Kristie L. Kahl is vice president of content at MJH Life Sciences, overseeing CURE®, CancerNetwork®, the journal ONCOLOGY, Targeted Oncology, and Urology Times®. She has been with the company since November 2017.

She is a graduate of Rider University, where she acquired a Bachelors of Art in journalism, as well as a graduate of Temple University, where she received her Masters of Science in Sports Management.

Follow Kristie on Twitter at @KristieLKahl, or email her at kkahl@mjhlifesciences.com.

Kristie L. Kahl

Dr. Lorenzo Cohen and Alison Jefferies discuss small yet meaningful changes that patients can make to their home environment to foster a sense of wellness: © stock.adobe.com.

When your body is going through something as difficult as cancer therapy, it becomes increasingly important to keep it as strong as possible throughout treatment, according to Dr. Lorenzo Cohen and Alison Jefferies, M.Ed., co-authors of the book “Anticancer Living: Transform Your Life and Health with the Mix of Six.”

In turn, this amplifies the importance of recognizing the average person’s exposure to harmful chemicals and substances through everyday products. However, the pair go on to say that there are ways that patients can lower their exposure to these harmful chemicals through small, yet meaningful changes.

“We live in a world that’s awash with different chemicals — everything that we can be exposed to through the air, through water and, of course, through things that we put on or in our bodies.” explained Cohen, who works at The University of Texas MD Anderson Cancer Center, in Houston, and is a member of the CURE advisory board.

Cohen continued by saying: "These chemicals modify how our endocrine system works, how our hormones function, and many cancers — prostate, breast, ovarian, endometrial — are linked to hormonal imbalances. Doing whatever we can to clean up what we can control is critically important, especially when the body is already carrying the burden of cancer or cancer treatment."

Jefferies emphasized that knowing and understanding your environment is the first step to making informed, proactive steps to living a healthier life during treatment. That said, it is important to recognize that not every product sold in stores is automatically safe just because it is on shelves. This shines a light on the precautionary principle, which encompasses avoiding unvetted products unless you know they are safe. This can help patients be more aware of what they breathe, apply, and consume at home, controlling their exposure. 

Jefferies explains, “You do have a lot of control \[of] what you put in your body, what you put on your body, and in your own home, what you breathe in. We do have a lot of different ways that we can reduce the burden on our bodies, and when we have a cancer diagnosis, we really want to reduce the burden that our body carries of things that are not health sustaining. 

"If we’re in treatment, we want all our body’s energy to go toward being successful in receiving that [treatment], in healing and getting better. Reducing the burden of chemicals that your body carries is a great place to start.”

There are also more exciting ways to ensure that you are reacting in a precautionary to your surroundings, Cohen said, referencing the impact that house plants have on the environment.

Overall, there are just a few steps that can be taken to help patients with cancer make more informed choices in reducing the toxic burden they may face, in order to help their body be as strong as possible while undergoing cancer treatment.

“Don’t get overwhelmed by this area. It’s the smallest of steps that lead to big changes. [You can] think [about this] in three ways: what you inhale, what you ingest and what you absorb. Start slow and harness your community to help support you make these changes,” Cohen and Jefferies conclude.

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Articles

Maintaining strength during cancer therapy is crucial, and reducing exposure to harmful chemicals can aid this process. Everyday products often contain chemicals that disrupt hormonal balance, potentially exacerbating cancer risks. Understanding one's environment and applying the precautionary principle can help patients make informed choices about what they breathe, apply, and consume. Simple steps, such as using house plants, can reduce toxic burdens. Patients should focus on what they inhale, ingest, and absorb, starting with small changes and leveraging community support to enhance their treatment outcomes.

Dr. Lorenzo Cohen and Alison Jefferies discuss small yet meaningful changes that patients can make to their home environment to foster a sense of wellness.

Meaningful Changes to Reduce Environmental Toxicities

Experts discuss treatment options for those with ER-positive, HER2-negative stage 4 breast cancer: © stock.adobe.com.

For patients navigating a diagnosis of estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer, understanding treatment options, such as hormone therapy, is crucial.

Hormone therapy, also known as endocrine therapy, works by blocking these hormones or reducing their levels in the body, thereby slowing or stopping cancer growth. Initial hormone therapy often involves a combination of medications, frequently including a CDK4/6 inhibitor paired with an aromatase inhibitor or fulvestrant.

These treatments aim to provide long-term control of the disease; however, cancer may become resistant to therapy over time. In this disease space, subsequent treatments often involve switching to a different type of hormone therapy, sometimes combined with other targeted drugs that address new genetic changes the cancer may have developed. Genomic testing, often through a liquid biopsy, plays a vital role in identifying these changes and guiding treatment decisions.

Following a CURE® Educated Patient® Updates event, Dr. Alicia Arnold and Dr. Priyanka Raval, both from Georgia Cancer Center, discussed key takeaways for patients to better understand their treatment options in advanced breast cancer.

As a provider, what questions do you wish your patients would ask you about their care?

 As a surgeon, I'm very much involved in all of my patients’ care. When it comes to surgery, (patients) sometimes don't truly understand what we're trying to accomplish with the surgery, (like)… getting a double mastectomy. People falsely think that that will cure you forever and you never, ever have to worry about breast cancer again. I think (patients) need to understand that with surgery, it's not 100% (curative).

We don't want you to worry about your breast cancer. We want you to live your life as if you don't have to worry about it. But, keep those appointments to continue to check yourself because (some people) falsely believe that mastectomies are curative forever.

Can you provide some key highlights that were discussed at the event?

 Overall, we had a really good turnout. (At the meeting, we covered) a lot of the basics, went over the different hormone receptors, and what that means; common treatments, medications and why they're used for those different receptors; as well as metastatic disease…

(In addition, Dr. Raval) went over what that all means and when to get genetic testing to see if you have an ESR1 mutation or deletion, and to see if (your disease becomes) resistant to therapies.

Can you discuss the treatment options available for ER-positive/HER2-negative metastatic breast cancer?

 CDK4/6 inhibitors are the backbone now… (and we should give patients) basic information on aromatase inhibitors and tamoxifen, which is essentially bread and butter.

What are you hoping was the biggest takeaway for patients?

 When you hear stage 4, it sounds like it's like a death sentence, it’s terminal, and you have no hope. (The Educated Patient Updates event) really showed that there are a bunch of options. The biggest takeaway, which really excited me, was that this type of breast cancer will almost be like a chronic condition that's managed like diabetes…or high blood pressure that can be controlled over a long period of time… I felt that the patients really benefited from hearing that.

 (I hope the biggest takeaway was) the power of knowledge to be able to ask the right kind of questions in clinic. If (the audience) retained even 40% of what we (discussed), if they took notes, then they could go back to their providers, or come back to us in clinic and be able to ask the right questions. … This may close those disparities or gaps in knowledge where the patient is not just talking about their own care, but they are looking at it from a wider lens, what research is happening, what has been the overarching treatment plan and how it's changed, and how exciting it is. It gives hope to some people as well.

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Patients with ER-positive/HER2-negative metastatic breast cancer must understand treatment options, including hormone therapy, which blocks or reduces hormone levels to slow cancer growth. Initial treatments often combine CDK4/6 inhibitors with aromatase inhibitors or fulvestrant. Over time, cancer may develop resistance, necessitating alternative therapies guided by genomic testing. Dr. Alicia Arnold and Dr. Priyanka Raval emphasize the importance of patient education, highlighting that advanced breast cancer can be managed like a chronic condition. They encourage patients to ask informed questions to improve care outcomes.

Dr. Alicia Arnold and Dr. Priyanka Raval discuss first- and later-line treatment options for those with ER-positive, HER2-negative stage 4 breast cancer. 

Understanding Therapeutic Options for ER+/HER2- Metastatic Breast Cancer 

Dr. Mabel Mardones educates patients on breast cancer updates: © stock.adobe.com.

It is crucial to understand the characteristics of the disease following a diagnosis of metastatic breast cancer, especially the cancers subtypes and associated biomarkers, as these directly impact the direction of treatment decisions. Moreover, advancements in treatment strategies within the therapeutic landscape aims to manage disease, control progression, as well as maintain quality of life for patients.

At a CURE® Educated Patient® Metastatic Breast Cancer Updates event, which was held in tandem with Rocky Mountain Cancer Centers, Dr. Mabel Mardones led a variety of discussions around understanding metastatic breast cancer and its subtypes. Notably, she focused on estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer.

“[One takeaway is] just understanding a lay of the land as to how a medical oncologist thinks and some updates in ER-positive metastatic disease, such as learning about staging and [circulating tumor cells], minimal residual disease scans, targeted options, [and more],” she explained.

Mardones is a board-certified medical oncologist and hematologist with a sub-specialty of expertise in breast cancer.

Breast cancer is a heterogeneous disease, meaning it presents with diverse characteristics among different patients.

The primary subtypes of breast cancer are defined by the presence or absence of specific receptors on the surface of the cancer cells, including:

Hormone receptor (HR)-positive breast cancer: This includes ER-positive and/or progesterone receptor (PR)-positive breast cancer. These cancers are fueled by the hormone’s estrogen and/or progesterone.

HER2-positive breast cancer: These cancers have an overexpression of the human epidermal growth factor receptor 2 protein, which promotes cell growth.

Triple-negative breast cancer (TNBC): These cancers lack expression of estrogen receptors, progesterone receptors and HER2.

To determine one’s subtype of disease, biomarker testing provides specific information about the characteristics of a patient’s tumor. Further, biomarker testing can indicate whether a specific treatment, such as hormone therapy or targeted therapy, is likely to be effective. For example, the presence of specific gene mutations, such as PIK3CA or ESR1 mutations, can also guide the selection of targeted therapies.

Treatment Options for ER-Positive, HER2-Negative Disease

For patients with ER-positive, HER2-negative metastatic, hormone therapy – which blocks the effects of estrogen, thereby inhibiting the growth of cancer cells that rely on estrogen for proliferation – is typically the initial systemic treatment approach. These typically include aromatase inhibitors and cyclin-dependent kinase 4/6 (CDK4/6) inhibitors.

In addition, for premenopausal women, ovarian suppression (which stops the ovaries from producing estrogen) or ovarian ablation (permanent removal of ovarian function) may be used in conjunction with hormone therapy.

If cancer progresses or treatment stops working, the next lines of therapy are considered based on the patient's prior treatments, the presence of new mutations and the overall disease characteristics.

Options in the second-line setting and beyond can include selective estrogen receptor degraders (SERDs), PI3K inhibitors, AKT inhibitors

“There's lots of options in the combination [therapy] space, in the first and second line with oral SERDs and CDKs. There's lots more options for targeted therapies and the PIK3CA space; there's at least four or five other agents and trials that are coming up in that space,” Mardones stated. “[Those agents] came up in the conversation at our meeting too, about their toxicities, which are, unfortunately quite a lot. Although effective agents, they are not conducive to really great quality of life for a long time.”

She concluded her discussion at the CURE® Educated Patient® Metastatic Breast Cancer Updates event by highlighting the need for more oral treatment options for patients.

Understanding metastatic breast cancer subtypes and associated biomarkers is essential for guiding treatment decisions. Advancements in treatment strategies aim to manage disease progression and maintain patient quality of life. Dr. Mabel Mardones emphasized the importance of understanding ER-positive, HER2-negative breast cancer, discussing staging, circulating tumor cells, and targeted options. Biomarker testing helps determine effective treatments, such as hormone or targeted therapies. For ER-positive, HER2-negative metastatic breast cancer, hormone therapy is the initial approach, with additional options like SERDs and PI3K inhibitors available if cancer progresses.

Dr. Mabel Mardones educates patients on breast cancer subtypes, as well as treatment options for those with ER-positive, HER2-negative disease.

Understanding Breast Cancer Biomarkers Drives Patient Treatment Decisions

The ADC zilovertamab vedotin plus Rituxan and chemo showed an ORR of 56.3% in relapsed/refractory DLBCL: © stock.adobe.com. 

Among patients with with relapsed or refractory diffuse large B-cell lymphoma (DLBCL), zilovertamab vedotin, a ROR1-targeted antibody-drug conjugate, plus Rituxan (rituximab) and gemcitabine-oxaliplatin (R-GemOx) elicited an objective response rate of 56.3%, according to findings from the phase 2/3 waveLINE-003 study which were shared at the 

At the recommend phase 2 dose of 1.75 milligrams per kilogram (mg/kg) for zilovertamab vedotin plus standard R-GemOx, the complete response rate was 50% in the study. After a median of 9.9 months of follow-up, the median duration of response was 8.7 months, with 28.6% of patients continuing to respond at nine months. The median overall survival was not yet reached, with a 12-month estimated overall survival rate of 68.9% at the RP2D.

"This combination had a manageable safety profile, and the objective and complete response rate of 56% and 50% of the zilovertamab vedotin plus R-GemOx combination at the recommended phase 2 dose suggest improved activity in relapsed/refractory DLBCL," said principal investigator Dr. Philippe Armand, from Dana-Farber Cancer Institute. "The study is currently enrolling the phase 3 portion."

The phase 2 portion of the study enrolled 40 participants with relapsed/refractory DLBCL. R-GemOx was administered at standard doses in each group, with zilovertamab escalated across three dose levels. There were 17 patients who received 1.5 mg/kg, 16 receiving 1.75 mg/kg, and seven who received 2.0 mg/kg. Across all groups, the median number of prior therapies was two, with two specifically having received the CD79b-directed Polivy (polatuzumab vedotin). Armand noted this agent specifically, as it carries the same cytotoxic payload as zilovertamab vedotin; however, data were not shown for this subgroup during the presentation.

Across all patients enrolled, the median age was 66.5 years, with 55% being 65 years or older. ECOG performance status was zero (43%), one (48%), and two (10%) and nearly half of patients had Ann Arbor stage IV disease (53%). The DLBCL cell of origin was most commonly GCB (45%).

At the 1.5 mg/kg dose, the overall response rate was 26.7% with a complete response rate of 20.0%. The median duration of response in this group was 14.4 months, with a 9-month duration of response rate of 100%. The median overall survival was 11.5 months in this group, with a 12-month overall survival rate of 40.8%. The median follow-up for this dose level was 18.1 months.

In the 2.0 mg/kg group, the overall response rate was 57.1%, with a complete response rate of 42.9%. The median duration of response in this group was not yet reached. The median overall survival in this group was 7.4 months, with a 12-month overall survival rate that was not yet reached. The median follow-up in this cohort was 9.3 months.

"The obvious caveat here are the few patients and still limited duration of follow up. So, the estimates are not very stable," Armand cautioned regarding the response duration data.

There was a total of 7 dose limiting toxicities observed across the three dose levels. At the 2.0-mg/kg dose, there were four, compared with one in the 1.5-mg/kg group and two at the recommended phase 2 dose group. In the 2.0-mg/kg dose level, there was one treatment-related death from sepsis.

Other dose limiting toxicities in this group included grade 3 diarrhea, grade 4 neutrophil count decrease, grade 4 thrombocytopenia, grade 3 febrile neutropenia, and grade 4 neutrophil count decrease. To address these side effects, midway through the trial the protocol was adapted to included mandatory prophylaxis with G-CSF. In the recommended phase 2 dose arm, the dose limiting toxicities were grade 3 alanine aminotransferase increase and intestinal obstruction.

This combination had a manageable safety profile, and the objective and complete response rate of 56% and 50% of the zilovertamab vedotin plus R-GemOx combination at the recommended phase 2 dose suggest improved activity in relapsed/refractory DLBCL.

Zilovertamab vedotin-related side effects of grade 3 (severe)/4 (life threatening) in severity were experienced by 63% of patients in the recommended phase 2 dose group. This compared with 86% of those in the largest dose and for 53% of those in the lowest dose. Two patients discontinued the drug in the highest dose group, related to sepsis and respiratory fatigue. There were no discontinuations at the other dose levels. Serious drug-related side effects were experienced by 24% of those in the low dose group, by 31% at the recommended phase 2 dose group, and for 57% of those at the 2.0 mg/kg dose.

Several studies continue to explore zilovertamab vedotin for patients with DLBCL, including the phase 3 portion of the waveLINE-003 study. Armand also drew attention to studies looking at zilovertamab vedotin as a first-line treatment for DLBCL in combination with chemotherapy compared with chemo alone. Additionally, waveLINE-011 is investigating zilovertamab vedotin with chemo as a first-line therapy for the GCB subtype of DLBCL compared with Polivy plus chemo.

“WaveLINE-003: Phase 2/3 trial of zilovertamab vedotin plus standard of care in relapsed/refractory diffuse large B-cell lymphoma” by Dr. Philippe Armand, et al., American Society of Clinical Oncology Annual Meeting.

Zilovertamab vedotin, a ROR1-targeted antibody-drug conjugate, combined with Rituxan and gemcitabine-oxaliplatin, demonstrated a 56.3% objective response rate in relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients. At the recommended phase 2 dose of 1.75 mg/kg, the complete response rate was 50%, with a median response duration of 8.7 months. The safety profile was manageable, though severe side effects were noted. The study is progressing to phase 3, with ongoing investigations into zilovertamab vedotin as a first-line treatment for DLBCL.

The antibody-drug conjugate zilovertamab vedotin plus Rituxan and chemotherapy showed an objective response rate of 56.3% in relapsed/refractory DLBCL.

Kristie L. Kahl

Meaningful Changes to Reduce Environmental Toxicities

Understanding Therapeutic Options for ER+/HER2- Metastatic Breast Cancer

Understanding Breast Cancer Biomarkers Drives Patient Treatment Decisions

Zilovertamab Vedotin Plus Chemo Combo Shows Responses in R/R DLBCL

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