Evolving Paradigms in Oncology

Dr. Ticiana Leal from Emory University's Winship Cancer Institute and Dr. Wade Iams from Tennessee Oncology discussed recognizing and managing Lambert-Eaton myasthenic syndrome (LEMS) in patients with small-cell lung cancer (SCLC). Cancer-associated LEMS affects approximately 3% of patients with SCLC but remains underdiagnosed in up to 90% of cases due to symptom overlap with disease progression or treatment effects in busy oncology settings.

LEMS results from voltage-gated calcium channel (VGCC) antibodies causing muscle weakness, autonomic dysfunction, and decreased reflexes. The classic triad includes proximal muscle weakness, orthostatic hypotension, and hyporeflexia. Updated NCCN guidelines now recommend VGCC antibody testing for suspected neurologic paraneoplastic syndromes, with 8-day median turnaround time making diagnosis feasible.

This program reviews evolving first-line management of advanced squamous cell carcinoma of the anal canal (SCAC), a rare but increasing human papillomavirus-driven malignancy with historically limited evidence to guide treatment. Although carboplatin and paclitaxel had been the prior standard based on phase 2 data, the phase 3 POD1UM-303 trial established carboplatin, paclitaxel, and the PD-1 inhibitor retifanlimab as a new NCCN category 1 first-line option, demonstrating improvements in response rate, progression-free survival, overall survival, and durability of response. Benefit appears consistent across patient subgroups, and no validated biomarkers currently guide treatment selection, supporting broad use in eligible patients. Management beyond first line remains a major unmet need, with treatment individualized based on timing of progression and clinical factors, and clinical trial participation encouraged. Practical considerations include proactive toxicity monitoring, logistical challenges of therapy, and the importance of multidisciplinary care. Because SCAC is treatment-sensitive, selected patients may achieve durable remission, highlighting the potential for long-term disease control with coordinated systemic and local approaches.

Targeted Oncology presents Evolving Paradigms in Oncology, a video series featuring oncology experts discussing recent advances and insights to the treatment landscape in oncology.

Expert clinicians discuss best practices in implementing more widespread and comprehensive biomarker testing in early-stage non-small cell lung cancer (NSCLC). Practical considerations are discussed that can be integrated into future clinical practice decisions.

Early-stage squamous cell carcinoma of the esophagus can often be managed with minimally invasive treatments. Endoscopic resection techniques, such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), are preferred for superficial, localized tumors without lymph node involvement. For patients unsuitable for endoscopic therapy, esophagectomy remains the standard surgical option. In select cases, chemoradiotherapy may be considered as a non-surgical alternative. Careful staging, patient selection, and multidisciplinary evaluation are crucial to achieve optimal outcomes.

Tara Graff, DO, discusses how chronic lymphocytic leukemia treatment has evolved beyond the traditional “this or that” approach to include personalized therapy selection based on patient preferences, genetic risk factors, and disease characteristics, with new all-oral combination regimens offering fixed-duration options that are particularly transformative for high-risk patients with TP53 mutations or 17p deletions.

Virginia Kaklamani, MD, DSc; and Megan Kruse, MD, discuss how advances in hormone receptor-positive metastatic breast cancer treatment, including ESR1 mutation testing and elacestrant therapy, help physicians optimize patient care and improve outcomes through personalized treatment selection.

Panelists explore the latest advancements in polycythemia vera management, from diagnosis to treatment selection and long-term patient care.

Panelists discuss how evolving paradigms in myelofibrosis management are shaping clinical practice through improved understanding of the disease landscape, emerging treatment options, and personalized strategies aimed at optimizing patient outcomes and quality of life.

Experts discuss the evolving treatment landscape of DLBCL, emphasizing the interpretation of 5-year Polatuzumab data presented at ASH and its implications for clinical practice.

Richard S. Finn, MD; and Amit G. Singal, MD, MS, discuss how systemic therapy plays a growing role in hepatocellular carcinoma (HCC) management, particularly in embolization-eligible and advanced stages. Combining systemic therapies with locoregional treatments like transarterial chemoembolization has shown potential in overcoming resistance mechanisms. Trials like LEAP-012 and EMERALD-1 support this approach, indicating enhanced efficacy. Tyrosine kinase inhibitor (TKI)+immune checkpoint inhibitor combinations offer advantages over TKI monotherapy, but challenges remain in clinical adoption. Lenvatinib, a key player in first-line treatment, shows promise across stages and may extend to second-line therapy.

Panelists discuss how emerging therapies, including luspatercept, are reshaping the front-linefrontline treatment landscape for lower-risk myelodysplastic syndromes (LR-MDS), with a focus on personalized approaches, prognostic scoring, and the improvement of anemia management and patient quality of life.

Medical experts discuss bispecific antibody utilization in the management of non-Hodgkin lymphoma (NHL).

Jamie Koprivnikar, MD, and Solly Chedid, MD, provide insights surrounding treatment management for patients diagnosed with lower-risk MDS.

Experts on hematologic malignancies have a comprehensive discussion on chronic graft-versus-host disease, focusing on clinical trial data, treatment practices, and the evolving therapeutic landscape.

Matthew Campbell, MD, MS, and Rana McKay, MD, provide a comprehensive overview of current treatment strategies, analyze long-term data from pivotal clinical trials, and explore ongoing challenges in clear cell renal cell carcinoma.

Medical oncologists specializing in breast cancer have a comprehensive discussion on the evolving treatment landscapes for HER2-negative and HER2-low metastatic breast cancer, focusing on ADC-directed therapies.

Rebecca A. Shatsky, MD, an expert on breast cancer, offers comprehensive insights on HER2-targeting therapies, highlighting treatment practices, clinical trial data, and exciting developments in the therapeutic space.

Experts on lung cancer discuss treatment strategies in early non-small cell lung cancer and the role of immunotherapy.

Explore the latest insights on Ruxolitinib in Steroid Refractory Chronic GvHD, as two experts share their perspectives on advancements and considerations in the field.

Experts on myelodysplastic syndrome provide comprehensive insights on the evolving disease and treatment landscape.

Anne S.Tsao, MD, and Edward B. Garon, MD, MS, review clinical trial data and discuss the evolving role of antibody-drug conjugates and TROP2-directed therapies in the treatment of patients with non–small cell lung cancer.

Key opinion leaders share an enlightening discussion about the latest updates in precision medicine for gastrointestinal malignancies, offering valuable insights for healthcare professionals and patients alike.

Experts David Morris, MD, FACS, and Benjamin Garmezy, MD, share insights about how they work together to offer multidisciplinary care for patients with advanced prostate cancer and discuss their current treatment approaches.

Expert oncologists discuss the evolving treatment paradigm of TROP2-directed antibody drug conjugates in patients with metastatic non-small cell lung cancer.

Michael Savona, MD and Amer Zeidan, MBBS provide an overview of myelodysplastic syndrome (MDS) and discuss emergent data and treatment updates for patients with lower-risk MDS.

Robert Motzer, MD, Elizabeth Plimack, MD, MS, and Brian Rini, MD discuss recent treatment updates for patients with advanced renal cell carcinoma (RCC) and their implications for the RCC treatment landscape and clinical practice.

On the role of CEACAM5 in the growth and progression of NSCLC, including the mechanism of action, current safety and efficacy data, and results from from recent trials.

Expert hematologist-oncologists share insight on the evolving role of XPO1 inhibitor therapy in the management of multiple myeloma and myelofibrosis.