Jacob Sands, MD

Explore a detailed case study on managing HER2-mutant non-small cell lung cancer, highlighting treatment strategies and progression monitoring.

Jacob Sands, MD, discusses challenges in the diagnosis and management of LEMS in patients with small cell lung cancer.

Ophthalmologists discuss the importance of grading dry eye symptoms and the necessity of eye exams before starting certain treatments.

Experts discuss the integration of ocular toxicity management in solid tumor care, focusing on antibody-drug conjugates and their impact on treatment.

Explore a detailed case study on managing HER2-mutant non-small cell lung cancer, highlighting treatment strategies and progression monitoring.

Explore innovative strategies for managing HER2 alterations in non-small cell lung cancer, including testing, treatment sequencing, and real-world case studies.

Ocular toxicities from cancer treatments present complexities; understanding symptoms and timely ophthalmology involvement is crucial for effective management.

Experts discuss the integration of ocular toxicity management in solid tumor care, focusing on antibody-drug conjugates and their impact on treatment.

Drs Sands and Shah discuss LEMS symptom identification and what guidelines currently note as best practices for the diagnosis of this disease.

Panelists discuss how the next 3 to 5 years will likely see T-cell engagers moving into earlier treatment lines, potential ADCs replacing chemotherapy in first-line therapy, and the critical need for better biomarker testing to optimize treatment sequencing and patient selection in an increasingly complex therapeutic landscape.

Panelists discuss how emerging therapies including DLL3-targeted ADCs, trispecific T-cell engagers, CAR T cells, and radioligand therapies represent promising approaches that may offer single-dose treatments or enhanced efficacy, though more data on durability and optimal sequencing are needed.

Panelists discuss how antibody-drug conjugates targeting B7-H3 show impressive response rates compared to historical controls, while T-cell engagers remain the priority for second-line therapy due to their demonstrated durability, though patient preferences and contraindications may influence individual treatment decisions.

Panelists discuss how tarlatamab implementation requires careful infrastructure planning, including 24-hour monitoring capabilities, staff education about cytokine release syndrome management, patient counseling, and coordination with community partners to ensure all eligible patients have access to this standard-of-care therapy.

Panelists discuss how neutropenia management varies widely across institutions, with some using primary prophylaxis with G-CSF or trilaciclib, while others tailor supportive care based on individual patient risk factors including age, comorbidities, and prior treatment tolerance.

Panelists discuss how monitoring for long-term immunotherapy toxicities requires regular imaging and symptom assessment, with early recognition and treatment of pneumonitis, hypothyroidism, and adrenal insufficiency being critical for maintaining patients on therapy and preventing chronic complications.

Panelists discuss how managing toxicities during chemoradiation requires proactive counseling about esophagitis and fatigue, while immunotherapy consolidation typically doesn’t enhance these acute toxicities, making it feasible to start within the recommended timeframe after completion of chemoradiation.

Panelists discuss how preliminary neoadjuvant chemoimmunotherapy data showing high response rates and pathologic complete responses in limited-stage SCLC appears promising but requires larger studies and careful patient selection given the complexity of staging and surgical candidacy.

Panelists discuss how while emerging biomarkers like inflamed subtypes and MHC class I expression show promise for predicting immunotherapy benefit, current clinical practice treats all patients with immunotherapy since the potential for exceptional responses cannot be reliably predicted.

Panelists discuss how the concerning underutilization of first-line chemoimmunotherapy in extensive-stage SCLC may stem from clinical nihilism, lack of urgency in treatment initiation, and inadequate education about the substantial benefits these therapies provide to patients.

Panelists discuss how pneumonitis risk management requires intensive patient education about symptoms, close monitoring for several months post radiation, and multidisciplinary coordination with pulmonology and radiation oncology teams to distinguish between radiation-induced and immunotherapy-related pneumonitis.

Jacob Sands, MD, provides a post hoc analysis of TROPION-Lung01 , which showed improved intracranial activity and progression-free survival with datopotamab deruxtecan (Dato-DXd) versus docetaxel. Among patients with measurable brain metastases, Dato-DXd achieved a central nervous system confirmed overall response rate of 38%, with all evaluable patients showing disease control. No intracranial responses were seen in the docetaxel arm.

Panelists discuss how patient selection for durvalumab consolidation requires careful consideration of autoimmune diseases, baseline lung function, and neurologic paraneoplastic syndromes, while emphasizing that most patients should receive immunotherapy unless they have severely active contraindications.

Panelists discuss how durvalumab consolidation after chemoradiation has become the standard of care for limited-stage SCLC based on the ADRIATIC trial, with most patients being considered candidates for the 2-year treatment course.

Panelists discuss the introduction of quantitative cell scoring (QCS) for TROP2 as a significant artificial intelligence (AI)-driven advancement in oncology, emphasizing its ability to provide precise, quantitative biomarker assessment that complements molecular data like EGFR status. The panelists also highlight the importance of pathologists embracing digital pathology tools to enhance diagnostic accuracy and treatment planning while recognizing the technology’s early but promising role in expanding patient identification for targeted therapies and its potential broader impact on precision oncology.

Panelists discuss the expanding potential of quantitative cell scoring (QCS) technology beyond TROP2, highlighting its ability to assess not only cell surface expression but also internalization critical for antibody-drug conjugate (ADC) efficacy. They also emphasize how artificial intelligence (AI)-driven pathology advancements promise to streamline lung cancer diagnostics, improve predictive accuracy, and reduce variability in biomarker testing, ultimately enabling more precise patient selection and better integration of complex biomarker data into clinical care.

Panelists discuss the strategic approach to implementing targeted therapies through advanced biomarker testing, emphasizing the importance of prioritizing next-generation sequencing (NGS) early in diagnostic workflows due to limited tissue availability, the growing role of liquid biopsies, and emerging technologies like multiplex immunohistochemistry (IHC) to maximize tissue use. The panelists also highlight the critical need for close collaboration and clear communication between oncologists and pathologists to streamline testing, reduce redundant procedures, and ensure timely, personalized treatment decisions.

Panelists discuss how biomarker testing in oncology is evolving beyond genomic sequencing to include complex protein and RNA analyses, highlighting challenges such as limited biopsy tissue, the need for recent samples, and the importance of clear, standardized reporting; they emphasize that effective collaboration between oncologists and pathologists, along with the use of specialized send-out labs, will be critical to streamline workflows and ensure timely, actionable results for personalized patient care.

Panelists discuss the significant changes needed to integrate quantitative continuous scoring (QCS) and TROP2 normalized membrane ratio (NMR) assays into routine clinical practice, emphasizing the current limited adoption of digital pathology, the likely use of artificial intelligence (AI)-based assays as send-out tests initially, and the importance of expanding digital infrastructure and collaboration to enable precise, automated biomarker evaluation that can guide personalized oncology treatment.

Panelists discuss several ongoing clinical trials, including AVANZAR and TROPION-Lung10, that are investigating the predictive utility of TROP2 normalized membrane ratio (NMR) in guiding treatment with datopotamab deruxtecan combinations in lung cancer while highlighting advances in artificial intelligence (AI)-driven pathology to refine biomarker assessments and emphasizing the need for prospective validation to establish NMR’s role in clinical practice.

Panelists discuss how data from the TROPION-PanTumor01, TROPION-PanTumor02, and TROPION-Lung02 studies reinforce the predictive value of the TROP2 normalized membrane ratio (NMR) biomarker across diverse patient populations and treatment regimens, highlighting its reproducibility and ability to specifically identify patients likely to benefit from datopotamab deruxtecan–based therapies rather than serving as a general prognostic marker.