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Simple Summary: Despite early utilization of new hormonal agents (NHA, i.e., abiraterone, enzalutamide and apalutamide) for combined androgen deprivation therapy (ADT) for metastatic prostate cancer, increasingly more men are dying from this disease. While continued development of new drugs is needed, we propose that improved survival of metastatic prostate cancer can be obtained through evolutionarily informed treatment strategies that adjust patient-specific-dosing to their current and past Prostate Specific Antigen (PSA) levels. Compared to the conventional treat-until-progression paradigm, our previous study in metastatic castration resistant prostate cancer (NCT02415621) showed that an on-and-off abiraterone therapy adapted to an individual's PSA response dynamics provided better cancer control with less drug usage. Here, we report the feasibility of applying this strategy to newly diagnosed metastatic prostate cancer. On-and-off ADTs with luteinizing hormone releasing hormone (LHRH) analog, an NHA, or in combination were based on individual's testosterone and PSA levels. The current study represents the foundation for future efforts to validate our adaptive therapy in randomized controlled studies for metastatic prostate cancer. Background: We hypothesize that cancer survival can be improved through adapting treatment strategies to cancer evolutionary dynamics and conducted a phase 1b study in metastatic castration sensitive prostate cancer (mCSPC). Methods: Men with asymptomatic mCSPC were enrolled and proceeded with a treatment break after achieving > 75% PSA decline with LHRH analog plus an NHA. ADT was restarted at the time of PSA or radiographic progression and held again after achieving >50% PSA decline. This on-off cycling of ADT continued until on treatment imaging progression. Results: At data cut off in August 2022, only 2 of the 16 evaluable patients were off study due to imaging progression at 28 months from first dose of LHRH analog for mCSPC. Two additional patients showed PSA progression at 12.4 and 20.5 months and remain on trial. Since none of the 16 patients developed imaging progression at 12 months, the study succeeded in its primary objective of feasibility. The secondary endpoints of median time to PSA progression and median time to radiographic progression have not been reached at a median follow up of 26 months. Conclusions: It is feasible to use an individual's PSA response and testosterone levels to guide intermittent ADT in mCSPC. [ABSTRACT FROM AUTHOR]

Oncologist well-being is critical to initiating and maintaining the physician-patient relationship, yet many oncologists suffer from symptoms of burnout. Burnout has been linked to poor physical and mental health, as well as increased medical errors, patient dissatisfaction, and workforce attrition. In this Call to Action article, we discuss causes of and interventions for burnout and moral distress in oncology, highlight existing interventions, and provide recommendations for addressing burnout and improving well-being at the individual and organizational levels to deliver ethical, quality cancer care. [ABSTRACT FROM AUTHOR]

Renal-cell carcinoma (RCC) remains a leading cause of cancer-related mortality worldwide. Though newer therapeutic combinations of immune checkpoint inhibitors and targeted therapies have greatly improved outcomes, resistance to these therapies is becoming a challenge for long-term control. Mechanisms of resistance have been explored in a variety of solid tumors, including RCC. Based upon our review of the current literature on the mechanisms of resistance to immunotherapies for the management of metastatic clear-cell renal cell carcinomas (mccRCC), the ensuing conclusions have been made: The management of mccRCC has progressed substantially with the advent of checkpoint inhibitors and targeted oral therapies, alone and/or in combination. Nevertheless, innate or developed resistance to these therapies remains an ongoing challenge, particularly to immune checkpoint inhibitors (ICIs). Several of the known mechanisms of resistance have been well defined, but recent progression in cellular therapies helps to expand the armamentarium of potential combination options that may overcome these modes of resistance and improve long-term disease control and survival for an otherwise dismal disease. In the ensuing review and update of the literature on the mechanisms of resistance to immunotherapies in mccRCC, we have revisited the known resistance mechanisms of immunotherapies in metastatic clear-cell RCC and explored ongoing and future strategies to overcome them., Competing Interests: Monica Chatwal has no conflicts of interest to report. Jad Chahoud reports advisory board consultation for Pfizer, Aveo, and Exelixis. Philippe Spiess has no conflicts of interest to report., (© The Author(s) 2023.)

Cancer is an inherently complex and intense medical condition that often requires prolonged treatment and surveillance over years. Treatments can lead to frequent side effects and anxiety, requiring constant communication and follow-up with patients. Oncologists have the unique privilege of developing close relationships with their patients that evolve through the course of their disease. The advent of newer technology and the changing landscape of medicine have drastically altered how oncologists now manage patient needs. These changes have allowed for much quicker and closer communication but are not without personal and professional challenges. Some may wonder how accessible they can and should be to their patients-essentially, the boundaries they may place to protect their own identities and well-being. An oncologist might wonder how much of their personal contact information they should provide to patients and how often they should be available for questions and discussions when away from the clinic without impairing their relationship. Here, we define and explore the role of boundaries in medicine, and review common ethical dilemmas that oncologists face daily when trying to balance patient care and lives outside of medicine. Although we recognize there is no clear single solution, we will propose possible approaches to setting boundaries and potential pitfalls.

Purpose: COVID-19 challenged medical practice and graduate medical education. Building on previous initiatives, we describe and reflect on the formative process and goals of the Hematology-Oncology Collaborative Videoconferencing Learning Initiative, a trainee-led multi-institutional virtual COVID-19 learning model., Methods: Clinical fellows and faculty from 13 US training institutions developed consensus needs, goals, and objectives, recruited presenters, and generated a multidisciplinary COVID-19 curriculum. Weekly Zoom conferences consisted of two trainee-led instructional segments and a trainee-moderated faculty Q&A panel. Hematology-oncology training program faculty and trainees were the targeted audience. Leadership evaluations consisted of anonymized baseline and concluding mixed methods surveys. Presenter evaluations consisted of session debriefs and two structured focus groups. Conference evaluations consisted of attendance, demographics, and pre- or postmultiple-choice questions on topic learning objectives., Results: In 6 weeks, the initiative produced five conferences: antivirals, anticoagulation, pulmonology, provider resilience, and resource scarcity ethics. The average attendance was 100 (range 57-185). Among attendees providing both pre- and postconference data, group-level knowledge appeared to increase: antiviral (n = 46) pre-/postcorrect 82.6%/97.8% and incorrect 10.9%/2.2%, anticoagulation (n = 60) pre-/postcorrect 75%/93.3% and incorrect 15%/6.7%, and pulmonary (n = 21) pre-/postcorrect 66.7%/95.2% and incorrect 33.3%/4.8%. Although pulmonary management comfort appeared to increase, comfort managing of antivirals and anticoagulation was unchanged. At the conclusion of the pilot, leadership trainees reported improved self-confidence organizing multi-institutional collaborations, median (interquartile range) 58.5 (50-64) compared with baseline 34 (26-39), but did not report improved confidence in other educational or leadership skills., Conclusion: During crisis, trainees built a multi-institutional virtual education platform for the purposes of sharing pandemic experiences and knowledge. Accomplishment of initiative goals was mixed. Lessons learned from the process and goals may improve future disaster educational initiatives., Competing Interests: Shonali MidhaStock and Other Ownership Interests: AbbVie, Moderna Therapeutics Jori MayStock and Other Ownership Interests: Roche, Novartis, Thermo Fisher Scientific Emily CollierResearch Funding: Mirati Therapeutics Nikesh ShahHonoraria: MJH Life Sciences Samuel RubinsteinHonoraria: SanofiConsulting or Advisory Role: Roche Jill GilbertLeadership: Tennessee OncologyHonoraria: UpToDate, Bayer, Loxo/Bayer, Exelixis, HRA PharmaConsulting or Advisory Role: Bayer, HRA Pharma, ExelixisResearch Funding: Pfizer, Exelixis Christine M. LovlyHonoraria: Novartis, Takeda, Pfizer, Cepheid, Foundation Medicine, AstraZeneca, Blueprint Medicines, Achilles Therapeutics, Lilly, Genentech, Syros Pharmaceuticals, Amgen, Roche, EMD SeronoConsulting or Advisory Role: Novartis, Foundation Medicine, Pfizer, Takeda, Cepheid, AstraZeneca, Blueprint Medicines, Achilles Therapeutics, Syros Pharmaceuticals, Genentech, Lilly, Amgen, EMD SeronoResearch Funding: Novartis, Xcovery, AstraZenecaTravel, Accommodations, Expenses: Pfizer, Takeda, Foundation Medicine, Novartis, Cepheid, Genentech Nagashree SeetharamuConsulting or Advisory Role: AstraZeneca, Genentech, Takeda, Amgen, Boehringer Ingelheim Deepa RangachariHonoraria: AstraZenecaConsulting or Advisory Role: Advance Medical, DynaMedResearch Funding: Bristol Myers Squibb, Novocure, AbbVie/StemcentrxOpen Payments Link: https://openpaymentsdata.cms.gov/physician/941245 Martina MurphyConsulting or Advisory Role: Pfizer Elizabeth HenryConsulting or Advisory Role: Seattle Genetics/AstellasResearch Funding: Seattle Genetics/Astellas, Bristol Myers Squibb, Nektar Frances CollichioResearch Funding: Amgen, Novartis, Merck, Replimune, NektarOther Relationship: ACGME Jennifer R. GreenHonoraria: Scripps HospitalTravel, Accommodations, Expenses: Scripps HospitalNo other potential conflicts of interest were reported.

Optimizing the well-being of the oncology clinician has never been more important. Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success. To date, 45% of U.S. ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization. As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout. In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability. Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health-related environmental, organizational, and psychosocial factors. These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology.