Choosing the Right Path

Triple-negative breast cancer (TNBC) has become recognized as a heterogeneous, hormone-driven disease, and increasing evidence suggests that within a subset of these tumors, a role for androgen signaling exists. In this issue of ONCOLOGY®, we speak with Tiffany A. Traina, MD, a medical oncologist with Memorial Sloan Kettering Cancer Center, about her work in targeting the androgen receptor (AR) pathway in patients with TNBC.

“I think we’re still trying to understand the best biomarker to be able to predict for benefit. It may be something beyond just the presence of the receptor, but perhaps more of a composite marker to predict benefit,” says Traina of the recent work with AR signaling. “Some data show that the AR may be relevant not just in TNBC, but also in estrogen receptor (ER)–positive breast cancer, where the coexpression of ER and AR is quite high.”

Traina also discusses the expanding use of immunotherapies for TNBC. “We’ve come to see that for metastatic disease, introducing these agents early in the first-line setting shows greater promise than using them in a later line,” notes Traina. “We are also now seeing, from early-stage trials, that moving these checkpoint inhibitors up into the neoadjuvant setting, even potentially the adjuvant setting, has great benefit.”

For this month’s clinical quandary, you will read about the challenges of starting immunotherapy for patients with cancer during the coronavirus disease 2019 pandemic. How have treatment protocols changed? What can we do to ensure the best possible treatment with the lowest possible risk? Read on to find out.

Also in this issue, you will read a review of molecular profiling in metastatic colorectal cancer (mCRC). The implementation of next-generation sequencing has changed the landscape of treatment in mCRC, identifying mutational targets and improving outcomes. In an accompanying editorial commentary, John L. Marshall, MD, director of the Ruesch Center for the Cure of Gastrointestinal Cancers, elaborates on the potential for molecular profiling to transform cancer care around the world. He states that cancer care can “no longer be a luxury item, only for the rich.”

Within these pages, you will also read a review of screening for phase 1 clinical trials; a commentary from Judd W. Moul, MD, of the Duke Cancer Institute on the effect of delayed radical prostatectomy in patients with prostate cancer; and the case study of a 68-year-old woman with the rare occurrence of breast metastases from EGFR-mutated non–small cell lung cancer.

I hope you find our journal helpful in caring for your patients through what is likely one of the most challenging times in their lives. As always, thank you for reading.