Navigating New Frontiers in Oncology: What's Next at Oncology Data Advisor With Matthew Hadfield, DO, and Rahul Banerjee, MD, FACP

Oncology Data Advisor: Hi everybody, and welcome to today’s Oncology Data Advisor interview. Today, we have a really exciting conversation planned. We’re currently wrapping up an amazing two years with Dr. Rahul Banerjee as Editor in Chief of OncData. We’ve seen some really great growth throughout the last couple of years and have covered some very important topics. We’re so thankful to him for serving at the helm of OncData. And we’re welcoming our new Editor in Chief, Dr. Matthew Hadfield, who has been on our Editorial Board for a couple of years now and has been a fantastic contributor. We’re really excited to see all the great ideas that he has for OncData over the coming years.

With that, I’ll turn it over to Dr. Banerjee to start off today’s conversation about where the field is right now, some of the challenges that we cover, and the new innovations that we’re looking forward to.

Rahul Banerjee, MD, FACP: Perfect. Thank you, Keira, for all of your help behind the scenes over the last two years with me at the helm. I’m excited to pass the baton on to Dr. Matthew Hadfield here, who’s an Assistant Professor of Medicine at Brown University, Legorreta Cancer Center in Providence, Rhode Island. Dr. Hadfield, Matt, if I may, congratulations, and I’m looking forward to having you take the helm.

Matthew Hadfield, DO: It’s very big shoes to fill, to be honest.

Dr. Banerjee: This has been a lot of fun. As I think some of you who are listening may know, the website has grown a lot and we’ve really expanded the content that we’ve covered. What I’ve really enjoyed has been writing the Letter From the Editor columns every three months. More recently, they’ve been about what the oncology field can learn from X, Y, Z.

One of my favorite ones was writing about Jimmy Carter. You may remember how he passed away last year, but after being on hospice for years, way longer than anyone expected. I would argue that he lived longer on hospice than he would have on treatment. I feel like we don’t really talk about that. It’s a nice question to stump medical students on, that you don’t need to only live six months to be in hospice. You need a six-month life expectancy. But knowing that he lived a high-quality life on hospice, you can’t really write about that kind of stuff in any other forum. Oncology Data Advisor is a great place to talk about these bigger-picture themes.

Dr. Hadfield: Absolutely.

Dr. Banerjee: But that was so last year—passe at this point—so much has changed in the world. Looking forward to your term, beginning in late 2025, early 2026, what do you see as some of the big issues in oncology and cancer care?

Dr. Hadfield: One of the things that I think is still a big issue, which is a little disappointing, is the fact that there’s still data to suggest that we’re not doing enough targeted sequencing of patients’ tumors outside of large academic medical centers. I’ve seen a lot of initiatives about globalizing next-generation sequencing (NGS) testing, but to be honest, I think we still have a lot of work to do in our country. We have to be really, really careful. I’m sure you probably see this in myeloma—we were joking before about how I see melanoma, you see myeloma, there’s lots of overlap just in the name—the lack of uptake of comprehensive genomic testing is a big thing.

The other thing is that as these therapies get more and more complicated and promising, kind of drawing from both of our worlds, something like teclistamab—while it’s a great drug in myeloma, there are logistics in giving it, right? You need to have ramp-up dosing, you need to have inpatient admissions, there needs to be familiarity with cytokine release syndrome (CRS) monitoring. It’s a great thing, but there are just lots of logistical burdens to try to bring these therapies to a broader population. I think the field is moving so fast that we have to scale it as opposed to just developing things. Do you have any thoughts about that?

Dr. Banerjee: Completely agreed. It’s interesting. I feel like I’ve learned a lot more about melanoma recently with lifileucel being approved, the tumor-infiltrating lymphocyte (TIL) therapy. I attend on our chimeric antigen receptor (CAR) T service at our institution, Fred Hutch in Seattle, and I’ve learned a lot from them. I think the patients intrinsically are clearly aware that I am not a melanoma specialist. They don’t even try to ask me to pronounce the names of the drugs that they’re on, because I would not be able to. I can talk about myeloma and lifileucel. But they lean to us to talk about CAR T therapy and the toxicities that extrapolate the TIL therapy.

It’s hard, because even at a specialized center like this, things are so uber-specialized that we can’t get our worlds colliding as nicely as we would like. We’re still figuring that out obviously, and I think it’s a relatively smooth experience, but work could be done. NGS is a good example where I think the melanoma doctor thankfully knows what to do with it. I don’t even know how to send that. They work very closely with us. But as you’re alluding to, I think for probably half the US, if not more, they do not live within 30 minutes of a center like this that can do cellular therapies or even basic next-generation or comprehensive genomic sequencing and they figure out what to do next. It’s a challenge. Obviously, across the world, it’s an even bigger challenge. But even within the US, it’s tricky.

I think a lot of the time, community oncologists don’t have the resources for it, or patients don’t realize that they should be asking for it. Even if you want to get it done, there are hurdles. Going to a third-party vendor or getting the linkages set are tricky for us in myeloma. Unlike in melanoma, we don’t use NGS as much, per se, to look for new qualitative mutations. We have an NGS platform to look for MRD. The same thing applies where, for example, in myeloma, the New York Times wrote an article this year, “From No Hope to a Potential Cure for a Deadly Blood Cancer,” talking about how MRD decision making is changing the world. But we can’t even get half the country to check for MRD. It’s not the doctor’s fault; it’s just so impractical at these smaller centers. It requires a bone marrow biopsy, first pull being sent to the lab, just a lot of resources which are tough to get.

Dr. Hadfield: I’m so glad that you mentioned MRD testing, because to be honest, I see these overlaps in the fields where what’s important in one field is kind of switching to another and then vice versa. MRD testing is something that has been more relevant in myeloma, but now we’re starting to see it more in the solid tumor space. We’re trying to figure out what to do with it in the adjuvant and the neoadjuvant settings, and then even in disease monitoring. Then you see how things like immune checkpoint inhibitors are now being used in lymphoma, and the toxicities are new for people, so things are changing fast. But for some people, what’s old is new, and it’s a whole new landscape.

Dr. Banerjee: Agreed. It’s the power of oncologists working together and the power of talking to people across disease group lines at academic centers. For us, immune effector cell–associated enterocolitis is now a boxed warning on ciltacabtagene autoleucel, which is our most commonly used CAR T therapy in myeloma. Basically, patients get horrible, bloody diarrhea, but it’s not infectious; we don’t know what’s going on. In our malignant heme world, we tend to say, well, everything in life is either caused by too little steroids or too many steroids. We just give steroids, but actually this is not the optimal treatment for this.

The optimal treatment for polyclonal T-cell infiltration CAR driven into the gut is actually to use what the solid tumor world has taught us for melanoma—where you have checkpoint inhibitor colitis, you use vedolizumab or infliximab. You use biologics. We’ve started using that, and it has been my first time prescribing infliximab, I think ever. I didn’t have to use it as a fellow. Thank goodness for our people both within the oncology field and outside of it, like our gastrointestinal (GI) colleagues who cover both worlds. Now ours are like, “well, your colleagues on that side of the office are using infliximab for melanoma or lung cancer for checkpoint issues. Why don’t you?” I’m like, “Oh, I learned something.” It’s the same with Oncology Data Advisor; we all learn from each other.

Dr. Hadfield: That’s a good plug, because I was just thinking to myself that those are the things that a platform like this is so good at is. At the end of the day, we obviously rely a lot on literature. We rely a lot on going to big meetings and things, but it’s so specialized. To be honest, we’re integrated with so much information all the time, from so many different sources, that sometimes more of a social platform like this is where you can learn the most, because it’s anecdotal and it’s not dense.

We’ve been having conversations about that here, because things like vedolizumab or infliximab or mycophenolate, these drugs that we use in melanoma for toxicities, have lots of their own side effects that can sometimes be confused with the checkpoint inhibitor side effects. There are lots of overlaps. It’s getting very, very complicated very, very fast. That’s getting back to that point of, are we going to be able to scale this out to everyone? Is it really going to be in the directions that we’re going? We have to be mindful of how to make it accessible to everybody, because it’s going to be harder and harder.

Dr. Banerjee: Agreed. We were talking about this before we started the podcast. One of the issues right now—we’re filming this on November 10, 2025—is that the telehealth waiver has not been extended for Medicare recipients. It’s been challenging, because for a lot of our patients, that is their window to benefit from the partnership between the community oncologist who knows them the best and the academic oncologist who knows the disease the best. Honestly, a third of my patients here in Washington state, whom I see in clinic, are actually from Idaho, Montana, Alaska, etc. It’s been devastating for them, because basically they’re being asked to make an impossible choice. Either you don’t see the academic specialist, or you drive or fly to see them, which makes no sense at all.

It’s interesting, because that’s one of the things that we were just talking about—I’m seeing it within my myeloma space, but it’s also the kind of health policy issue in the US that’s cutting across your clinic in melanoma and cutting across everyone’s clinic. It needs to get fixed—many things need to get fixed—but that, for example, is one of them.

Dr. Hadfield: Just to ask a little bit more about that, the Medicare waiver going away for the telehealth visits—what do you think the long-term implications of that are going to be if there is no change? Do you think people are going to no longer be able to access academic medical centers? And to what degree is it going to put off that access? I mean, to your point, it’s just forcing people to drive or fly to try and make it, and then you’re putting up these barriers that don’t need to exist.

Dr. Banerjee: Absolutely. For me, the patients I worry the most about are the ones for whom just getting them in the door to consider an academic consultation or a CAR T or lifileucel referral, for example, is the hardest part. Unfortunately, it feels like we’re in the ivory tower—it’s hard to get here to Providence or Seattle for a lot of our patients. Just being on a busy highway might be new and terrifying for them. Everything is scary about the big city. So, it’s hard. I think telehealth is a really nice way to at least show that I don’t bite. I’m not there to take their money. I’m here to help, and I’m here to work with their primary oncologist. I think telehealth has helped extraordinarily there.

I trained in Rhode Island for med school, and Rhode Island is smaller than other states, but the same issue applies with patients coming across state lines for care. That became challenging with the COVID waiver going away, but we were able to figure that out. In my case, I have an Idaho, Montana, Alaska, California, and Washington state license. I can at least ethically and legally see these patients and offer medical advice, no matter where they’re sitting. But now that I can’t even see them, period, it’s tricky.

A lot of them who were already known to us have gotten better at being able to send us electronic messages through the electronic medical records, or at least they have some way of getting in touch. We have a phone number for the ones who could benefit from a one-time consultation with us. They’re the ones who will fall through the cracks and won’t see us until it’s too late, until they’ve gotten therapy which, unfortunately, was suboptimal. To your point, they didn’t have someone telling them about doing genomic sequencing, or in my case, they didn’t have someone say, “look, we should go for CAR T therapy while you can, because it’s better than your standard treatment options.” Those are the ones I worry about. Even if it gets fixed soon, getting lost to follow-up is a big problem in oncology, particularly for vulnerable patients, rural patients, or patients with limited access to healthcare. For some of those patients, even three months—during which a scheduled visit with us got canceled—is a health issue. They may not schedule again, and we may lose them logistically until things are too late.

Dr. Hadfield: That’s your biggest nightmare right there, that you’re losing patients and they’re not making it back to you, or they’re not getting the care that they need in follow-up. Especially as you think about these therapies like CAR T where it’s not like a one-and-done thing—there’s ongoing potential for toxicity and harm. These are very, very big issues and important ones.

I guess to round out, what would you say has been one of your best experiences over the last two years with Oncology Data Advisor, and what advice do you have for myself, the incoming Chief?

Dr. Banerjee: Absolutely, though you won’t need my advice, you’ll do amazingly. But writing those columns, for me, has been really illuminating to be about to talk about these bigger issues—hospice referral, telehealth waiver, things that I think really important. Leaning on the community of oncologists and other members of the care team here has been very impactful. Both of us actually joined this website when we were fellows, and Oncology Data Advisor is very welcoming towards fellows and junior faculty—they have the best ideas.

You and I both joked about how neither of us are AI experts, but we will someday become AI expert. But we have other people on our board, for example, who specialize in this, and we can learn from them. The junior faculty and fellows are the ones spearheading these innovative ideas and crosscutting institutional disease groups in terms of access to care, health policy, AI, all of that, which is really cool. Is there anything on your bucket list for the next two years that you’re excited to work on or write about or talk about?

Dr. Hadfield: Kind of in the same vein of what you’re talking about, with things like referral to hospice—there are a lot of things that if you’ve been in oncology for long enough, you kind of know and you understand how things work, but they seem slightly inaccessible as a trainee because you just don’t have the questions to ask. On that thought, things like clinical trial design, just basic information on how to understand hazard ratios and things—there’s so much about oncology that’s just different than other fields, you know what I mean? I’d love to break that down for trainees, so it feels less intimidating. It’s okay to ask about how a study was designed. Inevitably, you read a paper or you watch podcast, and they’re like, “the alpha allocation was this.” And you’re like, “I don’t even know what alpha allocation means,” but you’re too afraid to ask.

Dr. Banerjee: Completely agreed.

Dr. Hadfield: So, it’s topics like that, I think, that I’m most excited to try and break down and make a little bit more digestible for fellows and trainees.

Dr. Banerjee: Excellent. Looking forward to it. Well, with that in mind, yes, the baton is being passed from one coast to the other, from sea to shining sea of the coast of the US, and I’m looking forward to it. For all of you listening, thank you again for your time and continued support of our platform.

Dr. Hadfield: Yes, thank you so much.

Oncology Data Advisor: Absolutely. I love all these topics that you both brought up today, and I agree these are the pressing issues that are important for OncData to cover and encourage these conversations within the community. We’re so excited to keep working with both of you to have these conversations and hopefully foster this change. With that, thank you again, and looking forward to next time.

About the Speakers

Matthew Hadfield, DO, is a Medical Oncologist and Assistant Professor of Medicine at Brown University/Legorreta Cancer Center. He recently completed his Hematology/Oncology Fellowship at Brown University. Dr. Hadfield’s clinical and research interests are in phase 1 clinical trials and developmental therapeutics, as well as treatment of cutaneous malignancies and management of immunotherapy-related adverse events.

Rahul Banerjee, MD, FACP, is an Assistant Professor in the Division of Medical Oncology at the University of Washington. He also holds a faculty appointment at the Fred Hutchinson Cancer Center in Seattle, Washington. Dr. Banerjee previously completed his Hematology/Oncology Fellowship and Advanced BMT/CAR-T Fellowship at the University of California, San Francisco. His clinical interests are in multiple myeloma, AL amyloidosis, and CAR-T therapy. His research interests are in toxicity management, digital health, and the patient experience.