The Power of Oncology Collaboration: An Interdisciplinary Conversation With Oncology Data Advisor and MedNews Week

Keira Smith: Good morning, everyone. Welcome to this podcast, which is a collaboration between Oncology Data Advisor and MedNews Week. We're really excited today to have this podcast and to join forces and discuss some of the topics in oncology that we're all passionate about.

We'll go around and introduce everybody. To start off, I'm Keira Smith. I'm the Senior Editor at Oncology Data Advisor. I plan and manage the content that OncData puts out, and I also liaison with our Editorial Board and our Fellows Forum. It's really awesome to work with some amazing people and learn something new about the world of oncology every day. I'm really excited to work with all of you and hear more about your research interests as well. To get started on the OncData side, Dr. Hadfield, would you like to introduce yourself?

Matthew Hadfield, DO: Sure thing. My name's Matt Hadfield. I am currently a third-year Fellow at Brown University in Providence, Rhode Island. I'm going to be staying on at Brown next year as a Junior Faculty Member, working predominantly in the early drug development and phase 1 clinical trial space, and also seeing patients with melanoma. I have a particular interest in novel immunotherapies and overcoming resistance mechanisms, as well as immunotherapy toxicities, which is something that I've spent a lot of time thinking about and working on.

Keira Smith: Awesome. Dr. Kalis?

Joseph Kalis, PharmD, BCOP: Yes, hello. I'm Joe Kalis. I'm an Ambulatory Oncology Pharmacy Specialist, a big mouthful of a title. I practice at the University of Colorado Health, or UC Health if any of our marketing folks are listening in. I'm based in Colorado Springs, Colorado. I have somewhat of a unique role, where even though I'm a pharmacist by training, I end up seeing and counseling patients whenever they start a new therapy, whether that's first-line, second-line, what have you, anything from orals to intravenous (IV) drugs to immunotherapy.

I have a large role in building some of our chemotherapy order sets, and I practice a lot in supportive care and symptom management. I have a special interest in multiple myeloma—some of the research and directions we're looking into now, such as various treatment combinations, what gets used first, some of the sequencing. I'm looking forward to expanding on that and then other topics as they arise.

Keira Smith: And then, Dr. Mouabbi?

Jason Mouabbi, MD: Good morning, everyone. I'm Jason Mouabbi. I'm an Assistant Professor at MD Anderson Cancer Center. I focus on breast oncology, and I'm an invasive lobular carcinoma specialist. That's what my research involves, and that's the bulk of my patients that I see. You might not know, but lobular has been very understudied for years and years now. It's always been mixed with the more common invasive ductal carcinoma, and we're trying to change that. We're trying to focus our research on lobular carcinoma. That's what I try to highlight at every meeting and everywhere that I can be an advocate for lobular breast cancer patients. And I'm happy to be here.

Keira Smith: And then, MedNews Week folks, would you like to introduce yourselves and then share a little bit about MedNews Week as well?

Gayathri Menon: Sure. I'm Gayathri Pramil Menon, and I'm one of the Associate Directors here at MedNews Week. I'm also a fifth-year medical student from Georgia. MedNews Week is something that was founded back in January of 2022 by Dr. Chandler Park and Dr. Yan Leyfman. It was founded to combat misinformation. People were just scared overall because of the pandemic, and there was a lot of anti-vaxxers out there as well, spreading misinformation. It was founded to combat all that and to make sure that people have the right medical information before you make your decision as to what you want to do when it comes to your health and your family's health.

So, MedNews Week was founded on the basis of that. We're really passionate about oncology, like you guys. It's something that we're all really passionate about, especially have the diversity of specializations. That's something that we really love doing here at MedNews Week, and that's why we're all really invested in it. Over to you, Muskan.

Muskan Joshi: Hi, everyone. It's truly a pleasure and a privilege to be here and speak with global leaders and some of the most amazing people that we know currently in oncology research. I'm really happy to be here. My name is Muskan, and I am also a fifth-year medical student from the Tbilisi State Medical University in Georgia. I have a lot to learn and discover, so when I stumbled upon MedNews Week, it was like a new world had opened up for me in the field of oncology. I'm truly really excited for the future and the prospect that is oncology. I'm so happy that I get to share it with Maduri and Gayathri.

I myself am an Associate Director. I got the privilege to get to this point and work with such amazing people and learn so much every single day. My interest, as I said, really lies in oncology research. I'm also heavily into infectious disease as well right now, considering the pandemic that has just happened. As to why MedNews Week is truly something amazing and something special, as Gayathri just mentioned as well, our goal when we started off was to combat medical misinformation. But we have reached a point now where our main goal is to help increase global health equity.

There is a huge disparity in health care and health care treatments, especially related to oncology, in different parts of the world. The US is the forefront of all research, and the US health sector has access to amazing health care education, but this is not a reality for most of the world. At MedNews Week, we stand for global health equity. We stand for spreading good and right information and promoting global health education. We have been really privileged in that we have actually reached a huge global mainstream audience. We have reached over 70 different countries and multiple different lower and middle Human Development Index countries and lower socioeconomic countries.

We have had tons of renowned keynote speakers, and we have had over 10,000 to 20,000 attendees so far in just a year. This is truly something amazing. We stand for patient education. We stand for so many different things, and our audience is a huge, vast variety of people. We have health care professionals, patient advocates, CEOs, business administration people, and mainstream people or people who are not in the medical field as well. We started off as wanting to combat medical misinformation, but we're growing into something bigger every day, and there's no bigger privilege than to be a part of something so amazing and to be here today.

Maduri Balasubramanian: Hi, everyone. Thank you so much, Muskan and Gayathri. I think you've covered pretty much everything I wanted to tell about our organization and a lot of the things I wanted to share. To reintroduce myself, my name is Maduri. I'm an Associate Director at MedNews Week and currently a sixth-year medical student in Georgia. I'm excited for today's podcast because oncology has been a passion of mine for over seven years. It is a field that I want to pursue, in surgical oncology to be specific. I've been reading a lot about it and learning so much, and MedNews Week has been one of the platforms which has taught me more about the field itself and more about the people as well. I think that's truly great. I'm really excited for today's session. I don't think there are any more words I can share about our organization, because Muskan and Gayathri have definitely covered it well in depth. I hope to enjoy today's podcast as well.

Keira Smith: Awesome, thank you all. It's great to hear more about MedNews Week. It's really a great organization, and you've made incredible strides in global education, reaching different parts of the world, and helping to spread all this information. I'd like to share a little bit more about Oncology Data Advisor as well. We're an online journal and podcast featuring expert perspectives and conversations focused on all aspects of oncology care. This can cover research and treatment advances, nursing, fellowship, patient advocacy, and pretty much everything in between. As I mentioned, our Editorial Board and our Fellows Forum are really the drivers of our content. They help keep us abreast of all the topics that we should be talking about in oncology and what's most relevant today.

This year we're also trying to shine a spotlight on patient advocacy. We have two members of our Editorial board, their names are Megan-Claire Chase and Allison Rosen, who are patient advocates. They're excited to participate in future episodes of this podcast as well, to shine more of a spotlight on that. We also do a lot of coverage of the major oncology conferences—the American Society of Hematology (ASH), the American Society of Clinical Oncology (ASCO), and the Oncology Nursing Society (ONS). We speak with all the leaders in the field so that we can really help share and disseminate the most up-to-date information that's being published.

It was actually just at ASCO this past June that I met Dr. Leyfman for the first time, and we connected there. We recorded an interview there that sparked the conversation towards planning this podcast. We're really excited for the collaboration and everything we can do with it, and I'm looking forward to seeing where it goes.

So, a question that we can go around the room with everyone—how do you think this podcast collaboration between OncData and MedNews Week will offer a new perspective on oncology commentary? And what are some of the ways that you think that this partnership can help us to join forces and spread the most relevant information?

Dr. Kalis: Sure, Keira, I'll take a stab at it first. From my perspective, with the group of people we've got here today, we have folks in different areas of practice and different stages of their career. I think that's important, because each of us is going to bring our own perspective and background and training into some of the cutting-edge advances and changes. Groups like this that I've been part of in the past have been very fertile ground for exchanging ideas about best practices. What I might be doing in Colorado might translate over to Georgia well, or vice versa. Our patient populations and practices may be different, but at the end of the day, we're still taking care of patients, and we're still trying to treat people who have cancer and do it to the best of our ability.

Keira Smith: I think it's a great point you bring up about all the differences in perspectives in having a panel like this. Everybody comes from different geographic areas and different stages in their career. I think that's really valuable in joining perspectives and even reaching conclusions about different ways that medicine can be practiced.

Dr. Hadfield: I'll echo what Joe said as well. Oncology is evolving so rapidly that every time you go to a conference, every time you open a journal, there are new opinions and new guidelines. Everything happens so quickly that having this type of a collaboration, where you have people, who are at different stages of their careers, using anecdotal evidence to try and weigh in and help guide discussions on what's relevant and what's not relevant to changing practice, is really important. It's important for cutting through just how much information there really is out there, because it is overwhelming for the entire field of oncology.

Dr. Kalis: That's a fantastic point. I've been mentoring some students and residents, and we've had had some chuckles recently because it seems that every new paper that comes out, whether it's in the New England Journal or Lancet, is talking about how something is the new standard of care in some subset of a population. What does that phrase even mean anymore? Maybe it is, and maybe it isn't. How do we take some of that clinical evidence and apply it to real-world practice?

Muskan Joshi: I definitely agree, and considering I'm a med student still in my training, I think it's so important to hear from the leaders and the experts. As you mentioned, oncology is an ever-evolving field. There's something new that comes out at every different conference, in every different journal. It's so important to have these conversations and share ideas. Then you're going to have a new generation of doctors who are involved, who are active, and who have the latest knowledge, because our growth does not happen without conversation. And that's all what we are here for.

Maduri Balasubramanian: I honestly agree with all of your points, and it's really interesting. I feel that having this collaboration itself will help us bring about some crucial health information, which not only will we learn as students, but we are also able to share it with our viewers and other members. I think that's going to be really important, because this is one of the main things that we need as we're trying to bring about data to show change. I think that'll be really great as well.

Dr. Kalis: Certainly, and especially with the volume of information coming out, how can we filter or sift through what is relevant? What applies to a broad scope of practice? What might be practice-changing? Joking about new standards of care aside, there are so many papers that come through. In past years, trials like the KATHERINE trial in breast cancer and others really have moved that needle forward. Even if it's a small increment, but if it's affecting a specific patient population, we're using therapies in a new way. I think providing that information and even perspectives, anecdotes, and opinions on it could certainly be helpful to the broader population. Even for patients—the more patients I've seen, many of them have gotten very, very savvy with information that's out there. But I think a lot of them are still searching not so much for answers, but just places that they can go to find grounded facts and grounded data they can then use, bring to their teams, and try to make the best decision for themselves.

Dr. Hadfield: I think those are fantastic points too. I would just add that oncology is becoming so siloed. If you're at a large academic medical center and you're a specialist who only sees uveal melanoma, then you're going to be dialed into that literature really well. You're going to know all the nuances, and you're going to know all the key opinion leaders. But as you get outside these major academic medical centers and it becomes oncologists who see one, two, or three types of tumors, or even general oncologists, staying on top of things is virtually impossible without having some type of jumping pad for what's relevant to actually change things for the patients they treat, as opposed to just information that is nice to know, but not necessarily critical to know when making treatment-related decisions.

Dr. Kalis: There are a lot of sources out there. I know we've got colleagues in industry, but you could argue perhaps there are biases introduced with that. We have our major conferences, but the siloing is definitely something that I've encountered before. I practice as a generalist, but my interests are more in hematologic malignancies. So, if I have an hour on Saturday morning before the kids wake up, well, I'm looking at some of the things from ASH rather than in breast cancer or lung cancer or other tumor types.

Gayathri Menon: I definitely agree with everyone's opinions. When it comes to oncology, my personal belief is there are never too many cooks. I think as you said, Dr. Kalis, every opinion matters, even anecdotal evidence. I guess the real question is how long would it be from when you take anecdotal evidence to get to the transition point where it's actually introduced into clinical trials? How do we actually get patient data that might be translated into drug approvals by the FDA? When it comes to that, I think we still have a little bit of a lag over there.

Speaking from the MedNews Week perspective, it's really great for us when we have speakers from the oncology field and we have viewers trace back their family history, someone's aunt or uncle who has cancer or has beaten cancer. It's really heartening to see people step up and ask the speakers, "My uncle's diagnosed with prostate cancer," or "My grandma has breast cancer, and these are the trials that she's currently going through and these are the drugs she's taking. What can be done?" The speakers really take a moment to ponder the question, and they really do give a heartfelt answer. I really love that part of being a physician. That's why I got into this field. I'm a student like Maduri and Muskan, still in my training right now. But when it comes to oncology, it's really interesting to me to read the data that comes out of different publications. I want to see it being introduced into clinical trials to see how much information is actually relevant and what can be discarded. That's my opinion.

Dr. Kalis: Absolutely. And I've noticed in my own practice and personal life so far, you get to know people in your neighborhood. Then they find out where you work and the type of field you're involved in, and you've got some of that foundational relationship already. There's that mutual respect and trust, and they're just like, "Oh, well, I was just diagnosed with this or with that. Joe, what do you think about this?" or "Matthew, what do you think about that in your area of practice?" I think that type of almost a grassroots effort, in a way, is really based on those individual relationships from the patient level up to us as providers. That's where I see a lot of information getting disseminated. Especially if patients don't know what sources to go to, they might say, "Hey, my neighbor across the street practices in oncology, let me see what they think about this."

Keira Smith: You all bring up amazing points, and like you said, having this diverse panel of standpoints, viewpoints, experiences, and training is something that's really valuable to have. That said, as we plan future episodes and things that we'll be talking about, are there any topics that each of you are particularly passionate about, in your research or in your field or your interest, that you're looking forward to discussing on future episodes?

Dr. Kalis: I'll dive in first, but I'm going to punt the ball—since, sports analogies, football is beginning here in a couple days. I know for me, I've got my areas of interest in drugs and things. I'd actually like to see a little bit more from Dr. Hadfield about managing immunotherapy and immunotherapy-related toxicities. Immunotherapy has grown quite exponentially in what tumors we're treating with it and what drugs we have available. We have new checkpoint inhibitors coming out soon, for lymphocyte activation gene 3 (LAG-3) and others. I'm particularly interested to see what some of that research is. Maybe we can look at what's out there to prevent some of these toxicities. Who might be more susceptible to it? Do we have options other than some of our baseline corticosteroids? They're a very valuable tool. I've joked about them being oncology duct tape before, but at the same time, they come with their own drawbacks.

Dr. Hadfield: Thanks for setting me up for that. I'm really passionate about immunotherapy toxicities. Immunotherapy is something I've been using for over a decade now, but we still have a very poor grasp on diagnosing immunotherapy toxicities. We have no biomarkers for definitively making a clinical diagnosis when you diagnose them. Especially now, as we start trickling from the metastatic setting of using immune checkpoint inhibitors more into the neoadjuvant setting, you're eventually going to be using immune checkpoint inhibitors in settings where you can give someone a life-threatening toxicity that will make curative-intent surgery no longer available. That's a horrifying thought, to think that you could take away the ability to cure someone's cancer with a toxicity that you caused.

I think coming up with predictive biomarkers is going to be something that's incredibly important in the future—learning how to, as Joe mentioned, use steroid-sparing agents to treat immunotherapy toxicities. We know from research in melanoma that corticosteroids decrease the efficacy of checkpoint inhibitors, and you lose the efficacy benefit when you have to give people high-dose steroids. I think we all know that using high-dose steroids in any setting is never good for patients for long periods of time, for a plethora of reasons. My interests are certainly in coming up with predictive biomarkers and collaborating with different researchers in different centers across the United States to do that, as well as coming up with novel concepts for steroid-sparing regimens to treat toxicity. I think it's going to be incredibly relevant as we move forward.

Again, as Joe mentioned, we've had programmed cell death protein 1 (PD-1) inhibitors, programmed death ligand 1 (PD-L1) inhibitors, and cytotoxic T-lymphocyte­–associated antigen 4 (CTLA-4). But now we have T-cell immunoreceptor with Ig and ITIM domains (TIGIT), and we have LAG-3. There are other agents that are coming out, and there are going to be novel combinations. It's going to get much more complicated. And that doesn't even get into adoptive cellular therapies like chimeric antigen receptor T-cell (CAR T) therapy and bispecific T-cell engager (BiTE) therapy. There's just a lot that's going to need to be managed. It's challenging at large academic medical centers, and it's incredibly challenging at smaller centers where they don't see as much volume. It's something that I'm looking forward to talking more about in the future and hopefully raising more awareness and making some progress in that area, because it's desperately needed.

Dr. Kalis: Absolutely. Even outside of oncology, when I counsel patients, it's almost every day that somebody is starting immunotherapy. It's coming down to me telling them, "Okay, here are some things that could happen, but really we're looking for foundational changes in symptoms and how you're feeling." Early identification has been so crucial. We've done some education with our emergency department colleagues, even primary care. If you have a patient that they're seeing in their own practice who comes in with these various complaints or ailments, we're raising that awareness that, "Hey, if they're on immunotherapy, maybe it's related, maybe it isn't." We can't miss a chance to intervene on the early side and prevent something from becoming, as you said, life-threatening or even chronic, with some of the endocrinopathies that can happen.

Dr. Hadfield: Absolutely, and we see this all the time. You get calls from the emergency department or primary care physician, and they say, "Oh, this patient is on chemotherapy," and then you look and they're on pembrolizumab. That's not chemotherapy. It's hard for oncologists to think about the mechanism of action and how these things cause toxicity, much less for physicians who are great at what they do but they're not aware. It misses the chance to intervene or diagnose earlier. It's a huge issue, and it's something that happens every single day. We've been using these as FDA-approved medications since 2011, so we're still pretty far behind.

There was a very interesting study that was done at Massachusetts General Hospital (MGH), it's a little dated now, but it was published around 2018. Basically, they did a survey of all the oncologists and hospitalists and sub-specialists at their center. What they showed was that for pneumonitis specifically, less than 50% of oncologists felt comfortable managing that toxicity, and less than 50% of pulmonologists felt comfortable managing that toxicity. So, it really becomes, who is managing these and who's owning them? It gets even more complicated as you have people who are on long-term steroid tapers with prolonged toxicities. How do you manage them? Do you rechallenge or do you not rechallenge? That data is still of coming out, but it's a rapidly evolving field for sure.

Dr. Kalis: There are so many specialties that can be involved—pulmonary, endocrinology, gastrointestinal, even dermatology in certain cases. Toxicities really can affect the entire body if there is an immunotherapy-related toxicity. That's where you also get the patient advocacy piece, having patients receiving all the baseline information and acting as their own advocate. But then it's also important to ensure that as a medical community, we've got folks across that spectrum who are not only aware of the therapies, but know, "Okay, if they're on pembrolizumab or nivolumab or one of the other checkpoint inhibitors, who are the oncologists in their community that they can lean on or reach out to?" I think that speaks to some of the siloing we're all encountering that we chatted on earlier. Perhaps the immunotherapy toxicity management is one way we can begin breaking down some of those walls.

Dr. Hadfield: I think that's something that we're starting to see. That's something we're working on locally here at my center—developing a network of sub-specialists who deal specifically with these toxicities and then chime in when something comes up. Another thing that I would mention is piggybacking off your point about patient advocacy. I've seen many, many times that immunotherapy pitched is as a chemo-sparing regimen, which has a lot of interesting connotations because it's not toxicity-sparing even though it's not chemotherapy. But we've seen a patient who has grade 3 pneumonitis or grade 3 colitis, or we've all had patients pass away from immunotherapy-related adverse events. It's really not giving it the respect that it needs, that these have very serious consequences in certain cases and can be life-threatening. It's important that we communicate that well enough to patients.

Dr. Kalis: Absolutely, because I think the general patient population folks that I'll see come in, with brand new diagnosis, have an idea already of what chemotherapy might be. "Oh, I might be nauseous. My hair might fall out. I'm going to feel tired or crummy." But immunotherapy is still new on the scene. Maybe as it gets more established and it works its way into popular culture and start showing up on TV shows or web series or whatnot, maybe there'll be a greater awareness. But people hear it, and you're exactly right, they're like, "Oh, the doc said I don't need chemo." "Well, that's true, but let's talk about what we need you to look for and why we need you to look for that."

I don't want to say we're trading one set of toxicities for another. I think it's a step in the right direction, but it brings up a whole new area. I'll say biome—my son's super into Minecraft and I hear about biomes all the time—a whole new spectrum of where these things could happen and an increased need for that awareness of what people should look for, how we're going to treat it, and then counteracting some of the silos and making sure patients have the correct information that they might need.

Muskan Joshi: Everything you guys just talked about really stuck out to me. It's super important to talk about the toxicities, and we need proper transparency with our patients. I think that's super important for patients to be aware that although immunotherapy is awesome, it's not just going to replace chemotherapy. They have their own different sets of side effects. I'm going to be thinking about this for a while, is all I can say.

Since we're all talking about what we're passionate about in research, as I said, I'm still in my training. I have been interested in a lot of things, but something that truly sticks out to me in oncology is epigenetics. When I studied it in my first and second year of med school, I was blown away. I was like, "No way. I had no idea that you could somehow silence our genes, or you could somehow activate our genes in different ways." I have been doing a lot of my own reading and research. What I'm really interested in is seeing epigenetic therapy, how we can silence or express certain genes and what targets could perhaps be involved in cancer genesis. It's very interesting to me because epigenetic modifications can go on for generations. They can be present in certain generations but won't be present in others.

What are the factors? Are they cultural? Are they emotional? Are there some forms of stressors? What are the environmental factors? Maybe it's your diet. It can be a multitude of reasons. I'm really, really passionate about how epigenetics may somehow involve this. We obviously know the role of epigenetics in cancer, but I don't think we know it to the extent where we can leverage its use and leverage its strength in treatment. Obviously, this is a huge field, our genome. There's so much to see and so much we don't know, but this is just yet another unexplored area. Obviously, there's tons of research, but I feel like there's so much more that we could do with epigenetic targets, epigenetic therapeutics, and how these may transfer over the generations. What are the certain factors? I'm super interested in that. Maybe in the future I could perceive researching something in this, who knows?

Another thing I've been reading about lately is artificial intelligence (AI). I'm sure we all know the revolution that is ChatGPT. I really believe that where we are right now is level one of AI. In the next 10 years, we are going to see a huge transformation in AI and how we use it. I don't believe AI is going to take our doctors, but what I do believe is that it's going to augment medicine and health care as we know it. I've read a lot of studies which talk about how AI and radiologists combined have a greater diagnostic strength compared to AI alone and radiologists alone. I've read studies in breast cancer research and many other different types of cancers.

So how can we leverage the strength of AI and augment cancer therapy across the world, whether it be in risk stratification, patient decision, et cetera? There are so many different aspects that we could explore this in. AI is just an amazing, amazing tool. I don't believe it's here to kick us out. I believe it's here to augment mankind in a way we've never known before. I'm really passionate and interested in the application of AI to augment oncological health care. I believe it has a great potential. So, these are the two fields I'm super interested in. Who knows, maybe we could look further into how AI could help in seeing various epigenetic targets, identifying them, and treating them. Maybe we could combine them. Who knows? It's just something I'm interested in and something I believe we should be putting finances into. It's unexplored, and I believe it's something worth looking into.

Gayathri Menon: Thank you so much. I've really enjoy talking with all of you and listening to all of your points. The field that I'm interested in, and I think could use a deeper perspective as well is pediatric oncology. I'm really, really interested in pediatrics. According to statistics, when we compare the 1970s to right now, the five-year survival rate for pediatric cancer patients around then was about 58%. Right now, we're well above 80%. I think it has a lot to do with how far we have come in terms of pediatric care and oncological care diagnosis and different treatments as well. A lot of credit goes to immunotherapies and CAR T cells and all that. But I also think it really depends on how fast we catch it, especially when it comes to pediatric patients.

Just talking a little about patient advocacy as well, according to studies, there's a huge financial burden upon the parents when their child is diagnosed with cancer, especially in the first year. I think physician, patient, and parent relationships have to be really emphasized when it comes to patient care in pediatric oncology. I think we need to find a good plan in terms of health care insurance, in terms of the prognosis and different types of treatments that we can use for pediatric patients. I think this is something that I would really love to hear an expert come and speak about. It's something I've read a lot about, and I'm just really excited to do more in this field.

Maduri Balasubramanian: I love all of your topics that were shared so far. Personally, for me, something that's really important is advanced pain management. We've seen so many changes in techniques other than over-the-counter medications and opioids. Now we're seeing neuromodulation of pain as well. How can each of these techniques further improve, and how they are constantly emerging? How can they help? We're seeing more peripheral nerve stimulation, acupuncture, and even spinal cord stimulation. Can these approaches be employed for all areas, or are they more specific? Can it actually address the significant unmet clinical need that's required? How can this further help with postoperative care or patients who are in remission? How can it help ease their lives, as well? Knowing how these techniques can help and be a significant part of cancer pain management is honestly something I'm really interested in.

To continue with that, in terms of postoperative functioning, I really believe that something that we should invest in is mapping. We're already seeing it in so much for neurosurgery as to preserve brain function itself. But if we can actually have something that can help us track how the spread is happening inside, this might actually make it easier and can help to preserve the whole functioning of certain parts and improve the patient's ease and comfort as well. Maybe having something to identify and thoroughly understand the connectivity can actually improve the patient's treatment care and planning as well. These are some of the points that I'm truly interested in and would love to learn more about and get more opinions on as well.

Keira Smith: Dr. Mouabbi, I know you've done a ton of research in lobular breast cancer. We have an interview coming up next week actually for Breast Cancer Awareness Month about some of this. Any particular topics in breast cancer or lobular in particular that you're passionate about discussing?

Dr. Mouabbi: Yes, breast cancer is an ever-evolving field, to be honest. A lot of research is always being conducted and published. It's important to go through that research, because a lot of the time, companies want you to think it's practice-changing and things like that. But it's important to go through the details of each study and really tease out if it's truly beneficial. Sometimes, statistical significance is not clinical significance. It's important to go through those and better understand whether it's truly practice-changing and how it will change the field.

For lobular specifically, yes, it's an emerging field. Unfortunately, at this point in time, there are not many clinical studies happening. We're trying to change that by opening some investigator-initiated trials (ITTs) at my institution and at other institutions. In the next few years, we'll definitely be getting more and more research specific to lobular breast cancer, and I'll be happy to discuss them when the time comes.

Keira Smith: Awesome. These are all amazing topics and avenues that we can go down in the future. There's definitely a lot of fodder for future episodes.

Muskan Joshi: I'm beyond excited to see where this collaboration leads us. I'm so happy to be having this conversation with all of you today on this amazing, amazing panel. That's all I have to say.

Keira Smith: Likewise, I'm really excited for everything we're going to be able to do with this and for talking with all of you more as time goes on. Again, thank you all so much for coming on today. This was a really fantastic conversation, and again, I'm looking forward to seeing where all this goes. So thank you again.

Dr. Mouabbi: Thank you.

Dr. Hadfield: Awesome, thank you so much. Take care.

Transcript edited for clarity. Any views expressed above are the speakers' own and do not necessarily reflect those of Oncology Data Advisor.