Connie L. Batlevi, MD, PhD, a medical oncologist specializing in lymphoma at Memorial Sloan Kettering Cancer Center, discusses emerging therapies in follicular lymphoma.

​Several emerging therapies ​in the follicular lymphoma pipeline ​have shown encouraging data, says Batlevi.

Strategies based on modulating immune response have comprised a significant area of research, ​Batlevi explains. Additionally, the utility of CAR T-cell therapy, antibody​-drug conjugates, and bispecific antibodies ​is also being evaluated.

​Future research efforts should focus on identifying an optimal sequencing method ​for patients with follicular lymphoma, especially as more options are introduced to the armamentarium, Batlevi concludes. 

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Connie L. Batlevi, MD, PhD, discusses emerging therapies in follicular lymphoma.

 Dr. Batlevi on Emerging Therapies in Follicular Lymphoma 

Alan P. Z. Skarbnik, MD, a hematologist/oncologist with Novant Health, discusses ongoing research with PI3​K inhibitors in follicular lymphoma. 

Among ongoing research efforts in follicular lymphoma is the development of novel PI3​K inhibitors, says Skarbnik.

To date, 3 PI3​K inhibitors ​are approved for patients with B-cell malignancies, including idelalisib (Zydelig), copanlisib (Aliqopa), and duvelisib (Copiktra)​, Skarbnik explains. 

The safety profiles of these agents ​vary, but common adverse include gastrointestinal toxicity, inflammatory diarrhea, and rash, ​Skarbnik says.

As such, the goal of second-generation PI3​K inhibitors, ​such as duvelisib, is to ​inhibit disease proliferation and ​minimize​immune-related toxicities by targeting the delta and gamma portions of PI3K, Skarbnik concludes. 

Alan P. Z. Skarbnik, discusses ongoing research with PI3​K inhibitors in follicular lymphoma. 








Dr. Skarbnik on the Utility of PI3K Inhibitors in Follicular Lymphoma   

John M. Burke, MD, associate chair of the Hematology Research Program for US Oncology and medical oncologist and hematologist at Rocky Mountain Cancer Centers, discusses treatment options in relapsed/refractory follicular lymphoma.


T​he optimal treatment for ​a patient with relapsed/refractory follicular lymphoma is contingent on what treatment they received in the first-line setting, says Burke. 

Although some patients relapse several years ​after remission, others may relapse more quickly​, Burke explains. 

Notably, patients who relapse within a few years ​of remission tend to have a less favorable prognosis, with a median overall survival of 4 or 5 years, ​Burke says.

For these patients, treatment options include additional chemoimmunotherapy, lenalidomide (Revlimid) in combination withrituximab (Rituxan), and PI3​K inhibitors, Burke concludes.

John M. Burke, MD, discusses treatment options in relapsed/refractory follicular lymphoma.

Dr. Burke on Treatment Options in Relapsed/Refractory Follicular Lymphoma  

Maha Hussain, MD, FACP, FASCO, Genevieve E. Teuton Professor of Medicine, Division of Hematology and Oncology, Deputy Director, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, discusses the importance of genomic profiling in metastatic castration-resistant prostate cancer (mCRPC).

Genomic profiling is critical in men with prostate cancer, says Hussain. Germline and somatic testing could inform not only current treatment selection, but potential future options for patients. 

For example, tissue-based testing can identify whether a patient harbors a targetable alteration, Hussain says. The results could inform whether a patient is a candidate for an approved PARP inhibitor or a clinical trial.

Additionally, early implementation of genetic testing could be important for blood relatives of men with prostate cancer, Hussain concludes. 

Maha Hussain, MD, FACP, FASCO, discusses the importance of genomic profiling in metastatic castration-resistant prostate cancer.  



Dr. Hussain on the Importance of Genomic Profiling in mCRPC 

Paul L. Nguyen, MD, senior physician and director of Genitourinary Clinical Center for Radiation Oncology at Dana-Farber Cancer Institute, as well as a professor of radiation oncology at Harvard Medical School, discusses standard and investigational treatment options in high-risk prostate cancer.

Typically, patients with high-risk prostate cancer are treated with standard androgen deprivation therapy with a gonadotropin-releasing hormone agonist plus an antiandrogen, Nguyen says. However, novel agents are in development to try to improve upon standard treatment. 

For example, enzalutamide (Xtandi) is currently being tested in the randomized phase 3 ENZARAD trial in men with high-risk, localized prostate cancer, says Nguyen. Additionally, the phase 3 ATLAS trial is evaluating apalutamide (Erleada) in patients with high-risk disease who are receiving primary radiation therapy.

Abiraterone acetate (Zytiga) was tested in the STAMPEDE trial, Nguyen adds. Although data from study were published, the field awaits additional follow-up to determine whether patients with node-negative nonmetastatic prostate cancer derived benefit from abiraterone. 

Additionally, other studies such as the phase 3 DASL-HiCaP trial, which is evaluating darolutamide (Nubeqa) in very high-risk prostate cancer, and the phase 3 Predict-RT trial, which is evaluating abiraterone plus apalutamide in patients with high genomic risk disease, are ongoing, concludes Nguyen. 

Paul L. Nguyen, MD, discusses standard and investigational treatment options in high-risk prostate cancer.  



Dr. Nguyen on Standard and Investigational Treatment Options in High-Risk Prostate Cancer 

Benjamin P. Levy, MD, associate professor of oncology and clinical director of Medical Oncology at Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, discusses the disease-free survival (DFS) benefit achieved with adjuvant osimertinib (Tagrisso) in patients with 

The most mature data available in targeted therapy for resected lung cancer is with osimertinib, says Levy. The field knows that osimertinib is the standard-of-care option for patients with advanced stage 

-mutant lung cancer, as it provides a survival advantage, is better tolerated, and yields a better intracranial response, says Levy. Building on these findings, osimertinib is under exploration in the adjuvant setting.

In the ADAURA trial, investigators enrolled patients who had stage IB to IIIA resected 

-mutant lung cancer. Those enrolled were randomized 1:1 to receive either osimertinib or placebo. Patients were allowed to receive chemotherapy at the discretion of their physician, says Levy. Data reported during the

, demonstrated a significant improvement in DFS. 

 showed a decreased relapse rate in the brain. The DFS benefit justifies potentially using this drug despite not yet having an FDA approval, accoring to Levy.

The challenge with this study is that no overall survival data are available; the data are too immature. Another challenge is the cost of the drug. Despite the challenges observed with the study,  the DFS benefit was profound enough to encourage the use of osimertinib in this setting, concludes Levy.

Benjamin P. Levy, MD, discusses the disease-free survival benefit with adjuvant osimertinib in the phase 3 ADAURA trial.

Dr. Levy on the DFS Benefit Achieved With Adjuvant Osimertinib in EGFR+ NSCLC

Natalie I. U. Vokes, MD, a medical oncologist fellow at Dana-Farber Cancer Institute, discusses investigative biomarkers of response to checkpoint inhibitors in the field of oncology.

Tumor mutational burden is the most well-developed biomarker in the field of oncology, says Vokes. Many of the early studies that used whole exome sequencing and looked for genomic correlates noted that TMB in patients who responded to treatment is often higher than in those who do not respond. 

This was initially demonstrated in studies that used whole exome sequencing in melanoma and has since been confirmed via a number of different sequencing techniques in an array of disease contexts. There has been a lot of interest in further developing TMB as a biomarker. 

Other biomarkers are not as well developed, adds Vokes. For example, in lung cancer, 1 biomarker that comes up quite a bit are 

 mutations; this is generally a poor prognostic marker across different treatment settings, Vokes adds. There is also some work showing the presence or absence of other comutations, such as 

 mutation is. There is a lot that the field still has to learn in that regard, says Vokes.

In lung cancer, the use of driver mutations as biomarkers, such as 

, are taken for granted, she adds. Those patients tend to not respond as well to treatment, but 1 should be cautious that this is not extended to all driver alterations in non–small cell lung cancer. This is because mutations such as 

 might be biologically different. The field is still learning about these other biomarkers and stronger understanding is anticipated over the next couple of years, concludes Vokes.

Natalie I. U. Vokes, MD, discusses investigative biomarkers of response to checkpoint inhibitors in the field of oncology.

Dr. Vokes on Investigative Biomarkers of Response to Checkpoint Inhibitors in Cancer

Arun Azad, PhD, an associate professor at Peter MacCallum Cancer Centre and the University of Melbourne; fellow at Victorian Cancer Agency; and chair of the ANZUP Cancer Trials Group Translational, discusses unmet needs for men with metastatic hormone-sensitive prostate cancer (mHSPC).

The management of patients with mHSPC has changed considerably in the past 5 years, says Azad. In addition to androgen deprivation therapy (ADT), the field now has strong evidence indicating that the use of docetaxel chemotherapy or 1 of the androgen receptor  antagonists improves survival, adds Azad. 

At the same time, this disease remains lethal for most patients, says Azad. Additional strategies are needed to further improve outcomes. These approaches could include new combinations, the addition of novel drugs to existing drugs, a better selection of existing drugs, treatment of the primary disease itself, and the identification of biomarkers, adds Azad.

Ultimately, the biggest untapped resource is using agents that are already in the arsenal, according to Azad. Data have read out in the United Kingdom, the United States, and Australia and show that the vast majority of patients are not getting access to these ne​wer therapeutic strategies. They are still being treated with ADT alone. 

It is known that this results in an undertreatment of the vast majority of patients with mHSPC, says Azad. Implementing clinical trial data into real-world practice is a key unmet need for these patients, concludes Azad.

Arun Azad, PhD, discusses unmet needs for men with metastatic hormone-sensitive prostate cancer.

Dr. Azad on Unmet Needs in Metastatic Hormone-Sensitive Prostate Cancer

Andrew B. Nixon, PhD, ​MBA, director, Phase 1 Biomarker Laboratory, associate professor of medicine, Duke University School of Medicine, discusses the role of microsatellite instability (MSI) in cancer.

MSI describes an accumulation of mutations in the telomere region of the chromosome, says Nixon. These mutations represent insertions or deletions, also known as tandem repeats.

Tandem repeats are measurable and occur in ​the DNA when nucleotide pattern repetitions are near one another​, Nixon says.

Notably, a large number of mutations or alterations is in this region of the chromosome, the tumor is deemed microsatellite ​instable, ​says Nixon. This instability is due to a functional loss of DNA mismatch repair (MMR) enzymes.

Although these consist of many proteins, ​MLH1, MSH2, MSH6, and PMS2 are looked at most closely. ​Moreover, an alteration in these MMR proteins results in an MSI phenotype, Nixon concludes. 

Andrew B. Nixon, PhD, ​MBA, discusses the role of microsatellite instability in cancer.

Dr. Nixon on the Role of MSI in Cancer

Petros Grivas, MD, PhD, physician of the Seattle Cancer Care Alliance; associate professor in the Department of Medicine in the Division of Oncology and clinical director of the Genitourinary Cancers Program at the University of Washington School of Medicine; and associate member of the Clinical Research Division at Fred Hutchinson Cancer Center, discusses findings from the subgroup analyses of JAVELIN Bladder 100 in advanced urothelial cancer.

​The phase 3 JAVELIN Bladder 100 trial ​randomized patients with unresectable locally advanced or metastatic urothelial carcinoma to frontline avelumab (Bavencio) maintenance plus best supportive care (BSC) versus BSC alone.

Avelumab plus BSC demonstrated statistically significant overall survival and progression-free survival benefits compared with BSC alone across all prespecified subgroups, ​Grivas says.

Moreover, the benefits were observed regardless of patients’ best response to induction chemotherapy and ​site of metastasis at baseline.

As such, all patients with ​advanced urothelial carcinoma who derive a response or stable disease ​from induction chemotherapy should receive avelumab maintenance, Grivas concludes.

Petros Grivas, MD, PhD, discusses findings from the subgroup analyses of JAVELIN Bladder 100 in advanced urothelial cancer.

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