®, McKay, who is an assistant professor of medicine and medical oncologist at the University of California, San Diego, explained how the biologic differences in the genetic profiles of men and women could impact the efficacy of certain treatments, and touched on how the toxicities that some patients experience could vary between younger and older patients.

There is a growing body of evidence that suggests that age and gender play a role in cancer outcomes, and there are multiple factors for this.

They could be biologic, (with) different genetic profiles for men and women and younger and elderly individuals. There's different chemical kinetics, for example, how we process different drugs may be processed differently in men versus women and also based on different ethnicities and presence of different enzymes that help with drug metabolism. We (also) know that toxicity patterns are different between younger and older individuals and male and female patients.

Videos

Many factors impact outcomes in patients with advanced renal cell carcinoma, but recent findings suggest a patient’s age and gender are perhaps more important than previously realized.

Age and Gender Could Factor into Advanced Renal Cell Carcinoma Outcomes

Despite recent advances in the treatment of multiple myeloma, more must be done to find effective treatment options for patients with advanced disease, said Dr. Luciano J. Costa, an associate professor of medicine in the Blood and Marrow Transplantation and Cell Therapy Program at the University of Alabama's Birmingham School of Medicine.

, Costa explained that because current options offer lower response rates of around 30%, more effective solutions are needed for patients who progress after proteasome inhibitors, immunomodulatory drugs​ and monoclonal antibodies.

Even though we had had several advances in therapy for multiple myeloma in the last couple of decades, we still have some substantial challenges which are essentially the patients who progress, whose disease progresses beyond the proteasome inhibitors, immunomodulatory agents and their monoclonal antibodies. There are very few agents in that scenario.

Most of the drugs or most approaches being investigated produce a relatively low rate of response, around 30%. Which is in general, not very durable.

So there's a huge need for drugs or regimens or approaches that could be effective in that population that is triple class refractory and can be performed with a reasonable level of safety.

Despite recent advances in the treatment of multiple myeloma, more must be done to find effective treatment options for patients with advanced disease, according to Dr. Luciano J. Costa.

More Effective Treatment Options are Needed for Patients with Advanced Multiple Myeloma

While the use of CAR-T cell therapy is currently still being investigated in patients with multiple myeloma, Dr. Nina Shah believes that these clinical trials will be what ultimately moves the field forward.

, Shah, an associate professor of medicine at the University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, discussed how heavily pretreated, relapsed or refractory patients currently involved in CAR-T trials are helping to pave the way for future breakthroughs, and noted that clinical trial enrollment should always be considered an option for patients.

So far, CAR-T cell therapy for myeloma is still investigational, because we're waiting for FDA approval for the first product. So, because of that, and the way that clinical trials have been run, it's mainly been for relapsed and refractory patients. And when I mean relapsed and refractory … I mean, 

 relapsed and refractory – median lines of treatment for these trials have been like six or seven lines – which might not be how we're going to eventually use it because the inclusion criteria had to have at least three lines and be progressing. But a lot of these patients were way beyond that, just because it's a clinical trial.

We're really excited about the new molecules and cellular therapies and immunotherapies that are coming to the myeloma space. I think each is going to build on the other one. And we may ultimately have combinations and move these more forward.

I am so thankful to all of the myeloma and oncology practitioners who have sent their patients to clinical trials all over the world, because we just could not do it without them. And we wouldn't know any of this without the patient and physician participation and partnerships, so, if anything, I just really hope that I can offer clinical trials to anybody who's watching this so that patients can reap the benefits as well.

While the use of CAR-T cell therapy is currently still being investigated in patients with multiple myeloma, Dr. Nina Shah of the UCSF Helen Diller Family Comprehensive Cancer Center believes that these clinical trials will be what ultimately moves the field forward. 

Clinical Trials Are Pivotal in the Evolution of CAR-T Cell Therapy in Multiple Myeloma

In the multiple myeloma landscape, therapies are often proven to be safe and effective in the relapsed and refractory setting before they make their way into the frontline setting via an investigation in clinical trials.

’s sister publication, Dr. Betsy O’Donnell, a medical oncologist in the Multiple Myeloma Disease Center and director of Lifestyle Medicine at Massachusetts General Hospital (MGH), discussed these research efforts, and explains why the future in this disease space looks promising, thanks to the current research in CAR-T cell therapies and the use of combination therapies.

There’s a lot going on, obviously, in the relapsed/refractory myeloma setting and that’s where all of our novel therapies emerge from and march their way forward into our armamentarium. Certainly, things targeting BCMA are very exciting, and there are upcoming studies incorporating CAR-T cells in the upfront setting as well for high-risk patients. So, all of that is really exciting.

On a personal level, we’ll be leading a study of the combination similar to that used in the GRIFFIN study, however, we’ll be using ixazomib (Ninlaro), which is the oral proteosome inhibitor, in combination with lenalidomide (Revlimid), dexamethasone, and daratumumab (Darzalex) for transplant-ineligible patients. That is a trial that I think is exciting, because it offers the opportunity to have a mostly oral regimen for older patients.

And I think we, too, at MGH are soon to open a trial looking at carfilzomib (Kyprolis) in combination with lenalidomide, dexamethasone, and isatuximab-irfc (Sarclisa).

So, there are some great combinations out there and a lot of great work being done in the upfront setting.

The future of multiple myeloma is heading toward combination therapies and CAR-T cell treatments, according to Dr. Betsy O'Donnell.

An Expert Discusses the Future of Multiple Myeloma Treatments

When a person hears they have cancer, their first immediate thought likely revolves around surviving the disease. But once a patient’s disease is in remission, the focus then shifts toward living.

“Therapeutic trials are very, very important because thanks to them, our patients are living longer,” said Dr. Narjust Duma, a thoracic oncologist at the University of Wisconsin Carbone Cancer Center, in an interview with 

®. “But we also need to stop and ask how our patients are living.”

Sexual Health Assessment in Women with Lung Cancer (SHAWL) study

, discussed why it is important for more research to be conducted to assess the quality-of-life of patients with cancer.

I think it's extremely important. Therapeutic trials are very, very important because thanks to them, our patients are living longer. But we also need to stop and ask how our patients are living. Yes, they may be here with us longer, but are they spending more time at home and less time in the hospital? Are they spending more time with their grandchildren, which is one of the things I hear very often from my patients, which is what you want to do? I want to spend time with my grandchildren, or with my kids. So, that is all important because surviving lung cancer is not only seeing the tumors shrinking, it's also that you're able to do the things you want to do when you are receiving the treatment that's making the tumor shrink.

And I also have conversations with my patients in which we decide stopping treatment to preserve the quality of life or completing treatment that can potentially prolong their life. Many of them prefer to stop treatment to maintain their quality of life. So, you can see how this is so important to our patients, that knowing that they may stay around for less time — a week, a month or two — they prefer to stop cancer-directed therapy to maintain their quality of life. That's what our patients are telling us, which is why this subject is so important. Because it affects them every day, they don't see (the oncologist) every day, but they have to deal with the symptoms and the side effects every day.

“Therapeutic trials are very, very important because thanks to them, our patients are living longer,” said Dr. Narjust Duma. “But (physicians) also need to stop and ask how our patients are living.”

More Quality-of-Life Research ‘Extremely Important’ for Patients with Cancer

The onset of the COVID-19 pandemic has forced oncology centers to transition into intensive care units, while oncologists are making emergency rounds. As a result, this has also put a halt on emerging research in supportive care.

, Dr. Ricahrd J Gralla details some of the interesting studies he and his colleagues at the Albert Einstein College of Medicine had to put on hold. Studies ranging from toxicities associated with PD-1 and PDL-1 agents in patients with lung cancer to looking at the timing of treatment and when they could switch treatment depending on side effects.

Most institutions, and for ours, studies that we were doing in supportive care in cancer were put on complete hold. And some studies that we were looking at, to really simplify antiemetics in many settings and really home in and prove we've had to put that on hold. There were some interesting areas that we were looking at where we were trying to predict, using some very interesting information, toxicities with anti PD-1 PDL-1 agents, could we predict from a genetic profile who's more likely to have those side effects and also do the same genes that we were looking at, predict the likelihood of response. That's partially based on the immune-genetics of thyroid disease, and we're trying to combine that. So, I hope we can get back to that fairly soon our chief of medicine at Montefiore. Dr. Yale, Tomer is an expert in this area. And as an immunologic endocrinologist, he's been very helpful to our thinking in this way into guiding some of our work.

Also, we've been looking at, can we tell within just two cycles of treatment within six weeks, who's likely to be benefiting from treatment and who is not? And is that a time early on to be able to make a change, and it's looking way beyond imaging, but also using patient reported outcomes to try to predict these things very early on. So far, the results are very encouraging.

So maybe we can get back to all of those when we have less COVID in our midst.

Dr. Richard J. Gralla discusses some of the studies in supportive care that have been put on hold due to the ongoing COVID-19 pandemic. 

COVID-19 Puts Supportive Care Studies on Hold for Patients With Lung Cancer

Emesis, the medical term for vomiting, is one of the most common side effects associated with cancer treatment, especially chemotherapy. But now the field has a host of antiemetic drugs to help prevent vomiting, a reality that wasn’t the case in the early days of medical oncology.

Dr. Richard J. Gralla was one of the leaders in the early medical oncology field looking at making supportive care an integral part of cancer care. Part of his work involved having patients with lung cancer take antiemetics to help prevent vomiting and avoid treatment discontinuation due to side effect fears.

® Gralla, director of oncology research for the North Bronx Healthcare Network, spoke about what the early days of research into cancer treatment-related emesis looked like and where supportive care stands now in the lung cancer space.

In those early days, when we were thinking what we should do, we needed to look at something a little different. Basically, over two or three days, or even less, I read the world's literature on clinical studies in emesis. It didn't take very long. However, these two pioneers, Boris and McCarthy, and several others had really worked out the physiology of emesis. And most of us really have not been well educated in reading their views and understanding the clinical problem.

We were able to look at some different areas, and then, because we've done work in phase one, said, hey, are we giving the right doses of these drugs? And then when we found ways that were working, the question came up: how are these working? And then it was through collaboration with some neuro pharmacologists, who were so bright and said, we think that these must be working in this pathway, not the original pathway, and the drugs that work in that pathway might be safer and more effective. And so that was kind of a fun way of putting that together. But then seeing the clinical aspect of it, as that nurse expressed to me, yeah, that’s true.

Then, one of my other interests has been in day hospitals, and doing (treatment) without overnight admissions in many, many aspects, and having proper antiemetics is kind of important for that. And then measuring, from a quality of life standpoint, do patients agree with us, and well let's hear the patient's voice. So, hearing those things together, has been very interesting and rewarding at the same time.

Dr. Ricahrd J Gralla discusses the history of the early medical oncology space and how things have changed when it comes to treating side effects related to chemotherapy. 

Pioneer in Supportive Care Research Discusses History of Emesis Management

While prostate cancer treatment can cause cardiovascular-related side effects, patients can take certain steps to mitigate those risks, according to Dr. Neal D. Shore, medical director of the Carolina Urologic Research Center.

’s sister publication, Shore recently discussed the role that general health-related interventions such as regular exercise and bloodwork play in keeping the risk of treatment-related cardiovascular toxicity low. Shore also touched on the idea that the choice of therapy could impact these risks in a positive way, based on the results of the recent HERO trial, which examined the use of the hormone-suppressing drug relugolix in this patient population.

Yeah, that's a very important question. The whole field of cardio oncology, across all the different oncology or cancer disease states, has gotten so much more traction. As we know, where we give testosterone suppression, we basically create what's described as this quasi-metabolic syndrome, where we see central adiposity (excessive body weight). We see, potentially, with LHR agonists — and it's in their label — a warning as it relates to arrythmia and potential QT prolongation (heart rhythm irregularities). We didn't see that with relugolix.

But what are the things that we can do? We can make sure that patients are following a better, heart-healthy diet, that they're regularly exercising (and) having their lipid panels and their cholesterol checked. If they have diabetes, they're under really tight glucose management, monitoring their hemoglobin A1C. And so, these are some factors, (including) avoidance of smoking (and) avoidance of a sedentary lifestyle; there are these classic, sort of ABCDE outlines that people can be thinking about.

I'm really happy and proud of our HERO trial, because this adds to a strategy to avoid cardiovascular toxicity, and yet at the same time achieve what we're trying to achieve, which is rapid T (testosterone) suppression and rapid PSA (prostate-specific antigen) corollary declines. We had really excellent results in our T levels that went below 20, even though less than 50 nanograms per deciliter is the pharmacologic endpoint for approval.

So, yes, we can be a lot more proactive in our cardio-oncology strategies, as well as in our prostate cancer therapeutic selections.

Prostate cancer treatments can cause side effects in a part of the body that might be unexpected— the heart. Here's how one expert believes patients can mitigate them. 

How Patients Can Mitigate the Heart-Related Side Effects of Prostate Cancer Treatment

After taking office as the Governor of Maryland, Larry Hogan began to experience some aches and pains that he chalked up to a whirlwind year of campaigning and travel. But when a handful of doctor’s visits led him to a series of CAT scans, he was devastated to hear the diagnosis: advanced, aggressive cancer.

, Hogan recently opened up about how he relied on the help of his family, both his personal and professional one, to take on treatment and eventually overcome the disease not once, but twice.

I had just been elected governor of Maryland and just was sworn in. I'd only been governor for five months and I was on our first trade mission to Korea, China and Japan. We had been really busy going through a year-long campaign, our first legislative session, had been working day and night. I had no idea I was really sick, but I started to have some aches and pains, and on this trip, I started to feel a little run down, but I thought it was I was okay. But I noticed a lump in my throat, and I said I better check this out.

And so I went to the doctor as soon as we got back, and the first primary care physician sent me to another doctor, who sent me to another doctor, and I ended up having three doctors after doing a bunch of CAT scans walk into the room together, which I said, this can't be a good sign when three doctors that you don't know walk into the room. And they said we have some bad news to share with you, governor: you have very advanced and aggressive cancer. We found about 50-some tumors from your neck to your groin, and we're going to have to set you up with a specialist oncologist right away.

I was, frankly, stunned that my first doctor said I didn't think it was anything to worry about. You know, it's probably just a benign cyst of some kind, fluid and my lymph node and my neck. And but then I heard this shocking news and it set off a whole series of things.

This was Father's Day weekend, the Friday of Father's Day weekend, and my very first thought was not really about being afraid of what was going to happen to me. But I think it's probably what so many other cancer patients go through, and my first thought was about my family, you know. How am I going to tell my wife? My three daughters were coming to visit for Father's Day weekend, I was going to break that news to them. And then my dad who was coming over for Father's Day weekend, and it doesn't matter how old you get, I was still his little boy. And he took it almost tougher than anybody, but it was a group hug, a little tears, and I thought everybody was going to be okay.

And then, I had to then break the news to my staff who worked so hard and just was getting started on our administration, and break it to the six million people of Maryland, who had just put their faith and trust in me to help run the state. I was trying to be as open and honest and transparent as I could possibly be with all the people of the state, and they kind of went through and shared the whole cancer battle with me.

After a cancer diagnosis, Maryland Governor Larry Hogan had to lean on family from both his personal and professional life to helping take on treatment and beat cancer twice. 

How Governor Larry Hogan Leaned on Family After a Cancer Diagnosis

Because genetic testing is becoming increasingly important in creating treatment plans for men with prostate cancer, a clinical trial was commissioned to investigate the effectiveness of a video education tool compared to in-person genetic counseling for this patient population.

, Dr. Huma Q. Rana, an assistant professor of medicine at Harvard Medical School and clinical director of Cancer Genetics and Prevention at Dana-Farber Cancer Institute, discussed in detail the rationale of the ProGen trial, and why genetic counseling could have a significant impact on treatment decisions in prostate cancer.

Access to germline cancer genetic testing has been a long-standing issue. There are increasing indications for germline genetic testing. Through studies by our colleagues, we had recognized that there was a high prevalence of inherited mutations among men with advanced prostate cancers, and that this could have significant implications on their treatment.

Men with advanced prostate cancer, in particular, men with advanced prostate cancers with underlying mutations in genes like BRCA two are known to have poor outcomes. Therefore, it's important to identify these men and to make matched, targeted therapy available to them and to their treating oncologist.

Recognizing that prostate cancer is a very common disease, and that testing germline genetic testing in traditional ways would be very difficult, and would potentially overwhelm already strained systems for genetic testing, we decided to conduct this randomized control trial, where we compared a short video education which focused on really the educational

components of a genetic counseling visit, as compared to in-person genetic counseling for men with potentially lethal prostate cancers.

Genetic testing is proving itself to be a vital tool in treating patients with prostate cancer but educating men on its importance also needs to take priority. 

Investigating the Role of Video Genetic Counseling in Prostate Cancer

With CURE® TV, you have access to a variety of informative and uplifting videos. You’ll find interviews with cancer experts, advocates, patients, caregivers, as well as highlights from our celebratory events showcasing interviews with award winners and celebrity speakers.