Welcome to The Five Under 5, your go-to roundup of the top 5 videos of the week.
These short videos are designed for busy oncologists to view on the go, and feature expert insights on breaking news, regulatory updates, practice-changing data shared at medical meetings, and other key topics in the realm of oncology.
Here’s what you may have missed:
FDA Approval of First-Line Sacituzumab Govitecan Plus Pembrolizumab for TNBC: Sara M. Tolaney, MD, MPH
Sara M. Tolaney, MD, MPH, of Dana-Farber Cancer Institute and Harvard Medical School, discusses the significance of the June 24, 2026 FDA approval of first-line sacituzumab govitecan-hziy (Trodelvy) plus pembrolizumab (Keytruda) for use in adult patients with unresectable locally advanced or metastatic triple-negative breast cancer (TNBC) whose tumors express PD-L1, with sacituzumab govitecan monotherapy simultaneously approved for patients ineligible for PD-1/PD-L1 inhibitor–based therapy. The decisions were based on data from the phase 3 ASCENT-04/KEYNOTE-D19 (NCT05382286) and ASCENT-03 (NCT05382299) trials, respectively. Tolaney highlighted that TNBC remains the most challenging breast cancer subtype to treat, given historically limited overall survival, making the development of newer therapies a critical priority. In ASCENT-04, which enrolled patients with treatment-naive metastatic disease and a centrally confirmed PD-L1 combined positive score of 10 or higher, sacituzumab govitecan plus pembrolizumab was compared with pembrolizumab plus physician's choice of chemotherapy; progression-free survival (PFS) was the primary end point. The combination demonstrated a statistically significant and clinically meaningful improvement in median PFS of 11.2 months (95% CI, 9.3-16.7) vs 7.8 months (95% CI, 7.3-9.3) with chemotherapy plus pembrolizumab (HR, 0.65; 95% CI, 0.51-0.84; P = .0009).
WCCL Debate: Treating Poor Mycosis Fungoides Prognosis Early: Jade Cury-Martins, MD, PhD and Maarten Vermeer, MD, PhD
Jade Cury-Martins, MD, PhD, of the University of São Paulo Medical School, and Maarten H. Vermeer, MD, PhD, of Leiden University Medical Center, debate whether patients with early-stage mycosis fungoides (MF) and poor prognostic features should be treated differently from disease onset, a topic that was presented at the 6th World Congress of Cutaneous Lymphoma. Vermeer noted that although diagnosis and staging in early MF are reliable, the IA/IB staging system does not fully capture individual risk, as patients with patches alone tend to fare better than those with plaques. Clinicians currently choose among available skin-directed therapies with no preferred order, guided largely by physician judgment and patient preference. Both experts agreed that the central trade-off involves competing errors—withholding aggressive therapy from a genuinely high-risk patient risks missing a treatment window, and treating a patient who would never progress exposes them to unnecessary toxicity. They also agreed that, unlike in hematologic malignancies where specific markers can justify different treatment, cutaneous lymphoma currently lacks comparable predictive precision. Vermeer concluded that even a validated prognostic indicator would only establish who is likely to progress, not that earlier intervention would alter the disease course, a distinction only a properly designed study could resolve.
Distinguishing Between Late-Onset irAEs and Underlying Comorbidities in Melanoma: Michael A. Postow, MD
Michael A. Postow, MD, of Memorial Sloan Kettering Cancer Center, addresses the diagnostic challenge of distinguishing late-onset immune-related adverse effects (irAEs) from underlying comorbidities unrelated to treatment in melanoma care. As patients receiving immune checkpoint inhibitors grow older with increasingly complex medical histories, clinicians must carefully determine whether a new or worsening condition reflects treatment-related toxicity, disease progression, or an independently evolving pre-existing comorbidity—a challenge further complicated by the fact that cancer itself can produce symptoms mimicking irAEs. Postow underscored that close, consistent communication across a multidisciplinary care team is key to resolving these uncertainties, noting that coordination is more straightforward within a single institution but becomes considerably harder when patients receive fragmented care across multiple systems with limited electronic health record (EHR) integration. He concluded that although better EHR integration and communication infrastructure are needed long term, proactive direct dialogue between oncologists, cardiologists, rheumatologists, and other specialists remains the most practical tool currently available for ensuring timely, accurate, and coordinated care.
Phase 1 Study of SYNC-T SV-102 in Prostate Cancer: Brian Myre, MD
Brian Myre, MD, of the Center for Thoracic Cancer Care and Center for Genitourinary Cancer Care at Brian Moran Cancer Institute of Duly Health and Care, discusses data from a phase 1 trial (NCT05544227) examining the locally delivered therapy SYNC-T SV-102 in patients with advanced or metastatic castration-resistant prostate cancer. Among the 15 patients treated at the time of analysis, the agent showed a favorable safety profile, with 95% of adverse effects (AEs) being grade 1 or 2—most commonly fever and hematuria—and no grade 4 or 5 AEs reported; this distinguishes it from the broader immune-related toxicity profile typically seen with systemic immunotherapies such as immune checkpoint inhibitors, he said. Myre noted that this predominantly low-grade, localized toxicity profile suggests SYNC-T SV-102 could offer a more tolerable option for patients who are not ideal candidates for systemic therapy. Notably, 8 of the 15 treated patients achieved a complete response, representing more than half of the study population. He concluded that these early results suggest locally delivered therapy may be capable of inducing meaningful and durable responses in patients with advanced disease.
What to Reach for Outside of a Clinical Trial in Platinum-Resistant Ovarian Cancer: David O'Malley, MD
David O'Malley, MD, of The Ohio State University College of Medicine and The Ohio State University Comprehensive Cancer Center–James, discusses how antibody-drug conjugates (ADCs) have reshaped the treatment paradigm for patients with platinum-resistant ovarian cancer (PROC). He also spotlighted ongoing trials like the phase 3 MAESTRA 2 trial (NCT07214779) examining patients with cyclin E1 overexpression. O'Malley noted that folate receptor alpha (FRα) and HER2 expression currently guide ADC selection, with National Comprehensive Cancer Network (NCCN) guidelines supporting FRα-targeted treatment at expression levels as low as 25% despite the absence of large prospective trials validating this threshold, and HER2-directed therapy has accelerated approval for immunohistochemistry (IHC) 3+ expression with NCCN guidelines also supporting IHC 2+ based on data from the phase 2 DESTINY-PanTumor02 trial (NCT04482309) showing similar response rates across reclassified expression levels. He noted that he routinely performs next-generation sequencing in his practice to identify clinical trial eligibility, prioritizing early testing to preserve access to relevant studies. O'Malley concluded that topoisomerase I and anti-microtubule payload ADCs should each be used only once, given the lack of data supporting sequential use of the same payload class, although the same tumor target may be revisited with a subsequently different payload class.
