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Oncologists Dish on Top Issues for 2018

Oncologists Dish on Top Issues for 2018

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MedPage Today asked physicians in several specialties to predict the news that will dominate their specialties during 2018.

Number one for oncologists could probably have been predicted at the start of 2017: immunotherapies and their impact on routine clinical practice.

Last year saw the first approvals of CAR T-cell therapies, and the roles of drugs targeting the PD-1 checkpoint on immune cells, allowing them to attack tumor cells, became clearer and larger in 2017.

In 2018, nearly all the oncologists we contacted mentioned immunotherapies, although many were not glowing expectations that patients will see dramatic improvements in outcomes.

Daniel Hayes, MD, University of Michigan; past president, American Society of Clinical Oncology: I think the biggest issue in the field of oncology will be ongoing advances in immunotherapy and precision medicine, with the former including both new targets and drugs as well as delivering them more precisely and the latter including better tests for all the new targeted drugs we use to treat cancers.

John W. Sweetenham, MD, University of Utah: In my opinion, the biggest clinical issue for oncology in 2018 is evaluating the true clinical impact of immunologic therapies including checkpoint inhibitors and CAR-T cell therapy from the perspective of outcomes and cost.

Ross Camidge, MD, University of Colorado-Denver: Recognition of the cost implications (financial and medical) of a one-size-fits-all approach to immunotherapy in lung cancer.

Sagar Lonial, MD, Emory University: I think that the biggest issue in our field will be how to more effectively pair immune therapy with genomic subtyping and sequencing data. Both separately are only effective in the minority of patients, but marrying these two ideas in a more coherent combination approach has the potential to yield greater benefits for all.

Howard Alan Fine, MD, Weill Cornell Medicine: One of the biggest clinical issues in this upcoming year in neuro-oncology in general, and malignant gliomas specifically, will be the maturation and release of clinical trial data on the efficacy of immunotherapeutic strategies in GBM. To date, the early data regarding immunotherapeutic strategies in the treatment of GBM (such as the highly touted anti-PD-1/PD-1L and anti-CTL4 so effective in melanoma, along with a plethora of vaccine approaches) have largely been negative (except for the approximate 1% of GBM patients that have tumor genomics that demonstrate DNA mismatch repair). The negative results are early, but it is likely that a number of these trials will become mature this year with the release of longer term follow-up data that will suggest whether this strategic approach for brain tumors has some clinical efficiency (e.g., proof of principle) or whether significantly more basic and translational research will need to be done in order to try and get this type of treatment to benefit patients.

But for some oncologists, other issues came to the fore.

Sidney Winawer, MD, Memorial Sloan Kettering Cancer Center: If the ACS [American Cancer Society] can reach its goal of screening 80% of Americans for colorectal cancer in 2018, approximately 200,000 lives can be saved over the next 20 years.

David Crawford, MD, University of Colorado-Denver: The indication of a PSA cutoff of 1.5 [ng/mL] for family practice doctors [to act on increased prostate cancer risk].

Herbert Lepor, MD, New York University: Using molecular and genetic testing to better define aggressiveness of prostate cancer.

Ed Kim, MD, Carolinas Healthcare: Balancing the increasing effectiveness of cancer drugs and the increasing costs of drugs.

And our favorite:

Derek Raghavan, MD, PhD, Carolinas Healthcare: The biggest clinical issue in oncology will be to create magic that allows oncologists to provide state of art care for the indigent and under-insured in this harsh political environment.

2018-01-05T09:15:00-0500

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