What Oncologists and “Mathletes” Have in Common During 2025
Expert Perspectives · Rahul Banerjee, MD, FACP · 2025-01-07
As we step into 2025, the unique mathematical significance of this year provides a thought-provoking backdrop for exploring advancements in oncology. In this Letter From the Editor, Dr. Rahul Banerjee, Editor in Chief, discusses how the “prime factors” of oncology—safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—can shape the future of cancer care, highlighting novel treatment modalities like bispecific antibodies and their potential to improve both efficacy and equity in real-world applications.
2025: A Perfect Square
I’m willing to guess that over 50% of you reading this column have heard the word “mathlete” before: in brief, someone who competes in mathematics competitions. If you’d asked me two decades ago (in the prime of my mathlete years) what came to mind when I thought of 2025, I’d have answered immediately—it’s a perfect square! Not only that, but it is the product of several sets of perfect squares: 452 x 12 = 152 x 32 = 92 x 52. Ultimately, the prime factorization is what matters: 2025 equals 34 x 52 when broken down into its prime factors.
“Prime Factors” in Oncology
Oncology has its own set of prime factors that drive the quality of healthcare delivery. As summarized in a 2015 position paper by the American Society of Clinical Oncology (ASCO), they are: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. Our focus on efficacy and tolerability as oncologists glosses over the overlapping sets of prime factors that drive these two processes. For example, real-world efficacy includes the principles of timeliness and equity that are so often lacking in clinical trials. Real-world tolerability includes not only safety but also the patient-centeredness of a drug’s dosing schema to allow for dose modifications as necessary.
Improving Equity With Novel Treatment Modalities
In 2025, I expect these types of discussions even more increasingly as novel treatment modalities continue to take root. Take bispecific antibodies (bsAbs), for instance: while originally limited to hematologic malignancies, they now have approvals in uveal melanoma and small-cell lung cancer.
In my own field of multiple myeloma, I have been happy to see various companies’ bsAb trial protocols race to de-escalate treatment frequency from weekly dosing to monthly and even less. Obviously, de-escalating bsAb dose frequency improves the safety and efficiency of care. However, based on emerging data around T-cell exhaustion, de-escalation may actually improve efficacy as well. Similarly, given the disparities inherent to relapsed/refractory multiple myeloma, de-escalating bsAb dosing in far-residing patients can also be an important step to improve the equity of care.
Evidently, the efficacy and tolerability of cancer treatment regimens are not always as straightforward as they seem. Less is often more in cancer care, and a focus on simplifying the logistics of treatment can move the needle on a drug’s long-term success even more than any dose optimization. Simplifying a complex problem into simple equations is of course a skill that any good “varsity mathlete” possesses.
Oncology Trends for 2025
As 2025 starts and throughout the year, I hope to see continued efforts by drug companies, regulatory agencies, and academic consortia to better understand the prime factors that explain how active and practical a cancer drug is in real-world settings. As 2026 will be a lot less interesting of a year mathematically (2 x 1013, and that’s it), this is our prime year to be curious!