A recent study found a link between mRNA vaccination and improved cancer immunotherapy response. The preclinical data demonstrated impressive results, leading to big questions. “We believe that [vaccination] actually does generate and even converts the cold tumors to hot tumors,” Steven H. Lin, MD, PhD, a physician-scientist and radiation oncologist at the University of Texas MD Anderson Cancer Center in Houston, tells Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer Center in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology.

Survival data from the KEYNOTE-905 trial and insights into the use of circulating tumor DNA to guide treatment decisions from IMvigor011 made big waves in bladder cancer care at the European Society of Medical Oncology Annual Congress. “Overall, this is going to change the standard of care for muscle-invasive bladder cancer,” says Amanda Nizam, MD, a genitourinary medical oncologist at the Cleveland Clinic Taussig Cancer Institute. She and Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, discuss how the findings are being incorporated into clinic and what questions remain. “I am continually surprised by the changes taking place in bladder cancer management,” notes Dr. Figlin. Dr. Nizam reported various financial relationships. Dr. Figlin reported various financial relationships.

Options for the treatment of acute myeloid leukemia (AML) are rapidly expanding, says Amir Fathi, MD, associate professor of medicine at Harvard Medical School in Boston and program director of the Center for Leukemia at Massachusetts General Hospital. “Over the course of the last 10 to 12 years, there have been a series of approvals, predominantly for targeted therapies,” he explains. Speaking with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, Dr. Fathi outlines how and when to look for mutations in AML and key considerations for various targeted therapies. He also shares what developments he is anticipating. “I’m most excited about where we’re moving in the upfront setting.” Dr. Fathi reported various financial relationships. Dr. Figlin reported various financial relationships.

The artificial sweetener sucralose may impair the efficacy of cancer immunotherapy, according to a recent study published in Science. Although further research is needed before these findings can be translated into actionable information for patients, the investigation highlights that “the science of nutrition in cancer is actually quite poor,” says senior author Diwakar Davar, MD, associate professor and clinical director of the melanoma and skin cancer program at the University of Pittsburgh School of Medicine Hillman Cancer Center in Pennsylvania. Dr. Daver shared why he and his colleagues chose to explore the potential effects of sucralose on cancer treatment, and what research is next, with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair. “What I think we are hoping to try to do is actually just kickstart a movement to get people to focus on nutrition,” Dr. Daver explained. “We spend $1 billion to try to get a hazard ratio of 0.8, and here it appears that if you eat just a little less of this, you can maybe double your likelihoods of success.” Dr. Davar reported various financial relationships. Dr. Figlin reported various financial relationships.

New survival data from the FLAURA2 and MARIPOSA trials represent “a massive advance for our patients” in terms of frontline treatment for EGFR-mutated non-small cell lung cancer says Sandip P. Patel, MD, professor of medicine at the University of California San Diego. However, the findings have led to new questions about sequencing. “Just like in chess, when you make a move, you’re restricted in the moves that you can make afterward,” he explains to Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair. Discussions have become “much more nuanced,” and “thinking about the patient holistically becomes even more important in the setting of all these excellent treatment options for our patients,” Dr. Patel shares. Dr. Patel reported scientific advisory income from Amgen, AstraZeneca, BeiGene, Bristol Myers Squibb, Certis, Eli Lilly, Jazz, Genentech, Illumina, Merck, Pfizer, Natera, and Tempus. Dr. Figlin reported various financial relationships.

The development of oral selective estrogen receptor degraders (SERDs) represents substantial progress for patients with metastatic breast cancer who have ESR1 mutations. “I’m extremely excited because they’re the most effective form of endocrine therapy today,” says Wassim Mchayleh, MD, MBA, the clinical program director of the breast cancer program at AdventHealth Cancer Institute and associate professor of medicine at the University of Central Florida in Orlando. He spoke with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology about SERDs that are currently available and those in development. When it comes to weighing toxicity, “across the board, they are very well-tolerated endocrine therapies with a very low discontinuation rate,” Dr. Mchayleh noted. In addition to recent key clinical trial results, he also looked ahead to what data may help establish the drug class as a replacement for the current standard of care. Dr. Mchayleh reported various financial relationships. Dr. Figlin reported various financial relationships.

From a “game-changer” in triple-negative disease to broader paradigm shifts and practice changes, the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting was pivotal for breast cancer care, says Sara M. Tolaney, MD, MPH, chief of the Division of Breast Medical Oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts. Dr. Tolaney broke down some of the top data at ASCO 2025 with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles, California, and Steven Spielberg Family Chair in Hematology-Oncology. She singled out findings from the ASCENT-04 trial, the plenary session on SERENA-6, and the DESTINY-Breast09 trial. “I think it’s been a very exciting ASCO for breast cancer overall, with just so much exciting data,” Dr. Tolaney concluded.

Results from the phase 3 ATOMIC trial are practice changing for colorectal cancer care and raise broader questions about immunotherapy use in patients with mismatch repair deficiencies across tumor types. Frank A. Sinicrope, MD, a professor of oncology and medicine at the Mayo Clinic Comprehensive Cancer Center in Rochester, Minnesota, presented the findings at the 2025 American Society of Clinical Oncology Annual Meeting. He discussed the significance of the ATOMIC results and next steps with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. “I think that microsatellite instability is a terrific predictive biomarker for immunotherapy, and all of these patients should get immunotherapy in some form or another,” Dr. Sinicrope noted.

“An increasingly unrealistic set of performance expectations” is putting a strain on oncologist faculty members, says Clifford Hudis, MD, CEO of the American Society of Clinical Oncology (ASCO). He discussed the mounting challenges for academic cancer physicians and how ASCO is working to address them with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Hudis explained that academic oncologists are expected to be clinicians, researchers, teachers, and administrators. “And in most cases, there just isn’t a pay line and salary support for all four of those jobs, nor are there enough hours in the week for somebody to do all four of those jobs in a superb way,” he said. When it comes to ASCO’s ability to enable proactive change, Dr. Hudis explains that “we don’t have an enforcement mechanism. All we can do is shine a very bright light on reality and then ask for collective action to identify best approaches.” Dr. Hudis reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

“For the first 15 years of my career, we had nothing new” in bladder cancer care, said Jonathan E. Rosenberg, MD, chief of the genitourinary oncology service at Memorial Sloan Kettering Cancer Center in New York City. Now, “the pace of change has been dizzying,” he told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Speaking at the 2025 American Society of Clinical Oncology Annual Meeting, Dr. Rosenberg discussed key studies that have recently changed practice and what questions still remain. For certain laboratory testing and other concerns, “it’s a bit of the Wild West right now,” he noted.

Findings from the SERENA-6 trial, which examined switching therapies in patients with breast cancer ahead of disease progression, made headlines during the 2025 American Society of Clinical Oncology Annual Meeting. However, big questions remain. “I don’t know for sure if the approach is practice changing yet. I think the approach is practice confounding,” said Stephanie Graff, MD, director of breast oncology at Brown University Health Cancer Center in Providence, Rhode Island. Dr. Graff discussed the high-profile data with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. The trial showed a progression-free survival benefit when patients switched from an aromatase inhibitor to camizestrant, based on circulating tumor DNA information. And yet, issues with the study’s design may make taking the results into clinic challenging. “We don’t have clear evidence on how changing based on molecular therapy changes overall survival,” said Dr. Graff. “I think we’re going to get there, but I don’t know that the point we are at with SERENA-6 has us there.”

From digitizing its guidelines to potential embedding them in EMRs, the National Comprehensive Cancer  Network (NCCN) is working to “make the workflow easier and better” for oncologists, Crystal S. Denlinger, MD, FACP, CEO of the NCCN, told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in  Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, at this year’s American Society of Clinical Oncology (ASCO) Annual Meeting. Dr. Denlinger broke down the organization’s current  priorities and key initiatives, including how the network is tackling preauthorization challenges and helping to educate clinicians about changes to best practices. She notes that initiatives to ensure NCCN  guidelines are available, useful, and up to date are crucial because “I truly believe that guideline-concordant care is one of the ways in which we can cure cancer.”

“Is it time to do something big and different? That’s always a good question to ask,” said W. Kimryn Rathmell, MD, PhD, MMHC, the immediate former director of the National Cancer Institute (NCI) and the current CEO of The Ohio State University Comprehensive Cancer Center–James Cancer Hospital and Solove Research Institute. At the 2025 American Society of Clinical Oncology Annual Meeting, Dr. Rathmell spoke with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles, and Steven Spielberg Family Chair in Hematology-Oncology, about how the NCI can adapt to the current environment. She also shared her thoughts on educating the next generation of cancer physicians. “How can we help enable them to look at every patient creatively and to think about how we incorporate all this immense amount of knowledge that we’re trying to impart with them?” she asked.

A late-breaking abstract presented at the 2025 American Society of Clinical Oncology Annual Meeting (LBA3) showed that rusfertide significantly increased hematocrit control and improved symptoms for patients with polycythemia vera, a chronic leukemia. “We thought if we could use our understanding of iron regulation, then we could change the game a little bit,” said Andrew Kuykendall, MD, assistant member in the Department of Malignant Hematology at the Moffitt Cancer Center in Tampa, Florida. He told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, about the rationale behind the trial, broke down key findings, and shared what comes next in this area of research. “I think it is very important that we continue to follow these patients. And this is an ongoing trial that has a part two to it, which is a long-term safety assessment period,” he explained.

When it comes to building support for cancer research in the current environment, “the message that we have had in our field is a good one. But we may need to craft a better message,” says Robert A. Winn, MD, director and Lipman Chair in Oncology at the Virginia Commonwealth University Massey Cancer Center in Richmond. Dr. Winn lays out a strategy designed to show the American public the benefits in oncology already yielded from previous investments in science, alongside what can be done if support continues. He tells Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, that “we’ve talked about the facts, but we have not been effective at telling the story of the big dream of how science could really impact lives.” From the fight for equitable access to cancer care advances to recruiting the next generation of researchers, Dr. Winn stresses that he will continue to fight for progress. “I’m going to continue to ring that bell until I can’t anymore,” he explains. Dr. Winn reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

The addition of perioperative durvalumab in gastric and gastroesophageal junction cancer improved event-free survival, according to findings from the MATTERHORN study. “This trial will be an important milestone,” said Yelena Y. Janjigian, MD, chief of the Gastrointestinal Oncology Service at Memorial Sloan Kettering Cancer Center in New York City, who presented the findings at the 2025 American Society of Clinical Oncology Annual Meeting. She spoke with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, about the significance of the data. “We demonstrated improvement in event-free survival, and this is the first regimen in the perioperative setting to do so,” Dr. Janjigian noted. She also shared next steps for the research and broader questions that the data raise across oncology. Dr. Janjigian reported various financial relationships. Dr. Figlin reported various financial relationships.

Data from the SERENA-6 trial, presented at the 2025 American Society of Clinical Oncology Annual Meeting, have the potential to dramatically change advanced estrogen receptor–positive, HER2-negative breast cancer care, says William J Gradishar, MD, the Betsy Bramsen Professor of Breast Oncology at Northwestern University Feinberg School of Medicine in Chicago. The study showed benefit in switching therapies based on circulating tumor DNA evidence of ESR1 mutation, ahead of disease progression. “If we find that the magnitude of benefit seems to be as meaningful as it’s been reported to be, then I think what we will find in practice is more and more people will be doing next-generation sequencing testing, doing it earlier, and doing it more frequently to identify these mutations and act upon them,” Dr. Gradishar told Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology. Dr. Gradishar also discussed key drugs in development, including selective estrogen receptor degraders, and questions about the sequencing of new treatments. “There may be diminishing returns, as we’ve seen with other drugs,” he noted.

Editor’s Note: This interview was recorded shortly before the 2025 American Society of Clinical Oncology Annual Meeting. Big questions associated with ESR1 mutations in patients with hormone receptor–positive breast cancer may soon have answers. New data are “going to take the whole breast oncology field from one place and put it in a different place. It’s going to be an inflection point in our history of treating breast cancer,” says Jason Aboudi Mouabbi, MD, assistant professor in the Department of Breast Medical at the University of Texas MD Anderson Cancer Center in Houston. Speaking with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, Dr. Mouabbi outlined current challenges in identifying and responding to the development of ESR1 mutations. Dr. Figlin and Dr. Mouabbi also discussed how eagerly anticipated findings may transform practice and important aspects of mutational testing to consider. Dr. Mouabbi reported consulting fees from GE Healthcare, Genentech, AstraZeneca, Gilead, Novartis, Fresenius Kabi, BostonGene, and Cardinal Health. Dr. Figlin reported various financial relationships.

The approach to ESR1 and PIK3CA mutations in patients with hormone receptor–positive metastatic breast cancer continues to evolve. What role does circulating tumor DNA (ctDNA) play in treatment decisions? How should oncologists best approach patients with PIK3CA mutations who subsequently develop ESR1 mutations? VK Gadi, MD, PhD, professor and director of medical oncology and deputy director of the University of Illinois Cancer Center in Chicago, discusses with Robert A. Figlin, MD, the interim director of Cedars-Sinai Cancer in Los Angeles and Steven Spielberg Family Chair in Hematology-Oncology, how recent data are informing care for patients with comutations. “We now have at least one ESR1-targeting drug out there, and more to come,” Dr. Gadi explains. “Elacestrant is the drug I’m of course referencing, and that is used essentially like a single agent and works well for those patients. Even when they have, for example, PIK3CA mutations present.” He and Dr. Figlin consider when to act on ctDNA findings and potential future strategies. Dr. Gadi reported no relevant financial relationships. Dr. Figlin reported various financial relationships.

The last few years have seen “a remarkable change in both our approach and management of EGFR lung cancer,” says Shirish M. Gadgeel, MD, division head for hematology/oncology and associate director of Patient Experience and Clinical Care at the Henry Ford Cancer Institute in Detroit. He discusses key considerations for managing EGFR-mutated non-small cell lung cancer with Robert A. Figlin, MD, the interim director and Steven Spielberg Family Chair in Hematology-Oncology at Cedars-Sinai Cancer Center in Los Angeles. Dr. Gadgeel describes considerations for leptomeningeal metastases, important treatment toxicities, and exciting advances on the horizon. Dr. Gadgeel reported various financial relationships. Dr. Figlin reported various financial relationships.