Surveillance. While adjuvant pembrolizumab has shown improvements in distant metastasis-free survival, time to first subsequent therapy, and PFS2, to date there is no significant improvement in overall survival and given the patient’s history of ILD requiring steroids the potential risks likely outweigh the benefit in the adjuvant setting. Everolimus has not shown a significant improvement in disease free survival, and has the potential to contribute to pneumonitis. Pazopanib has not shown a significant improvement in DFS. Axitinib/pembrolizumab is indicated for 1L metastatic ccRCC. Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Olalekan Oluwole, lymphoma care expert from Vanderbilt University, reviews takeaways from the FLIRT follicular lymphoma study from the 2022 ASCO Annual Conference. FD ibrutinib + venetoclax continues to demonstrate deep, durable responses and clinically meaningful PFS rate of 88% at 3 years, including PFS rates ≥80% in patients with del(17p)/TP53 mutated or unmutated IGHV. Early data suggest that patients who progress after FD treatment with ibrutinib + venetoclax can be successfully retreated with single-agent ibrutinib. Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Russell Pachynski, genitourinary cancer care expert from Washington University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. 63 yo male with history of smoking, s/p TURBT for NMIBC followed by BCG + maintenance. After 3 months on maintenance, he presents with metastatic disease to the lungs and lymph nodes. He undergoes 4 cycles of cisplatin/gemcitabine with stable disease, followed by maintenance avelumab. After approximately 4 months, his scans show progressive disease. A biopsy of one of the lung lesions reveals a somatic FGFR1 mutation by NGS analysis; nectin-4 expression was not reported. Which is the next best treatment for his metastatic bladder cancer? a. Docetaxel 75 mg/m2 IV q  3 weeks b. Erdafitinib 8 mg PO QD (to start) c. Enfortumab vedotin 1.25 mg/kg IV day 1,8,15 q 28days d. Paclitaxel 175 mg/m2 IV q 3 weeks   Answer: C) Enfortumab vedotin (EV). Enfortumab is FDA approved and indicated for metastatic urothelial carcinoma after platinum-containing regimen and immunotherapy with PD(L)1. Long term outcomes of the EV-301 trial continued to show significant improvements in OS and PFS over chemotherapy (eg either docetaxel or paclitaxel). Demonstration of nectin-4 staining on tumor biopsy is not required for treatment with EV given the high levels seen across advanced UC. Erdafitinib is indicated for treatment of advanced UC after a platinum containing regiment for those patients whose tumors harbor FGFR2 or FGFR3 mutations, but not FGFR1 (although there is in vitro inhibition of FGFR1 seen). Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Premal Thaker, gynecologic cancer care expert from Washington University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. All of the following are options for treatment of recurrent cervical cancer except: 1.       Tisotumab Vedotin 2.       Pembrolizumab 3.       Adriamycin 4.       Paclitaxel/Carboplatin/Bevacizumab Correct Answer: 3) Adriamycin Find more oncology education opportunities at www.totalhealthconferencing.com

Dr. Jane Meisel, breast cancer care expert from Emory University, reviews the following case question, incorporating updates from the 2022 ASCO annual conference that have changed the standard of care. You have a 41yo female with ER+ (99%) PR + (26%) HER2 1+/FISH negative metastatic breast cancer that has progressed on palbociclib/letrozole (18 months), fulvestrant (six months), capecitabine (9 months), and is now interested in options for the next line of treatment.  She has progressed in the liver, lungs, and bone, but is minimally symptomatic with ECOG PS 1. The patient is willing to start trastuzumab deruxtecan, but asks about whether sacituzumab govitecan might be a better option for her.  As she weighs her options, what do you tell her about the side effect profiles and effectiveness of both drugs? 1. Sacituzumab govitecan had a small but statistically significant PFS benefit over chemo alone, and also improved several quality of life measures, but based on the data we have currently, did not improve survival in patients with ER+ breast cancer 2. Trastuzumab deruxtecan causes alopecia, nausea, and vomiting most commonly; interstitial lung disease can be seen with this drug but can be managed with well-defined steroid regimens and other measures 3. Trastuzumab deruxtecan is given once every three weeks, whereas sacituzumab govitecan requires administration on day 1 and 8 of a 21 day cycle. 4. Sacituzumab govitecan is more likely to cause issues with low blood counts than trastuzumab deruxtecan 5. You could always try sacituzumab govitecan after trastuzumab deruxtecan, if desired. 6. 1, 2, and 5 7. 1, 2, 3, 4, and 5 The answer is 7, all of the above - - because all of the above are accurate statements! Find more oncology education opportunities at www.totalhealthconferencing.com