Oncology for the Inquisitive Mind

This week, we talk about metastatic bladder cancer. The last two years have seen drastic changes in this space, with the addition of immunotherapy and ADCs in a first-line setting. While exceptionally effective, toxicity and patient selection remain challenging. The other big issue with what's best for the second line? That's the golden question. Studies discussed in the episode: EV-302 THOR For m...

This week, we explore muscle-invasive bladder cancer (MIBC). This space has made significant progress with the completion of two pivotal trials. The first was VESPER, comparing two chemotherapy regimens. The key to this trial may be the amount of cisplatin delivered, but there are some unknowns in a real-world setting. It also compared the neoadjuvant to the perioperative space. The second trial u...

As we "EMBARK" on our next Prostate Cancer adventure via the "SOLAR" system to "SATURN," Michael and Josh explore the idea of biochemical recurrence in prostate cancer and the role of radiotherapy in tumour-directed therapy for de novo versus recurrent PSMA PET–defined oligo-M1 prostate cancer. Both excellent studies raise the question of newer technologies and how we apply this information to tri...

Marie Curie's life work laid the foundations for theranostics. This week, we talk about Lutetium, a rare earth metal, and its role in Prostate Cancer. Lutetium-177 PSMA therapy is a radiation therapy that targets prostate cancer. It is used in the advanced, metastatic, and castrate-resistant space. Lutetium is bound to a protein called PSMA. PSMA is overexpressed in many prostate cancers and...

Prostate Cancer has a multitude of presentations, but when metastatic, it usually spreads directly to the lymph nodes or the bones. This episode focuses on the contentious definition of "M0 Castrate Resistant Prostate Cancer (CRPC)", also known as Nonmetastatic CRPC. Does this definition exist, and what role will PSMA PET have in this cohort of patients? The second trial, TITAN looks at apalutamid...

This week, we interview Dr. Cristofanilli, a globally recognised expert in inflammatory breast cancer research and precision medicine. With decades of clinical experience and groundbreaking contributions to translational research, he has transformed the way we approach metastatic breast cancer, leading advances in liquid biopsy, molecular profiling, and targeted therapies. Dr Cristofanilli serves...

Today, we discuss the role of triplet therapy (ie, chemotherapy and androgen receptor signalling inhibitor and ADT) in high-volume metastatic hormone-sensitive prostate cancer and whether darolutamide is equivalent to the other androgen receptor signalling inhibitors in the castrate-sensitive space. Two good trials, and as always, some interesting discussion points. Studies discussed in the episod...

The rise and rise of Androgen Receptor Pathway (or Signalling) Inhibitors has changed the world of metastatic prostate cancer forever. What was once a cancer with a finite number of treatment options has flourished into a chasm of therapies, many more effective and less toxic than their therapeutic grandparents. Studies discussed in the episode: ARCHES ENZAMET For more episodes, resources and blog...

Our final breast cancer episode is here! Today, we are talking about the role of Gene Expression Assays in early hormone receptor-positive breast cancer management. The specific questions we asked included when we can de-escalate and for which cohort of patients these assays can be used. There's lots more to this episode, but we explore the role of Oncotype Dx! Studies discussed in the episode: TA...

This week, we prematurely dive into prostate cancer (one breast episode remaining - whoops!), where we explore the early pivotal trials, including the role of abiraterone in metastatic hormone-sensitive prostate cancer and the use of docetaxel in high and low-volume prostate cancer. Studies discussed in the episode: LATITUDE STAMPEDE For more episodes, resources and blog posts, visit www.inquisiti...

As our breast cancer journey comes close to finishing, it was always the destiny of your cohost's on Oncology for the Inquisitive Mind to talk about HER2-positive breast cancer. This week, we target both antibody-drug conjugate therapy and targeted therapy (trastuzumab deruxtecan and pertuzumab). While HER2-positive cancer's survival is one of the best for metastatic disease, this was not always t...

Metastatic Triple Negative Breast Cancer is one of the most challenging breast cancer subtypes to treat. Recurrence rates can be as high as 40%. This episode covers the role of immunotherapy and antibody-drug conjugates in the advanced space. Once again, targetable receptors are lacking but research is underway! Studies discussed in the episode: KEYNOTE 355 ASCENT For more episodes, resources and...

It's been an "Olympic" ride to get here, and this is our penultimate breast cancer episode! Today, we talk about the BRCA mutations and how they impact both breast cancer and outcomes using targeted therapy. BRCA is a tumour suppressor gene. Today, we explore olaparib and its role in the adjuvant and metastatic setting for breast cancer. Studies discussed in the episode: OLYMPIA OLYMPIAD For more...

Metastatic Hormone Receptor-Positive Breast Cancer truly represents the frontier of Medical Oncology, with life expectancy creeping up to and beyond five years. This week, we discuss Monaleesa-2 (Ribociclib), Paloma-2 (Palbociclib) and, of course, highlight the importance of Monarch-3 (Abemaciclib). The great CDK debate continues, and while the phase three trials have a clear winner, it's importan...

Early Triple Negative Breast Cancer remains an aggressive variant of all breast cancers, affecting those under 40 more and has a higher propensity for being in those with BRCA1/2 mutations. It represents about 15% of all breast cancers. This week, we explore the benefit of immunotherapy (pembrolizumab), looking at improved complete pathological response as a surrogate marker for OS and the role of...

Our second SABCS (San Antonio Breast Cancer Symposium) episode covers everything (else) you need to know from 2024. In this episode, we dive into the role of trastuzumab deruxtecan in HR +ve, HER2 low cancers, perioperative atezolizumab in tnbc, the use of a novel ADC (SHR-A1811) and the role of tumour mutational burden in triple-negative cancer. Studies discussed in the episode: DESTINY-Breast06...

Welcome back to Oncology for the Inquisitive Mind, where we head back to late 2024 and cover some pivotal trials and ideas from the San Antonio Breast Cancer Conference 2024. This episode broadly covers hormone receptor-positive breast cancer and looks at another CDK comparison (real-world data). While the idea is not new, the potential implications from well-gathered "phase 4" data is a curious d...

Before immunotherapy, targeted chemotherapy (ADCs) and precision oncology, there was endocrine therapy, the forefather (or mother) of effective treatment to reduce breast cancer recurrence as well as delay disease progression. This episode dives into a past of phenomenal improvement in the adjuvant breast cancer space. How long should one take endocrine therapy? We cover all the facts you need to...

HER2 Breast Cancer is complicated, and this week, we explore those with residual disease post neoadjuvant therapy (KATHERINE) and the idea of de-escalation in a subpopulation of HER2-positive breast cancer patients (PERSEPHONE). The advent of a new class of drugs leads to excitement, unanswered questions and boundless opportunities. With ADC (antibody-drug conjugates) making their mark on traditio...

Human epidermal growth factor receptor 2 (HER2) is overexpressed in multiple cancers, including breast, gastric, colorectal, and epithelial ovarian cancers. However, this receptor's complexity doesn't stop there. It has multiple subdomains and various responses to drugs, and the complete picture is yet to be understood. This week, we explore the original wonder drug (Trastuzumab) in the early brea...

Early Breast Cancer had one of its defining moments in the 1990s, when five years of adjuvant tamoxifen reduced the recurrence risk of invasive breast cancer by 49%! These days, those types of improvements are much harder to substantiate with the effect treatments currently on the market, but there is promise. This week, on our Back to Basics episode, Michael and Josh look at the role of abemacicl...

Breast Cancer is complex, as are the treatment options that clinicians and patients must traverse. Stage III breast cancer has up to a 57% chance of recurring up to 20 years after diagnosis. Josh and Michael look at one of the practice-changing papers that tried to address how to manage high-risk patients. This study is called Soft and Text. It asked if adding ovarian suppression to aromatase inhi...

Prof Enrique Grande, a medical oncologist from Madrid, Spain, is our guest on Oncology for the Inquisitive Mind this week. Enrique is not your average oncologist nor your average podcast guest with a fascinating back story, a varied career and the charisma and wisdom to match! Enrique has worked in all facets of oncology, including industry and is helping transform how patients access oncology car...

In our final ESMO 2024 analysis this week, we bring back Dr. Adam Brufsky, "a giant among men (and women)" in breast cancer research and management. He discusses the field, the pivotal updates in ESMO, and what this means for patients. He also explores many of the unanswered questions. Links to studies discussed in this episode (subscription may be required): DESTINYBREAST012 KEYNOTE522 Many other...

Lung cancer treatment has changed seismically since 2018 and the NEJM publication of Keynote 189. This week, we have Dr. Ned Mcnamee on the show to give us his highlights of lung cancer updates from ESMO 2024. He explores the resectable lung cancer space with Checkmate-77T; crosses the ADRIATIC trial in patients with limited-stage small cell lung cancer, and brings in a home run with an updated LA...