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Issue 8


image of the lungs. you can see everything inside in detail
Adjusting to lung cancer
Interview with the new president of EUROPA DONNA Switzerland
FDA approves combo therapy and expands enzalutamide’s reach
Now representing triple- negative breast cancer







General practitioners play a pivotal role in oncology screening by conducting initial asessments, recognizing potential cancer symptoms, and facilitating timely referrals.
As a first point of contact, attention to cancer awareness and screening by general practitioners (GPs) emerges as crucial to early detection and diagnosis. Our advocacy for preventive measures has the potential to reduce the prevalence of advanced-stage cancers in communities. As our role becomes increasingly vital, it necessitates not just acknowledgement but active support.
To excel in our frontline diagnostic roles, we require more than clinical knowledge—we need a robust support system. Access to advanced diagnostic tools, ongoing education, and streamlined pathways for specialist referrals are essential components in our fight against cancer. Establishing collaborative relationships between GPs and specialists becomes crucial, creating a network where knowledge flows seamlessly, consultations are timely, and shared responsibility is the norm.
As a general practitioner, my dedication to actively participating in early cancer detection is profoundly personal. Each patient I encounter carries not just a medical history but a unique narrative, aspirations, and cherished relationships. The awareness that timely detection can be a crucial turning point in someone’s life motivates me to take a proactive stance in the battle against cancer.
In the moments when hope appears, I discover the strength to delve into the complexities of oncology screening. Being part of a patient’s journey from uncertainty to early intervention is more than a professional obligation; it’s a solemn commitment to safeguard their well-being, guiding them away from the shadows of despair and toward a realm of possibilities.
For me, it’s about translating empathy into tangible action, recognizing that each early detection signifies a triumph over adversity. Every triumph stands as a testament to the resilient spirit of the human will, showcasing the transformative power of timely intervention.
In essence, the contributions of GPs as frontline clinicians extend beyond the clinical to the practical. Our role in recognizing early warning signs, providing patient education, facilitating referrals, and offering steadfast support becomes instrumental in the collective fight against cancer.
As we strive to advance cancer care and improve patient outcomes, recognizing and elevating the indispensable role that GPs play is paramount. By equipping and empowering us, we take meaningful steps in the battle against cancer, enhancing the well-being of individuals and communities worldwide.
Photo courtesy of Dr. Fatima B. Khan, General Practitioner, KZN, South Africa
Photo courtesy of Dr. Fatima B. Khan, General Practitioner, KZN, South Africa




Terri Conneran’s dad died without knowing she had lung cancer. “I didn’t want the stress of telling him. I didn’t want to add to his anxiety because managing people in your circle, whether it’s family or friends, is challenging,” explains Terri, a lung cancer survivor and founder of KRAS Kickers, a global patient empowerment group serving over 5000 people supporting them on their journey navigating lung cancer.
Photo courtesy of Terri Conneran
Photo courtesy of Terri Conneran
Lung cancer is the second most prevalent cancer after breast cancer. 2.21 million cases worldwide in 2020 reflect the magnitude of its impact on health outcomes.1 The physical and psychological impacts of lung cancer are profound. Patients often experience severe pain, with about 80% reporting ineffective pain management that limits daily activities.1
The mental burden is also noteworthy—about 75% of individuals battling lung cancer are susceptible to developing associated psychological impacts like depression and anxiety. These mental health effects critically influence disease outcomes—they can limit treatment compliance, heighten care expenses, and decrease survival likelihoods.2
But what hides in plain sight behind statistics, and how does a lung cancer diagnosis impact an individual’s identity?
New unexpected journeys
Amy Grove is a lung cancer survivor and patient advocate living in Philadelphia who understands how a lung cancer diagnosis instantly changes a life, “It changed my life almost immediately. I lost my job – not bothering to look for another one because I was dying – felt like I was alone, people I previously talked to ghosted me, and I felt ill all the time, making even going to the grocery store tough.”
Terri concurs, “A cancer diagnosis is a call to action. You’re facing your mortality. And in your own family, it changes things. In my family, I’m not just the mom and the wife, right? I don’t just think of myself as a mom or a cancer patient, but when my husband talks to people about it, referring to himself as the caregiver, that makes me the patient, right? And I don’t always take too kindly to that.”
A study of lung cancer patients and caregivers revealed that patients often undergo major life restructuring to handle substantial treatment workloads, given the disease’s severity.3
“Everyone tells the patient, ‘Be strong. Be courageous. You’ve got this.’ But it implies that it’s up to me. Putting that on me as a patient feels like a heavy burden. Yeah. We know better, but that’s how it feels,” adds Terri.
The body and the person
Research is unveiling how the body copes with lung cancer interventions—chemotherapy, corticosteroids, and immunotherapy are fundamental to stopping disease progress. However, they may also spur depression and anxiety by altering biochemistry, for example, creating a cascade of inflammatory cytokine surges. Chemotherapy medications can induce nausea through dopamine pathway disruption, also causing mood symptoms; likewise, corticosteroid treatments and androgen deprivation regimens present an increased risk of depression and anxiety.1
“During treatments – I’ve personally been through chemo, surgery, ablation, radiation – there is so much fatigue: physically, mentally, emotionally. There is confusion in wrapping your head around a diagnosis, let alone treatments; all the while, a fog can set in. It is overwhelming beyond treatment,” explains Terri Conneran.
Heavy demands
Navigating cancer care is challenging. In one way or another, lung cancer survivors face the complexities of this journey, often experiencing an intense impact on their sense of self. The relentless cycle of appointments, treatments, and bureaucratic hurdles can lead to a loss of personal autonomy, as individuals feel they must, in a way, put their lives on hold to deal with their diagnosis.
As Terri declares, “Situations like this touch every aspect of your life. When people put you in a box and expect you always to act a certain way, it creates much friction. It makes managing the disease more complicated than it already is. I’m still trying to be a mom, a wife, a good neighbour, a good friend.”
Mental health care is cancer care
Research reveals lung cancer patients experience the highest levels of depression among cancers—with a study indicating 29% suffer from depression post-surgery. The deep connection between mental and physical health demands attention, as individuals with emotional difficulties report lower quality of life and heavier symptom loads compared to their counterparts without such issues.4
“I absolutely believe psychosocial support would be great. I felt so alone and wanted to talk to people who had or were going through the same thing. Hearing about others’ anxieties would have helped relieve some of my own,” comments Amy Groves.
Targeted mental health interventions—tailored to match an individual’s treatment regime and personal circumstances—have proved effective in reducing depression scores among underserved lung cancer patients. In a study, the intervention group showed significant improvements in depression (mean difference Δ = 1.75) and coping self-efficacy (Δ = -15.24) compared to standard care.5
A diagnosis that follows
It’s difficult for survivors to disengage from their diagnosis. Despite efforts to, in a way, establish “boundaries” with the disease, its presence remains close.
Terry explains, “I get scanned every three or four months. I’ve had five recurrences. The hardest part is coming home, feeling like you’re six years old and failed a spelling test. It’s a test I can’t prepare for. There’s nothing I can do. It’s not like I didn’t study or did anything wrong. I have what I have. Suddenly, you realise how vulnerable you are and how much you depend on others. And that’s a very uncomfortable position to be in. Everyone wants to be the helper. No one wants to need help.”
Healing the whole person
The constant companionship component of lung cancer is the reason why interventions that help to put a healthy distance between an individual and their diagnosis are critical steps to bring patient-centred care to life in clinical practice. “I believe support should be offered to you within a week or so after diagnosis by your cancer team,” adds Amy Grove.
Care initiatives that focus on nurturing the entire person, such as mind-body resistance training, have shown beneficial results in trials—alleviating physical symptoms like dyspnea and lowering elevated cortisol levels associated with depression and sleep disturbances, suggesting that holistic healing pathways easing physical, mental, and emotional burdens unlock the ability for patients to thrive beyond illness.4
Personalised care goes beyond tending to a person’s body; it encompasses validating every aspect of the lung cancer experience and intentionally assembling an ecosystem of support that shields the survivor from the invisible identity threats around them. As Terri Conneran reminds us, “What really resonates with us is hope.’’
Amy Grove, lung cancer survivor Photo courtesy of Amy Grove
Amy Grove, lung cancer survivor.
Photo courtesy of Amy Grove




Terri Conneran, who founded KRAS Kickers during her stage 3 lung cancer fight beginning in 2017 and facing five recurrences, didn’t discover her KRAS G12D biomarker until three years into her battle – a finding that propelled her to create a global patient empowerment group. KRAS Kickers connects individuals to research, resources, and community support, championing the mantra: Knowledge + Research + Advocacy = Survivorship. Speaking with Oncology Compass Digest, Terri emphasised her commitment to narrowing the divide between medical science and cancer patients.
Photo courtesy of Terri Conneran.
Photo courtesy of Terri Conneran
What happened when you were first told you had lung cancer?
In January 2024, it will be seven years since I was diagnosed with lung cancer. I underwent chemo and surgery as a stage 3 patient, and as a result, I had no remaining disease. After my diagnosis, as I started to regain my life, I got involved with lung cancer support groups. That’s when I started hearing about biomarkers. I realised I didn’t have all the information I wanted about my diagnosis, so I started learning more about biomarkers and talking to other people. In lung cancer groups, I noticed people often group themselves based on the biomarker driving their cancer. So, I asked my doctor about my biomarkers, only to learn I had no specific ones.
Can you describe the journey of your recurring lung cancer and seeking a second opinion?
About a year and a half after my first diagnosis, I experienced my first recurrence. Over the past seven years, I’ve had five total recurrences. I tried discovering my biomarker during that first recurrence but had no luck.
The same happened with my second recurrence. My cancer progressed from stage 3 to stage 4 as it spread, but I had no visible disease due to the radiation and treatments controlling it. After talking back and forth with my doctor, I decided to go out for a second opinion. I had been seeing a local community doctor who wasn’t a lung cancer specialist. So, when I consulted a specialist, the first thing they said was that I have a lung cancer biomarker.
How did learning about your bio-marker propel you to take action?
I have the KRAS biomarker. When I went home, I fully expected to find an online group like the others I had heard about, but there wasn’t one, which led me to start the KRAS Kickers. The KRAS Kickers, which began in January 2020, is a group of people wanting to connect around information related to KRAS. We’ve since become a global organisation, a patient empowerment group in 89 different countries, connecting with over 5000 people. We focus on connecting people, whether researchers, doctors, patients, or nurses, because we don’t want anyone to walk this journey alone. We walk alongside them.
How have your personal experiences with cancer in your family influenced and inspired you to share information and support with others?
It’s incredible to think about the changes in cancer treatment over the years. My grandmother died from cancer in the 60s, and I was very young then. My mom passed away in the 90s. Thirty years later, when I was diagnosed, my frame of reference was what I saw back then. A major barrier, not just for me but for many patients, is overcoming our frame of reference. We tend to gravitate towards the worst-case scenario we know. For me, it was what I saw with my grandmother and my mother. I thought being diagnosed with cancer meant undergoing gruelling treatments and then the end.
So, it was inspiring to learn that it doesn’t have to be like that. The question became, how do I take this inspiration and share it with others? They need to know that things have changed.
My goal is to package this information so that it’s a reliable source for others. Information evolves so rapidly that, as patients, we often don’t know where to turn or what to ask. We learn that lung cancer isn’t just one type; it varies. What do we need to know about it, and how can we ensure we have the most current information to act upon? My role is to bring that information to people in a way they can understand. I had to learn, understand, and reach out to do so.

Terri discovered she has the KRAS biomarker – a mutation seen in about 1 in 4 cases of non-small cell lung cancer, particularly in adenocarcinomas – which can speed up tumour growth.

Testing for KRAS mutations is crucial, as it informs targeted therapy decisions. Identifying this biomarker prompts doctors to bypass ineffective methods and explore alternative therapies, such as chemotherapy.

How does your organisation empower patients to participate actively in their treatment decisions?
We have a list of clinical trials on our website, and this helps facilitate shared decision-making. Patients can bring up these trials in their discussions with doctors, leading to more informed choices. It’s not just a paternalistic situation where the doctor dictates everything; patients can feel informed and part of the conversation. Even if they follow the doctor’s advice, they have a role in defining their treatment path.
Can you talk about how common phrases of encouragement, like ‘be strong’ or ‘be brave,’ might not always be what patients need to hear?
Many people around us can be in denial, saying things like ‘You’re going to be fine’ or ‘Just don’t give up.’ However, this isn’t always what a person battling lung cancer needs. Individuals need to feel validated for what they are experiencing. For instance, before I went in for surgery and started chemo, I was a wreck. I couldn’t find peace until I got my will done.

My husband thought that if I did it, it meant I was accepting death. I told him that whether I did it or not, what would happen would happen. Getting my will in order was something tangible I needed to do to confront my own mortality in an administrative way. I have confidence in my faith, family, and friends, but I felt a tangible action was necessary for my comfort and confidence. My husband meant well, but his reaction was dismissive of my need for this practical step.
As you reflect on your journey and the lessons you’ve learned, what message do you want to leave for others navigating their own battles with cancer?
Survivorship isn’t about death; it’s about living and choosing what’s best. Cancer has been an enormous blessing in my life. It reminded me that I won’t live forever, so I should get my affairs in order and prioritise what’s important. If you say your family and faith are the most important things in your life, what are you doing about it? Walk the walk.




Politically, you have to reckon with EUROPA DONNA Switzerland, the Swiss association for breast cancer patients. The new president, Christina Christen, wants to rally politicians from left to right to ensure that all women have access to quality-controlled mammography screenings.
“I hope that many more women will become aware of us in the future”: Christina Christen, President of EUROPA DONNA Switzerland.
Photo: EUROPA DONNA Switzerland
“I hope that many more women will become aware of us in the future”:
Christina Christen, President of EUROPA DONNA Switzerland.
Photo: EUROPA DONNA Switzerland
The members of EUROPA DONNA Switzerland try to raise political awareness. To do this, they want to win over female parliamentarians for their concerns. They have already been successful with breast asymmetry correction, and breast reconstruction is covered by health insurance. The next political push is for the quality-controlled mammography program to be introduced nationwide.
“Today, the offer only exists in a few cantons, although mammography is currently the most important method for early detection of the disease in women over 50,” explains Christina Christen. The benefits of breast cancer screening have long been controversial, even though scientific studies show that a quality-controlled program can prevent deaths. Whether the Federal Office of Public Health (BAG) should take action remains a long-running political issue.
Still considered taboo
Christina Christen is convinced that “we are heard better, precisely because we are those affected ourselves and not just an interest group.” That’s why it’s so important to continue to expand EUROPA DON- NA’s membership base. Every breast cancer patient can become a voice for many in order to make her voice heard politically. But enthusiasm for volunteer work in Switzerland is declining. And breast cancer is still considered a social taboo topic, especially among the older generation. Christen has had good success in recruiting younger women through the Tavola Rosa, regular meetings for women with breast cancer (already established in Chur, Berne, Biel, Saint-Gall, Zurich and Aarau and now also growing in the canton Ticino). “With the generational change comes a new understanding of how to deal with the disease.”
Now 58, she is a survivor herself. When she was confronted with the diagnosis almost 20 years ago, it was still commonplace in society for a woman with breast cancer to “hide”. A lot has improved in education since then. “I see myself as a source of encouragement for young people affected as long-term survivors.”
Photo courtesy of Christina Christen, President, EUROPA DONNA Switzerland
Photo courtesy of Christina Christen, President, EUROPA DONNA Switzerland




For decades, androgen deprivation therapy has been the backbone of treatment and standard of care for prostate cancer patients. Recently, researchers began to explore ways to get better outcomes than the standard of care.
Lab worker looks at a microscope virus
Photo credit: Freepik.com
Enzalutamide, an androgen receptor inhibitor that was well tolerated by most patients, seemed a promising candidate drug for better outcomes. Dr. Stephen Freedland was the principal investigator on the EMBARK study—a large study designed to compare the effects of enzalutamide along with ADT and enzalutamide alone to ADT alone.1
The study found that enzalutamide, whether used alone or in combination, significantly prolonged the metastasis-free survival of patients and had no negative impact on the patients’ quality of life.
Oncology Compass spoke with Dr. Freedland to gain more insights into EM- BARK and its implications for the larger oncology community.
OC Digest:
Tell us a little about yourself.
Dr. Stephen Freedland:
I am a urologist and a professor of urology at Cedars Sinai Medical Center, Los Angeles as well as the Durham VA Hospital in Durham NC.
I am very focused on prostate cancer and trying to make our patients live better and longer.
OC Digest:
Tell us more about your work with the clinical trials, prostate cancer, and enzalutamide.
Dr. Stephen Freedland:
Enzalutamide is a drug that blocks testosterone from binding to receptors and activating genes. And we know this pathway is very important for prostate cancer. Enzalutamide has also been shown to have benefits in many stages of prostate cancer therapy and to improve survival for patients.
We wanted to ask if we could use this agent even earlier than when it’s currently being used. And would that lead to improved outcomes and maybe much better outcomes by using it earlier?
OC Digest:
That’s fascinating. But what led you to enzalutamide? What made you consider that particular agent?
Dr. Stephen Freedland:
There were a number of reasons this agent stood out to us. First, it is an oral drug. Second, it is taken once a day.
Third, it is pretty well tolerated. Of course, we know that every medication has side effects, but enzalutamide has been on the market for over 10 years, and we are quite familiar with the different side effect profiles. Also, patients can be on it for years and tolerate it pretty well.
And importantly, it is very effective and strongly blocks testosterone and other androgens from binding to its receptors.
So, we have a potent drug that is orally available and reasonably well tolerated. So, it was a great agent to attempt using even earlier in the disease process.
OC Digest:
What was the most challenging aspect of putting together this kind of clinical trial?
Dr. Stephen Freedland:
Our greatest challenge was just learning patience.
We had to wait and see what the outcomes would be. For a disease such as this, time is a major factor because you don’t have the development of metastases within a year for everyone. Each case is different.
We enrolled thousands of people in the study. And then, we had to wait several years until the results came out.
Dr Stephen Freedland, Professor of Urology at Cedars Sinai Medical Center, Los Angeles
Dr. Stephen Freedland, Professor of Urology at Cedars Sinai Medical Center, Los Angeles
Tremendous thanks to the companies who sponsored the study–Pfizer and Astellas Pharma, for having that commitment. The time from enrolling the first patient until we saw the results was over eight years.
OC Digest:
What do you think the results of this study mean for the practice of prostate cancer treatment?
Dr. Stephen Freedland:
I have two thoughts on this.

One is specific to prostate cancer patients and what we can now offer them, which is better than the high risk of biochemical occurrence with failed surgery or radiation. We now know that adding enzalutamide with or without hormonal therapy can delay metastasis or death and preserve quality of life. And for these patients, this is highly impactful. It is a major step forward.
The second is that, more broadly, we have been able to advance practice.
I think this study is more in that line of logic. And the argument we made to move the use of enzalutamide even earlier. We argued that when the time is right to start hormonal therapy, we can use enzalutamide with or without ADT.
Of course, there are always exceptions to every rule, but for most patients, ADT alone is not good enough.
So again, I think the patient population is going to benefit. Ours is not the first study to show benefits, but it is the first to show the benefits at an early stage and show that even at that early stage, ADT alone is not good enough.

"For 80 years, androgen deprivation therapy has been the mainstay of treatment for this cancer. We have evolved, but the concept has not changed in 80 years. Multiple studies are now coming out to say that ADT alone is not good enough; we can do better."

OC Digest:
So what’s the next stage now? I saw an article where you said US Food and Drug Agency (FDA) approvals were being awaited. Has that changed?
Dr. Stephen Freedland:
Yes, we received FDA approval a few weeks ago.
OC Digest:
Dr. Stephen Freedland:
Thank you. It is pretty exciting. Both enzalutamide in combination with ADT and enzalutamide alone have been approved for use by the FDA.
It is the first time a novel hormonal agent in the class enzalutamide falls into has been approved for this purpose.
There are a few other drugs in that class, but this is the first one ever approved for monotherapy in any disease state using the oral drug alone. That’s a great change.
Looking back to our work in prostate cancer treatments 20-30 years ago, we didn’t have the right drugs at the time, even though we knew the science.
There was concern about more toxicity than benefits. But now we have come up with better agents that can better block the androgen receptor.
Also, we are picking the right patients to study, and we see significant benefits.
Presently, I think there are ongoing studies for advanced prostate cancer asking do we even need the ADT anymore?
So, on multiple levels, I think this study is potentially game-changing, not just for patients in this disease space but conceptually for the field of prostate cancer treatment.
OC Digest:
Any parting thoughts?
Dr. Stephen Freedland:
Yes, I think providers need to know about the side effects of the drug. It is generally well tolerated, but we have noticed hot flashes, muscle and joint pain, memory issues, and breast tenderness.
Also, I think the arguments for choosing this regimen are very strong. We are continuing to follow up with patients to assess overall survival, and the trends are certainly promising and reassuring. It looks like the overall survival is improving, but it is still a very early look at the data.
So, we need to keep following the patients to keep learning more as we dive deeper into the data and understand the nuances more.
Finally, I think the study’s process is appealing to patients. Something really unique about EMBARK is that there are 8-9 months of aggressive treatment, and those with a good response have therapy stopped and get a treatment holiday. Patients don’t have to be on the drugs for years and years.
I think it is a unique angle: let’s be aggressive for a few months, and then we stop and see how it works. I think this will appeal to people.
In the end, I think there are plenty of appealing aspects to this study and the data it has yielded. Hopefully, it is going to get widely adopted and ultimately lead to better outcomes for our patients.




Breast cancer is the most commonly diagnosed cancer among women and is the second leading cause of cancer-related death worldwide.1 As a result of this high prevalence, research into the identification of therapeutic targets and the development of agents that act upon these targets, are a great unmet need. There have been exciting recent developments in the battle against treatment-resistant breast cancers, such as advanced or metastatic breast cancer and triple-negative breast cancer (TNBC).
IDE161 in advanced or metastatic breast cancer
In September 2023, the US Food and Drug Administration (FDA) granted Fast Track designation to the development program investigating IDE161 for the treatment of adult patients with advanced or metastatic, HER2-negative breast cancer with BRCA1/2 mutations. This designation came following impressive preclinical efficacy outcomes demonstrated by IDE161 in these patients. IDE161 is an inhibitor of PAR glycohydrolase (PARG), a key enzyme involved in the DNA repair processes of cancer cells. It was speculated that the inhibition of PARG by IDE161 may prevent DNA repair in cancer cells, inducing cytotoxicity and subsequent death.2
In preclinical studies, IDE161 was found to arrest cell cycle progression and induce key DNA damage markers. Additionally, higher concentrations of IDE161 were correlated with a greater accumulation of poly (ADP-ri-bose) (PAR) chains, the moiety that is broken down by PARG, indicating target engagement. Tumor growth stasis and regressions were observed in breast, gastric, and ovarian xenograft models, indicating significant efficacy.2  The preclinical efficacy and tolerability demonstrated were enough to justify the launch of a Phase 1 trial that evaluates the safety, tolerability, pharmacokinetic and pharmacodynamic properties, and preliminary efficacy of IDE161 in patients with advanced or metastatic solid tumors.
This trial is now underway. “The US FDA Fast Track designations for our potential first-in-class PARG inhibitor, IDE161, in both BRCA1/2-mutant breast and ovarian cancers reflect the potential for IDE161 to address the significant unmet medical need in these indications,” Dr. Darrin Beaupre, chief medical officer at Ideaya Biosciences, said in a recent news release.3
Dr Laura Pascual-Reguant
Dr Laura Pascual-Reguant, first author of the study and postdoctoral researcher at the Center for Genomic Regulation in Barcelona. Photo courtesy of Laura Pascual-Reguant.
BRD4 and LOXL2: Two novel molecular targets in TNBC
Recent research in TNBC has uncovered two novel molecular targets, bromodomain-containing protein 4 (BRD4) and lysyl oxidase-like 2 (LOXL2), which play a key role in the expression of cell cycle genes and the aggressive nature of TNBC. LOXL2 is highly expressed in aggressive tumor types, and it has been shown that LOXL2 can predict the treatment outcome of BRD4 inhibition, with cells expressing low levels of LOXL2 being more susceptible to BRD4 inhibition.
This discovery led researchers to uncover a functional interaction between LOXL2 and BRD4, whereby suppression of both successfully reduced tumor growth via suppression of TNBC cell proliferation and cell death. This research showed that the dual inhibition of BRD4 and LOXL2 may potentiate dysfunctionality in the key interactions responsible for cell cycle gene expression in cancer cells, halting the proliferation of TNBC cells. This exciting discovery has laid the foundations for further research into co-targeting BRD4 and LOXL2 as a novel TNBC therapy.4
“Our deep dive into how triple-negative breast cancer cells grow at the molecular level has revealed a new mechanism that can be exploited for treatment purposes. It is exciting because a double-strike strategy that targets both proteins could be combined with other treatments and transform triple-negative breast cancer from a disease with a very poor prognosis into one that is manageable,” said Dr Laura Pascual Reguant, first author of the study and postdoctoral researcher at the Center for Genomic Regulation in Barcelona.5




Oncology Compass took part in the 5th International Lung Cancer Summit (ILCS) on November 10th.
This interactive conference was hosted by the renowned Oncology Compass scientific leaders, Dr. Solange Peters, MD-PhD, and Dr. Alfredo Addeo, MD. During the event, speakers from the USA, Spain, UK, Italy, Netherlands, France, Austria, and Switzerland held presentations and participated in debates to highlight the most recent findings and advancements made in the fight against lung cancer. Here, we summarise clinical trials and data that have an impact on clinical practice and raise important questions that should be investigated in future studies.
EGFR-mutated NSCLC: Current standards of care and future strategies
Dr. Zofia Pietrowska, a clinical researcher and lung cancer oncologist at the Massachusetts General Hospital Cancer Center, hosted an excellent discussion on current standards and future perspectives in the treatment of EG- FR-mutated non-small cell lung cancer (NSCLC).
What is the current first-line standard for EGFR-mutated NSCLC?
“Next-generation tyrosine kinase inhibitors (TKIs) have become the first-line standard of care for EGFR-mutated NSCLC’’, stated Dr. Pietrowska. According to the FLAURA trial, osimertinib, a third-generation EGFR-TKI, as a first-line treatment showed survival benefits in EGFR-mutated NSCLC compared to standard EGFR-TKIs. The treatment improved the median overall survival (OS) by nearly 7 months and the median progression-free survival (PFS) by nearly 9 months. Therefore, the well tolerated and oral drug osimertinib is the current standard of care for patients with classical EGFR-mutated NSCLC.1 These results were considered quite impressive by the presenter, triggering the question, “Can we do even better for our patients?”1
Dr. Alfredo Addeo
Dr. Alfredo Addeo
Photo credit: Oncologycompass.ch
Can we improve the current standard of care?
In terms of how to improve the current standard of care, Dr. Pietrowska highlighted two combination strategies with two positive large, randomised phase III trials, FLAURA2 and MARIPOSA.1
The FLAURA2 phase III trial demonstrated that adding platinum-based chemotherapy to first-line osimertinib significantly improved PFS. Although the combination treatment improved median PFS for 8.8 months, the speaker reminded the audience that adding chemotherapy to osimertinib adds toxicity to a very well-tolerated oral regimen.
The findings presented at the ESMO 2023 revealed that hematologic toxicities in the combination arm were highest during the first 3 months of treatment. “Do patients need the chemotherapy during the entire treatment period? Do all patients need these, or can we identify a group of interest?” are key questions that Dr. Pietrowska believes should be assessed in future trials.1
The MARIPOSA phase III trial found that combining amivantamab, an EGFR/ MET bispecific antibody, with lazertinib, a third-generation EGFR TKI, significantly improves the median PFS compared to osimertinib monotherapy. This combination strategy, however, comes at the price of increased toxicity.
“These all have an impact on quality of life. So, the question is: what is the right balance? Do we need amivantamab during all treatments or only at the beginning? These are still open questions that we have to answer,” concluded Dr. Pietrowska.1
SCLC: What are today’s standards, and what regimens show promise to enhance clinical practice?
Dr. Kaushal Parikh, an oncologist at the Mayo Clinic in Rochester, Minnesota, discussed recent advances in the treatment of small cell lung cancer (SCLC). He explained that the current standard of care first-line option for extensive-stage SCLC is platinum-based chemotherapy combined with an anti-PD1/PDL1 agent, while second-line treatment options are limited and have poor outcomes.
The IMbrella A trial revealed a historical 5-year OS
The IMbrella A trial reported durable survival benefits up to 5 years for extensive-stage SCLC patients who received first-line atezolizumab (anti-PD-L1) plus chemotherapy.
The study found that patients with extensive-stage SCLC who received the combination of atezolizumab and platinum chemotherapy had a 5-year OS rate of 12%. This result, according to the study’s presenter, does not appear to be impressive at first. However, when compared to previous 5-year OS rates of around 2% in extensive-stage SCLC patients treated with chemotherapy alone, the results appear encouraging.2
“The question for us now is who these patients are and how we subtype them,” Dr. Parikh added.2
Is DLL3-targeting the best way to improve the standard of care?
Delta-like ligand 3 (DLL3) - targeting agents, according to Dr. Parikh, are the most advanced in development and may represent a novel immunotherapeutic approach for SCLC. However, based on previous experience with the Rova-T regimen, which showed encouraging results in phase I and II trials but disappointing results in phase III trials due to a lack of efficacy, experts should proceed with caution in evaluating this approach.2
The results of the phase II DeLL- phi-301 trial, evaluating the antitumor activity of tarlatamab - a bispecific T-cell engager targeting DLL3 - were presented at ESMO 2023. Tarlatamab met the primary endpoint, with an overall response rate of 40% in patients treated with 10 mg tarlatamab and 32% in those given 100 mg tarlatamab.2
According to experts, longer follow-up of patients in the DeLLphi-301 study will provide more information about the long-term durability of the response and the long-term survival benefits. Additionally, the phase III DeLLphi-304 study, comparing tarlatamab to standard of care in previously treated extensive-stage SCLC, is underway.2
Prof. Solange Peters
Photo credit: Oncologycompass.ch
Prof. Solange Peters
Photo credit: Oncologycompass.ch




In a groundbreaking advancement for prostate cancer therapy, the food and Drug Administration (FDA) has recently approved a novel combination treatment for metastatic castration-resistant prostate cancer (mCRPC).
This approval, uniting enzalutamide (Xtandi) and talazoparib (Talzenna), heralds a new era in therapeutic strategies for this challenging form of cancer, which has historically been difficult to treat due to its resistance to standard hormone-blocking treatments.1-3 In another significant development, the FDA approved enzalutamide for the treatment of nonmetastatic castration-sensitive prostate cancer at high risk for metastasis.4,5
Novel combination treatment for metastatic castration-resistant prostate cancer
The newly approved combination therapy for mCRPC involves talazoparib, a PARP inhibitor that blocks DNA repair pathways in cancer cells, leading to their death, and enzalutamide, an androgen receptor inhibitor that blocks the action of male hormones fueling prostate cancer growth. This dual approach is par- ticularly effective for cancers with specific gene alterations related to DNA repair, such as BRCA mutations, offering a new therapeutic strategy for mCRPC patients.1-3
The TALAPRO-2 trial, a pivotal study funded by Pfizer, played a crucial role in the FDA’s approval. This phase 3 trial, conducted across 223 hospitals in 26 countries, enrolled men with asymptomatic or mildly symptomatic mCRPC.
Participants were assessed for homologous recombination repair (HRR) gene alterations and randomly assigned to receive either talazoparib or a placebo, in addition to enzalutamide. The trial’s double-blind nature ensured unbiased results, focusing on radiographic progression-free survival (rPFS) as the primary endpoint.1-3
The trial’s findings showed a notable improvement in median rPFS compared to the placebo group. The hazard ratio indicated a 37% reduction in the risk of radiographic progression or death. These results, combined with a manageable safety profile, underscore the potential of this combination therapy in improving patient outcomes in mCRPC.1-3
Talazoparib’s approval marks it as the third PARP inhibitor for prostate cancer treatment. Its mechanism, focused on inhibiting the PARP enzyme, is especially effective in cancers with DNA repair gene alterations, offering a new line of defense against aggressive prostate cancer. This development represents a shift towards personalized medicine in oncology, where treatments are increasingly tailored based on the genetic makeup of the tumor.1-3
Study co-lead Neeraj Agarwal, M.D., highlighted the prevalence of DNA repair gene alterations in prostate cancer, emphasizing the importance of genetic testing in identifying patients likely to respond to this therapy. However, concerns remain about the long-term survival benefits, calling for extended follow-up to fully understand the impact on overall patient survival.1-3
FDA Approval of enzalutamide for high-risk nonmetastatic prostate cancer
The EMBARK trial, a randomized, phase 3 study, evaluated the efficacy and safety of enzalutamide in combination with androgen deprivation therapy, as well as enzalutamide monotherapy, in patients with high-risk biochemical recurrence of prostate cancer.
The trial’s results showed significant improvements in metastasis-free survival and reduced risk of PSA progression for patients treated with enzalutamide, either in combination with leuprolide or as monotherapy.4-5
The safety profile of enzalutamide was well-tolerated, with common adverse events being fatigue and hot flashes. The EMBARK trial’s primary investigator, Neal Shore, MD, emphasized the success of the study, noting the effectiveness of both therapeutic arms.
Ongoing work and future expectations of the EMBARK trial include monitoring and analyzing long-term patient outcomes, with a focus on overall survival and a holistic understanding of patient outcomes.




Justin Cheung is a second-year resident physician in internal medicine at Massachusetts General Hospital, Boston, USA, with aspirations to specialize in hematology/oncology. His interest in drug development and discovery was sparked by early experiences in nanotechnology and chemical engineering research during his high school years in Long Island, New York.
Cheung pursued a combined BS/MD program at Stony Brook University, focusing his research on novel nanotechnologies for cancer drug delivery and high-throughput drug screening, including internships at the NIH’s Vaccine Research Center and Memorial Sloan-Kettering Cancer Center.
Graduating from medical school in 2022, Cheung continued his training at Massachusetts General Hospital, working under Dr. Jessica J. Lin, a thoracic oncologist. His primary research project involves brain metastases in ALK-rearranged lung cancer, contributing to his growing expertise in targeted therapeutics for lung cancer. Cheung’s work has been recognized with abstracts accepted to ASCO 2023 and NACLC 2023, where Oncology Compass Digest asked him a few questions about his aspirations in Oncology Research.
Justin, can you provide an overview of your involvement in the research project presented at the NACLC23?
Under the guidance of my fantastic mentor Dr. Jessica J. Lin at Massachusetts General Hospital, I conceived and spearheaded a retrospective analysis assessing, for the first time, the efficacy and safety of dose-escalated alectinib (an FDA-approved ALK inhibitor) in patients with metastatic ALK-rearranged lung cancer who have experienced disease progression of brain metastases on standard dosing of alectinib. As the first such cohort study to date, it will provide insight into the clinical management of patients with ALK-rearranged lung cancer and brain metastases—a patient population for whom there are severely limited therapeutic options at this time. Our findings demonstrated that dose escalated alectinib may represent a viable treatment approach, and therefore, is likely to be directly clinically impactful. I am honored and grateful that the project received an Educational Award at the NACLC 2023 conference.
Photo courtesy of Justin Cheung, Resident Physician at Massachusetts General Hospital
Photo courtesy of Justin Cheung, Resident Physician at Massachusetts General Hospital
What motivates you to push barriers during the early stages of your career, and what aspects of oncology would you say influence your future study choices most?
Initially, prior to residency, my primary motivator to push barriers was very much the thrill of scientific discovery. I was drawn to oncology because I appreciated the speed with which novel technologies and medications moved from the laboratory to the clinic and ultimately resulted in meaningful gains in patients’ lives. Since starting residency, my experiences with patients have reshaped some of my motivations and aspirations in oncology.
In the summer of 2023, I had the privilege of doing an away rotation in rural medicine with the Maniilaq Health Center in Kotzebue, Alaska – a small regional hospital in a town of about 3,000 people above the Arctic circle. Patients with cancer in Kotzebue would have to fly to Anchorage or Seattle, over 500 and 1,900 miles away, respectively, to receive routine cancer care, infusions, and treatment. This placed a tremendous logistical and physical burden on patients with cancer living in the Arctic. I saw on several occasions during my time there, how patients with newly diagnosed cancers that we would deem highly treatable with excellent survival outcomes in places like Boston, chose instead to opt for comfort-based measures to avoid the grueling pro- cess of traveling out of the Arctic to receive cancer care.
This experience helped me to realize how often the advancements in oncologic medication and technology, while life-saving for many, are still very limited to areas near major academic medical centers. Even in more metropolitan areas, there is still tremendous amount of work to be done to ensure access to cancer care and equitable enrollment in clinical trials.
The juxtaposed experiences I have had in working with patients in resource-deprived settings as well as with those receiving care at major academic centers like MGH, have both motivated and shaped how I envision my future career. My passion is in drug discovery and clinical trials, but I recognize that even the most impressive responses to new drugs are only impactful to those who have access to them; and even the most practice-changing results of clinical trials are limited in applicability based on the populations included in the study. Currently, we still struggle to ensure broad access to novel medications and cutting-edge trial enrollment. Therefore, my hope is to not only build a career as a clinical trialist and translational investigator but also, to work towards expanding the breadth of critical access oncology and improving equitable access to clinical trial enrollment.
What do you see as the potential long-term impact of your current research on cancer treatment or our understanding of the disease?
In the short term, my hope is that my current research will help to establish additional treatment options for patients with brain metastatic ALK-rearranged lung cancer and help to define the most effective and safe treatment approaches for this patient population. More longitudinally, I think it will help serve as an important step in improving our foundational understanding of how ALK-rearranged lung cancer with brain metastases responds to various targeted therapies. Moreover, my current research will hopefully lay important groundwork for validation and implementation of future generations of targeted therapies that will overcome many of the existing challenges current treatment options face.
In what ways do you invest in your own professional development and stay current with advancements in oncology?
I try to stay up to date with reading primary literature and trial results as they are released. I also think the best way of remaining up to date with advancements in oncology is chatting with colleagues and going to conferences where one can hear about new research advancements, changes in guidelines, and colleagues’ personal practice experiences. Resources like Oncology Compass are incredibly valuable in making sure the constant stream of news and practice changing findings in the oncology world are made available to a wide audience.
How do you envision the future of oncology research and treatment, and what role do you see yourself playing in shaping that future?
I view oncology as a leader in personalized medicine, with recent years bringing numerous targeted therapies and combined chemotherapy/immunotherapy regimens. In lung cancer, we now standardly use next-generation sequencing to identify targetable mutations for specific treatments, reflecting a shift towards highly personalized cancer care.
Our growing understanding of tumor molecular profiling and micro-environments is leading to increasingly multi-modal treatments, combining targeted therapies, immunotherapy, chemotherapy, radiation, and surgery to optimize patient outcomes and reduce toxicities.
I aspire to contribute to this evolving treatment paradigm in thoracic oncology, particularly in the clinical testing and validation of new drugs developed in labs. The most thrilling part for me is the first-in-human study of new compounds, where the excitement of potential breakthroughs meets the challenge of interpreting empirical data to make informed decisions. I am eager to be part of the process that transforms laboratory discoveries into meaningful patient outcomes.




Oncology Compass has recently launched a new conference news section on their website, specifically designed for registered oncologists. It represents a valuable tool for oncologists, not only keeping them informed about the latest developments in their field but also supporting their clinical practice, research endeavors, and ongoing professional development.
Photo credit: Freepik.com, illustration by Capptoo
Photo credit: Freepik.com, illustration by Capptoo
This exclusive feature provides updates and news from major oncology conferences such as ESMO, ASCO, AACR, and ASH, with plans to expand coverage in the coming months and years. This section is a significant addition for oncologists, offering several advantages, such as keeping oncologists abreast of the latest developments and breakthroughs in the field. With the rapid pace of advancements in oncology, staying updated with the most recent research findings, clinical trial results, and therapeutic approaches is crucial. This feature ensures that oncologists have access to cutting-edge information, which can directly impact patient care and treatment strategies.
Furthermore, the section serves as a time-saving resource. Attending every major conference is often not feasible for busy oncologists. This feature provides a concise and comprehensive summary of key takeaways from these significant events, allowing oncologists to efficiently stay informed without the need to be physically present at each conference.
The conference news section also fosters continuous learning and professional development. By providing insights into emerging trends, new treatment modalities, and evolving best practices, it supports oncologists in their pursuit of excellence in patient care. This is particularly beneficial for oncologists who are keen on integrating the latest research findings into their clinical practice.
Additionally, for oncologists involved in research, this feature offers an overview of the current research landscape, potentially guiding their own research directions and collaborations. It also provides a platform for learning about ongoing trials and studies, which could open opportunities for participation or collaboration.




Oncology Compass is proud to announce the addition of a new indication dedicated to Triple Negative Breast Cancer (TNBC), a complex and challenging area of oncology.
TNBC, accounting for approximately 10-15% of all breast cancers, is a subtype of breast cancer characterized by the absence of estrogen receptors, progesterone receptors, and minimal human epidermal growth factor receptor 2 (HER2) expression. It is known for its aggressive nature and poorer prognosis compared to other breast cancer subtypes, partly due to the lack of targeted therapies. Leading this new section is Prof. Dr. Jens Huober, a distinguished expert in the field of breast cancer research and treatment.
Prof. Dr. Jens Huober currently serves as the Chief Physician at the Breast Center St.Gallen and is a member of the Steering Committee at the Comprehensive Cancer Centre. He is a specialist in gynecology and obstetrics, with a particular focus on senology and the systemic therapy of breast and gynecological malignancies.
Prof. Huober has held significant roles, including Center Director at the Breast Center, Kantonsspital St. Gallen, since January 2021, and prior positions at the Comprehensive Cancer Center Ulm and the University Women’s Hospital in Ulm. He is actively involved in clinical trials and research in breast cancer, serving on various committees and holding qualifications in palliative medicine, medicinal tumor therapy, and psychosomatic primary care. Prof. Huober is also a member of multiple professional societies, contributing extensively to the field of oncology.
Photo courtesy of Prof. Dr. Jens Huober
Photo courtesy of Prof. Dr. Jens Huober
The new feature is set to become a vital resource for oncologists worldwide. It will provide the latest insights, research findings, and treatment strategies in this challenging field, furthering the mission of Oncology Compass to deliver cutting-edge information and support to oncologists in their clinical practice.
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Forthcoming in 2024:

Oncology Compass is dedicated to bringing the most value to our users worldwide. Therefore, we are pleased to announce a new feature coming in Q1 2024: a comprehensive calendar of global oncology conferences. The calendar will feature a precise filtering system that will enhance accessibility, encourage global participation, aid in strategic planning for research dissemination, and foster a more interconnected and informed oncology network.





Adjusting to lung cancer
  1. Eseadi C, Ngwu MO. Significance of music therapy in treating depression and anxiety disorders among people with cancer. World Journal of Clinical Oncology. 2023 Feb 2;14(2):69.
  2. Feng L, Yang D. Observation on the Effect of High-Quality Nursing Intervention plus Health Ed- ucation in Chemotherapy for Non-Small Cell Lung Cancer and Its Influence on the Physical and Mental Health of Patients. Evidence-Based Complementary and Alternative Medicine. 2022 Aug 18;2022.
  3. Adam R, Duncan L, Maclennan SJ, Locock L. Treatment burden in survivors of prostate and colorectal cancers: a qualitative interview study. BMJ open. 2023 Mar 1;13(3):e068997.
  4. Lei J, Yang J, Dong L, Xu J, Chen J, Hou X, Bai Z. An exercise prescription for patients with lung cancer improves the quality of life, depression, and anxiety. Frontiers in Public Health. 2022 Nov 17;10:1050471.
  5. Borrayo EA, Juarez‐Colunga E, Kilbourn K, Waxmonsky J, Jacobson M, Okuyama S, Swaney R, Wamboldt FS, Karam S, Lopez Alvarez S, Jin X. Stepped‐care to improve mental health outcomes among underserved patients with lung and head and neck cancer. Psycho‐Oncology. 2023 Sep 29.



Novel therapy promises faster relief for people living with biochemically recurrent prostate cancer
  1. Freedland SJ, de Almeida Luz M, De Giorgi U, Gleave M, Gotto GT, Pieczonka CM, Haas GP, Kim CS, Ramirez-Backhaus M, Rannikko A, Tarazi J, Sridharan S, Sugg J, Tang Y, Tutrone RF Jr, Venugopal B, Villers A, Woo HH, Zohren F, Shore ND. Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer. N Engl J Med. 2023 Oct 19;389(16):1453-1465. doi: 10.1056/NEJMoa2303974. PMID: 37851874.



Novel therapeutic targets and recent developments in TNBC
  1. Li Y, Zhang H, Merkher Y, Chen L, Liu N, Leonov S, Chen Y. Recent advances in therapeutic strategies for triple-negative breast cancer. Journal of hematology & oncology. 2022 Aug 29;15(1):121.
  2. Abed M, Muñoz D, Seshadri V, Rao AA, Maskey R, Federowicz S, Bhupathi D, Liimatta M, Ousterhout R, Jaipuri F, Zang R. IDE161, a potential first-in-class clinical candidate PARG inhibitor, selectively targets homologous-recombination-deficient and PARP inhibitor resistant breast and ovarian tumors. Cancer Research. 2023 Apr 4;83(7_Supplement):6093.
  3. CureToday. FDA Grants Fast Track Designation for New Breast Cancer Treatment. Available from: [https://www.curetoday.com/view/fda-grants-fast-track-designation-for-new-breast-cancer- treatment]. Last accessed [04.12.2023].
  4. Pascual‐Reguant L, Serra‐Camprubí Q, Datta D, Cianferoni D, Kourtis S, Gañez‐Zapater A, Cannatá C, Espinar L, Querol J, García‐López L, Musa‐Afaneh S. Interactions between BRD4S, LOXL2, and MED1 drive cell cycle transcription in triple‐negative breast cancer. EMBO Molecular Medicine. 2023 Nov 8:e18459.
  5. Medical Xpress. ‘Double strike’ strategy slows growth of drug-resistant breast cancer, study shows. Available from: [https://medicalxpress.com/news/2023-11-strategy-growth-drug- resistant-breast-cancer.html]. Last accessed [04.12.2023].


Insights from the Lausanne lung cancer summit 2023
  1. Z. Pietrowska. Current standards and future perspectives in targeting EGFR and ALK. Presentation at Internacional Lung Cancer Summit 2023. 10th November 2023.
  2. K. Parikh. SCLC: Current Standards and Future Opportunities. Presentation at Internacional Lung Cancer Summit 2023. 10th November 2023.


FDA approves combo therapy and expands enzalutamide’s reach
  1. FDA. FDA approves talazoparib with enzalutamide for HRR gene-mutated metastatic castration- resistant prostate cancer. Available from: https://www.fda.gov/drugs/drug-approvals-and- databases/fda-approves-talazoparib-enzalutamide-hrr-gene-mutated-metastatic-castration-resistant-prostate [accessed 08th December 2023]
  2. National Cancer Institute. FDA Approves New Initial Treatment Option for Some Metastatic Prostate Cancers. Available from: https://www.cancer.gov/news-events/cancer-currents-blog/2023/fda-talazoparib-enzalutamide-prostate-cancer [accessed 08th December 2023]
  3. Agarwal N, et al. Talazoparib plus enzalutamide in men with first-line metastatic castration- resistant prostate cancer (TALAPRO-2): a randomised, placebo-controlled, phase 3 trial. The Lancet. 2023 Jun 4.
  4. FDA. FDA approves enzalutamide for non-metastatic castration-sensitive prostate cancer with biochemical recurrence. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-enzalutamide-non-metastatic-castration-sensitive-prostate-cancer-biochemical-recurrence [accessed 08th December 2023]
  5. Serani S. Behind the FDA Approval of Enzalutamide for Prostate Cancer. Available from: https://www.targetedonc.com/view/behind-the-fda-approval-of-enzalutamide-for-prostate-cancer [accessed 08th December 2023]



16 Scientific Leaders
selected practice-relevant publications for lung, renal, gastro-esophageal, melanoma, multiple myeloma and prostate cancer.
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