Presenter: William J. Gradishar
Recent advances in the understanding of the molecular underpinnings of metastatic breast cancer have led to the identification of novel therapeutic targets. The latest update to the NCCN Guidelines for Breast Cancer reflects a rapidly evolving treatment landscape, highlighting the growing importance of combination therapies and personalized medicine in managing estrogen-receptor (ER)–positive, HER2-positive, and triple-negative subtypes. For patients with ER-positive disease, the standard of care remains combination therapies involving cyclin-dependent kinase 4/6 inhibitors, endocrine therapy, and PI3 kinase. In patients with HER2-positive disease, the use of fam-trastuzumab deruxtecan-nxki and tucatinib have demonstrated improved outcomes. For those with triple-negative breast cancer, pembrolizumab, PARP inhibitors, and antibody–drug conjugates (eg, sacituzumab govitecan-hziy) have shown activity.
Presenters: Bláz Bush, Paula Chambers Raney, Shail Maingi, Mandi L. Pratt-Chapman, and Scout
Moderator : Clifford Goodman
Patients with cancer in the LGBTQ+ community experience worse health outcomes when compared with their non-LGBTQ+ peers because of a variety of factors, including stigma, underrepresentation in research, lack of support, and implicit bias on the part of clinicians. For generations, many LGBTQ+ people have feared disclosing their identity to providers, leading to gaps in care and even higher mortality. As more people are identifying as members of the LGBTQ+ community, it’s crucial for providers to recognize them appropriately in healthcare, take steps such as acknowledging chosen names and pronouns, and provide care free from judgment. In today’s political climate, members of this community are facing increasing scrutiny, challenges, and barriers to accessing safe and affirming care. Providers can do their part to improve health outcomes among LGBTQ+ people by making their practices known as safe and affirming spaces, working to increase inclusivity in oncology care and improving data collection.
Presenter: Arlene O. Siefker-Radtke
The advent of targeted agents, such as enfortumab vedotin, erdafitinib, and sacituzumab govitecan, have revolutionized the treatment of metastatic urothelial cancer. Although these novel therapies have demonstrated favorable efficacy outcomes, their toxicity must be carefully monitored. The NCCN Guidelines for Bladder Cancer recommend platinum-based chemotherapy in this clinical context, but the combination of targeted and immunotherapeutic agents may have the potential to replace it as frontline standard of care.
Presenters: Rebecca L. Caires, Anne H. Gross, Todd A. Pickard, and Kristi Stiffler
Moderator : Timothy Kubal
Recruitment and retention in healthcare were uniquely impacted by the COVID-19 pandemic. An existing workforce shortage was significantly exacerbated by high attrition, early retirements, and people leaving healthcare altogether because of burnout and exhaustion. Since the pandemic crisis has eased, individuals have shown the desire for healthier work–life balance and opportunities for remote or hybrid work environments with clearly defined career paths. Recognizing this shift and aligning with the current environment are imperative to recruiting and retaining employees in healthcare. At the NCCN 2023 Annual Conference, a panel of experts from 5 major academic oncology centers shared their struggles with recruitment and retention (both before and after the COVID-19 pandemic) and offered valuable insight into some of the systems and processes they’ve since implemented to attract desirable candidates, make them feel heard and appreciated, and retain them in the long run.
Presenter: Leigha Senter
Although BRCA1 and BRCA2 pathogenic or likely pathogenic variants are a well-established cause of hereditary ovarian cancer, recent studies have brought other homologous recombination repair pathway genes into the limelight. The current NCCN Guidelines reflect the most up-to-date, evidence-based data relating to the risk management of patients who are carriers of BRCA1/2 and/or other variants. Risk-reducing bilateral salpingo-oophorectomy is the current standard of care, but a recommendation for salpingectomy alone may be on the horizon.
Presenter: Joyce F. Liu
Treatment approaches for advanced ovarian cancer should consider several factors. Among the most important are platinum sensitivity, the status of BRCA and homologous recombination deficiency (HRD), and the changing indications for PARP inhibitors in recurrent disease and maintenance. PARP inhibitors have demonstrated clear benefit in patients with BRCA mutated tumors, especially in the first-line setting, and HRD testing can guide their use for patients without BRCA mutations. A new antibody–drug conjugate, mirvetuximab soravtansine, has been approved for use in a subset of patients with platinum-resistant disease. Newly diagnosed patients with advanced-stage ovarian, fallopian tube, or primary peritoneal cancers should always be evaluated by a gynecologic oncologist if possible.
Presenters: Archana Ajmera, Rana R. McKay, and Kelly L. Stratton
Androgen deprivation therapy is a well-established standard of care for the management of metastatic prostate cancer; however, recent studies have investigated additional therapeutic options, escalation strategies, and primary directed therapy for patients with advanced disease. Treatment decisions are based on clinical parameters, disease characteristics, and patient factors. At the NCCN 2023 Annual Conference, a panel of experts used 3 case studies to develop an evidence-based approach for the treatment of patients with metastatic prostate cancer. The session focused on the current research regarding both systemic and local therapy options in each clinical context.
Presenter: Nadeem R. Abu-Rustum
Cervical cancer often affects individuals aged <50 years, with the main cause being a long-lasting infection with certain types of human papillomavirus (HPV). Prevention of cervical cancer includes screening tests and the HPV vaccine and, if found early, it can be treatable. Metastatic disease, however, is more lethal and is a significant problem worldwide due to screening and treatment limitations. Clinicians should discuss early detection options and treatment modalities with patients with cervical cancer for informed decision-making.