Peer Exchange

Kevin Harrington, MBBS, PhD, FRCP, FRCR; Will Ince, MRCP, FRCR; and Ross Merkin, MD, discuss first-line strategies for recurrent or metastatic head and neck squamous cell carcinoma, including how human papillomavirus status shapes tumor biology and testing, efficacy and safety data for emerging epidermal growth factor receptor-directed combinations, toxicity management, dosing and administration, and treatment sequencing.

In this OncLive Peer Exchange, moderator Tanios S. Bekaii-Saab, MD, leads a discussion with Shiraj Sen, MD, PhD; Paul E. Oberstein, MD; Anne Noonan, MB BCh, PhD; and Jonathan Lee, MD, on RAS-driven metastatic pancreatic ductal adenocarcinoma, covering the biology behind RAS inhibition, the design and outcomes of the phase 3 RASolute 302 trial of daraxonrasib, practical prevention and management of adverse events, patient selection and counseling, molecular testing, and the future of RAS-targeted therapy.

This peer exchange convenes a multidisciplinary panel to examine how refractory chronic graft-versus-host disease is treated and coordinated across care settings. The discussion establishes where the field stands today, describing the shift from a steroid-only approach toward mechanistically distinct targeted therapies and evolving goals: minimizing steroid exposure, preserving organ function, improving quality of life, and achieving durable disease control. Faculty compare the systemic and non-pharmacologic options in steroid-refractory disease across mechanism, pivotal evidence, and clinical trade-offs, addressing sequencing, tolerability-driven decisions, patient-reported outcomes, and realistic goals of therapy. The program then turns to the practical work of coordinating infusion-based care, walking through administration logistics, monitoring, and the transition from transplant center to local oncology or home infusion. Faculty stress that transitioning care is not transferring management, sharing approaches to handoff communication, telemedicine, access barriers, and caregiver burden, before a forward look at individualized treatment.

In this OncLive Peer Exchange®, a panel of experts discusses the evolving treatment landscape for relapsed/refractory multiple myeloma (RRMM), with a focus on the expanding role of BCMA-directed bispecific antibodies and antibody-drug conjugates. Dr. Hans Lee, Dr. Paul Richardson, Dr. Jing Christine Ye, and Dr. Douglas Sborov examine how these therapies compare with CAR T-cell therapy in terms of mechanism, administration, toxicity, and practical use. The discussion highlights longer-term efficacy and durability data from the LINKER-MM1 and DREAMM clinical programs, including response depth, progression-free survival, and outcomes in patients with high-risk disease features. The panel also explores how disease burden, treatment urgency, access, manufacturing timelines, patient preferences, and toxicity profiles influence treatment selection and sequencing in RRMM. Additional discussion addresses emerging combination and earlier-line strategies, management of treatment-related toxicities, outpatient implementation, real-world considerations, and the importance of balancing treatment efficacy with safety and patient quality of life.

In this OncLive Peer Exchange, Dr. Jacob Sands, Dr. Narjust Florez, Dr. Christian Rolfo, and Dr. Edward Kim discuss the evolving treatment landscape for patients with advanced squamous non-small cell lung cancer (NSCLC) whose disease progresses following frontline immunotherapy and platinum-based chemotherapy. The panel reviews the current role of docetaxel, with or without ramucirumab, and examines why treatment advances in squamous NSCLC have historically lagged behind those in nonsquamous disease. The discussion explores emerging approaches under investigation in the post-immunotherapy setting, including antibody-drug conjugates, bispecific therapies, novel immunomodulatory strategies, and next-generation CTLA-4-directed agents. Particular attention is given to the mechanistic rationale, efficacy findings, safety considerations, and interpretation of early clinical data for newer CTLA-4 approaches, including gotistobart. The panel also discusses patient selection, genomic testing, treatment sequencing, chemotherapy-free strategies, toxicity monitoring, community management, clinical trial referral, and anticipated developments in advanced squamous NSCLC.

In this OncLive Peer Exchange filmed at the World Conference on Lung Cancer 2026, a panel of thoracic oncology specialists tackles the rapidly evolving treatment landscape for EGFR-mutant non-small cell lung cancer from frontline decision-making through progression and beyond. Across eight episodes, the panel covers how to choose between monotherapy and combination regimens, how tumor features like brain metastases and TP53 co-mutation shape intensification decisions, what new data from key trials mean for adjuvant and frontline practice, how to approach resistance at progression, and where the field is headed for historically underserved populations like exon 20 insertion patients. With a focus on practical, individualized decision-making and real-world applicability, this program delivers clinically grounded insights for oncologists managing this disease at every practice setting.

Dr. Shreyas Kalantri of University of Cincinatti moderated a discussion with Dr. Jia Luo of Dana-Farber Cancer Institute and Dr. Matthew Karr of Rutgers Cancer Institute unpack how RAS inhibitors and bispecific antibodies are reshaping subsequent-line treatment, quality of life, and toxicity management across solid tumors and hematologic cancers.

Dr. Zunairah Shah of Roswell Park Comprehensive Cancer Center moderated a discussion with Dr. Jia Luo of Dana-Farber Cancer Institute and Dr. Yu-Wei Chen of UC San Diego to break down ASCO 2026's most practice-changing data — from perioperative prostate cancer results to a pan-RAS inhibitor breakthrough in pancreatic cancer.

Dr. Misty Shields from Indiana University moderated a discussion with Dr. Ditte Primdahl, neuro-oncologist at Northwestern University, and Dr. Triparna Sen from The Ohio State University Comprehensive Cancer Center on cancer-associated Lambert-Eaton myasthenic syndrome (CA LEMS) in small cell lung cancer (SCLC).

CA LEMS is a paraneoplastic neuromuscular junction disorder characterized by proximal muscle weakness, hyporeflexia, and autonomic dysfunction, arising from autoantibodies against presynaptic voltage-gated calcium channels (VGCCs). Despite estimated prevalence of 3% to 6% in SCLC, CA LEMS is diagnosed in under 1% of patients in real-world practice. The program addresses clinical recognition, differential diagnosis from treatment-related toxicities, VGCC antibody testing including seronegative cases, electrodiagnostic studies, the 2025 NCCN guideline update, amifampridine (Firdapse) as FDA-approved symptomatic treatment, immune checkpoint inhibitor safety considerations, and optimal multidisciplinary care models. Evidence gaps including prospective prevalence data, immune checkpoint inhibitor safety in CA LEMS, and validated patient-reported outcome instruments are identified as priority research needs.

This OncLive® Peer Exchange brings together a panel of breast medical oncologists to examine the rapidly evolving role of antibody-drug conjugate therapy in metastatic triple-negative breast cancer. Moderated by Dr. Tiffany Traina, the discussion reviews the clinical characteristics and natural history of mTNBC and contextualizes TROP2-directed ADCs within the current standard-of-care paradigm and updated guideline recommendations. The panel examines efficacy, safety, and patient-reported outcomes from pivotal first-line trials, exploring meaningful differences in trial design, patient populations, and the clinical relevance of primary and secondary endpoints. The conversation also addresses practical approaches to adverse event management, patient experience, and individualized treatment sequencing, incorporating patient-specific factors and emerging combination data. Throughout, the faculty translate complex evidence into actionable perspectives for community and academic oncology care teams managing this aggressive disease, where therapeutic windows are often narrow and thoughtful, biomarker-informed decision-making is essential to optimizing outcomes for patients.

Dr. Aman Chauhan from UCSF moderated a discussion with Dr. Andrew Hendifar from Cedars-Sinai Medical Center, Dr. Heloisa Soares from University of Utah Health, and Dr. Ghassan El-Haddad from Moffitt Cancer Center on the emerging regulatory and nomenclature landscape for radioligand therapy in neuroendocrine tumors (NETs).

The program introduced the term radioligand equivalent (RLE) to describe products approved through the FDA's 505(b)(2) pathway, a mechanism accounting for 55% of new drug applications approved between 2020 and 2024, yet unfamiliar to many clinicians. The discussion distinguished RLEs from both novel reference-listed drugs (approved via 505(b)(1)) and generics (approved via abbreviated new drug application), explained the scientific bridging requirements, and explored practical implications for formulary decisions, multidisciplinary communication, staff education, and patient counseling.

Key themes included supply chain resilience, institutional infrastructure preparation for different waste-handling requirements between carrier-added and non-carrier-added products, barriers to RLE adoption, and the potential for RLE terminology and the 505(b)(2) pathway to accelerate innovation across an expanding radioligand therapy landscape.

Dr. Jason Westin moderated a comprehensive discussion with Drs. Tara Graff, Patrick Connor Johnson, and Matthew Lunning on the rapidly evolving DLBCL treatment landscape.

The program addressed two major positive Phase 3 trials now shaping frontline practice: POLARIX establishing polatuzumab vedotin-R-CHP as a first standard beyond R-CHOP, and the frontMIND trial demonstrating tafasitamab-lenalidomide-R-CHOP superiority across cell-of-origin subtypes and risk groups (IPI 3-5), with over 10% progression-free survival benefit in centrally confirmed patients.

Key discussions included treatment sequencing between these enhanced regimens, management of double-hit lymphomas, elderly patient considerations, interim PET and ctDNA interpretation, and the downstream consequences of frontline CD19-directed therapy on subsequent options including anti-CD19 CAR-T cell therapy.

The relapsed/refractory landscape section covered the EPCORE DLBCL-1 trial results for epcoritamab, outpatient bispecific antibody administration, bispecific agent differentiation, second-line CAR-T access barriers, CNS prophylaxis strategies, and cost-access considerations. Future directions emphasized frontline bispecific trials and novel-novel combinations.

Dr. Marc Hoffmann from University of Kansas moderated a comprehensive discussion with Drs. Catherine Coombs, Andrew Lipsky, Sameer Parikh, and Mazyar Shadman on optimizing CLL treatment strategies in 2026.

The program covered the two dominant frontline strategies: continuous covalent BTK inhibitor therapy (zanubrutinib or acalabrutinib) and fixed-duration venetoclax-based combinations including venetoclax-obinutuzumab and the recently approved acalabrutinib-venetoclax. Patient preference, molecular risk features (TP53 aberrations, IGHV mutational status), comorbidities, disease bulk, and logistical considerations collectively guide individualized treatment selection.

Key data highlights included CLL14 9-year follow-up showing median progression-free survival of approximately 6 years overall and 8.5 to 9 years for IGHV-mutated patients, SEQUOIA 6-year zanubrutinib data, and the CLL17 trial confirming non-inferiority of fixed-duration regimens versus continuous ibrutinib. Sonrotoclax's emerging 98% undetectable MRD rates in combination with zanubrutinib generated substantial discussion about potential paradigm shifts. BTK degraders, CAR-T therapy, and Richter's transformation management represent exciting pipeline developments.

This OncLive Peer Exchange brings together leading thoracic oncologists to examine the evolving treatment landscape for ALK-positive and KRAS G12C-mutant non-small cell lung cancer (NSCLC). The discussion opens with the biology and clinical identification of ALK-rearranged disease, covering molecular testing strategies, first-line treatment selection, and long-term disease monitoring. Faculty reviewed mature 7-year data from the CROWN trial, examining durability of progression-free survival and intracranial disease control, alongside long-term safety considerations associated with extended ALK inhibitor therapy. The conversation then shifts to KRAS G12C-mutant NSCLC, where panelists discuss emerging combination strategies, patient selection across the PD-L1 spectrum, and the biological rationale for pairing targeted inhibition with immunotherapy. The program concludes by addressing broader unmet needs in the second-line NSCLC setting, including adjuvant data in RET fusion-positive disease and the evolving role of antibody-drug conjugates. Panelists offer practical, real-world perspectives on testing, sequencing, and patient management throughout.

Dr. Benjamin Levy from Johns Hopkins led a comprehensive peer exchange with thoracic oncologists Drs. Ross Camidge, Julia Rotow, Siddhartha Devarakonda, and Gilberto Lopes discussing the evolving landscape of EGFR-mutant advanced non-small cell lung cancer treatment post-ELCC 2026.

The program addressed the transformation from simple osimertinib monotherapy to complex decision-making involving three frontline options: osimertinib alone, FLAURA-2 (osimertinib plus chemotherapy), and MARIPOSA (osimertinib plus amivantamab). Key discussions centered on risk stratification using TP53 mutations, CNS disease, and ctDNA levels to guide treatment intensification decisions.

Second-line strategies comparing COMPEL versus MARIPOSA-2 regimens highlighted ongoing challenges in sequencing therapies. The panel explored subcutaneous amivantamab's impact on tolerability, emerging resistance mechanisms including MET amplification, and the role of antibody-drug conjugates like datopotamab deruxtecan.

Patient-reported outcomes, shared decision-making, and personalized approaches based on molecular profiling emerged as critical themes. The discussion emphasized balancing efficacy gains with quality of life considerations while advancing toward cure through novel combinations and resistance prevention strategies.

In this OncLive Peer Exchange filmed at ASCO 2026, a panel of uveal melanoma experts examines the full clinical landscape of metastatic uveal melanoma, from molecular workup and HLA testing at diagnosis through the latest long-term survival data and the real-world challenges of getting eligible patients to effective therapy. Across twelve episodes, the panel covers disease biology, treatment sequencing, bispecific T-cell engager therapy, toxicity management, and academic-community collaboration, with a focus on practical takeaways for oncologists at every practice setting.

Dr. John Strickler from Duke Cancer Institute moderated a comprehensive discussion with Drs. Eleonora Teplinsky, Benjamin Weinberg, Petros Grivas, and Luis Raez on integrating circulating tumor DNA (ctDNA) and minimal residual disease (MRD) testing across breast, colorectal, bladder, and lung cancers.

The panel established foundational concepts distinguishing tumor-informed from tumor-naïve assays, emphasizing that ctDNA positivity represents a prognostic marker across tumor types, with bladder cancer having the strongest predictive evidence following FDA approval based on the IMvigor011 trial. Discussion addressed practical challenges including reimbursement inconsistencies, patient communication strategies for asymptomatic positive results, and the treatment on molecular recurrence (TOMR) paradigm.

Tumor-specific data highlighted the GALAXY and BESPOKE CRC observational studies for colorectal cancer, SURVIVE and iSPY trials for breast cancer, and emerging whole-genome sequencing approaches for lung cancer. Panelists emphasized that although de-escalation strategies show promise, particularly in stage II colorectal cancer, intensification trials have been largely disappointing. The discussion concluded with calls for prospective randomized data, clinical trial enrollment, and addressing clonal hematopoiesis as a key technical challenge requiring resolution before widespread guideline adoption.

Dr. Joshua Sabari from NYU Langone moderated a comprehensive discussion with Drs. Anne Chiang, Jacob Sands, Misty Shields, and Ticiana Leal on evolving maintenance strategies for extensive-stage small cell lung cancer (ES-SCLC).

The program centered on the IMforte trial, demonstrating that lurbinectedin plus atezolizumab maintenance reduced progression risk by 46% and death risk by 27% versus atezolizumab alone, with median overall survival benefit of approximately 3 months from randomization. The panel addressed practical considerations including myelosuppression management, G-CSF prophylaxis, and patient selection criteria excluding those with brain metastases or ECOG performance status above 1.

Significant attention focused on tarlatamab, a DLL3-targeted bispecific T-cell engager showing remarkable second-line efficacy (DeLLphi-304) and promising first-line maintenance data (DeLLphi-303) with 82% 1-year overall survival, with the phase 3 DeLLphi-305 trial ongoing.

The discussion emphasized individualized treatment approaches, multidisciplinary palliative care integration, brain metastasis surveillance strategies, and the evolving role of platinum rechallenge. Panelists highlighted the importance of early, aggressive treatment given high patient attrition rates and discussed emerging therapies including antibody-drug conjugates and radioligand therapies.

An expert panel reviews the evolving treatment landscape for advanced neuroendocrine tumors, examining CABINET trial efficacy and safety data alongside practical guidance on cabozantinib sequencing, dosing, and adverse-event management.

Dr. Jason Sicklick from UC San Diego moderated a comprehensive discussion with sarcoma experts on evolving GIST treatment strategies, marking the first major shift in 6 years since ripretinib's approval. The panel explored the established 4-line sequence: imatinib first-line, sunitinib second-line, regorafenib third-line, and ripretinib fourth-line post-3 TKI progression.

Key highlights included PEAK Phase 3 trial results demonstrating bezuclastinib plus sunitinib combination therapy's superiority over sunitinib monotherapy, with median progression-free survival extending from 9.2 to 16.5 months (HR 0.50, P < 0.0001). The combination doubled objective response rates from 26% to 46% while maintaining manageable toxicity profiles.

The discussion emphasized mutation-guided therapy selection using ctDNA analysis, particularly for patients with KIT exon 11 plus secondary mutations in exons 13/14 versus 17/18. Panelists addressed practical community oncology challenges including molecular testing accessibility, toxicity management across treatment lines, and avoiding treatment gaps that can accelerate disease progression.

Future directions include first-line combination strategies and resistance mechanism understanding to optimize sequencing decisions.

In this OncLive® Peer Exchange, moderator Zev Wainberg, MD, MSc (David Geffen School of Medicine at UCLA, Santa Monica, CA) is joined by panelists Elena Elimova, MD (Princess Margaret Cancer Centre, Toronto, ON); Manish A. Shah, MD (Weill Cornell Medicine, New York, NY); and Raj Shameem, MD (Orlando Health Cancer Institute, Orlando, FL) for a discussion on evolving first-line treatment strategies in HER2-positive metastatic gastroesophageal adenocarcinoma (GEA). The panel unpacks the phase 3 HERIZON-GEA-01 trial of zanidatamab plus chemotherapy and zanidatamab plus tislelizumab plus chemotherapy versus trastuzumab plus chemotherapy, addressing the biparatopic mechanism of zanidatamab, interpretation of PD-L1 tumor area positivity (TAP) and combined positive score (CPS) data, HER2 heterogeneity and retesting at progression, proactive diarrhea prophylaxis, second-line sequencing with trastuzumab deruxtecan (T-DXd), upcoming trials (ARTEMIDE-Gastric01, DESTINY-Gastric05, HLX22), and patient-facing conversations. Tailored for community and academic oncologists, board-certified oncology pharmacists (BCOPs), and multidisciplinary oncology care teams.

In this OncLive Peer Exchange filmed live at SGO 2026 in San Juan, Puerto Rico, Robert M. Wenham, MD, MS is joined by Premal H. Thaker, MD, MS, Tiffany M. Redfern, MD, FACOG, and Gottfried E. Konecny, MD, for an expert discussion on practice-changing advances in endometrial cancer, including long-term RUBY trial data, biomarker-driven treatment selection, real-world evidence, second-line sequencing, and the future of immunotherapy and targeted therapy in this rapidly evolving field.

Expert faculty examine the evolving role of antibody-drug conjugates in endometrial, ovarian, and cervical cancers, with discussion focused on biomarker-driven treatment selection, sequencing strategies, toxicity management, and emerging targets poised to further reshape care.

In this OncLive Peer Exchange, Dr. Mohamed Abdelbaki (Washington University, St. Louis) moderates a panel with Dr. Susan Chi (Dana-Farber Cancer Institute), Dr. Murali Chintagumpala (Texas Children's, Houston), and Dr. Ashley Margol (Children's Hospital Los Angeles) on treatment decision-making in pediatric low-grade glioma (PLGG).

The panel of experts will explore opportunities for how circulating tumor DNA and molecular residual disease testing are reshaping risk assessment and treatment decision-making across genitourinary malignancies, with a primary focus on muscle-invasive bladder cancer. They will discuss how emerging molecular data informs response evaluation, sequencing strategies, escalation and de-escalation decisions, and the evolving role of liquid biopsy in real-world clinical practice.

This expert-led oncology program features Dr. Hope Rugo, Dr. Aaron Lisberg, Dr. Neel Pasricha, Dr. Sarah Sunshine, Liz Castronovo, NP, and Stephanie McDonald, NP, who provide a clinically focused discussion on adverse events associated with antibody–drug conjugates (ADCs) in breast and lung cancer. The discussion synthesizes emerging clinical trial data and real‑world experience to guide frontline clinicians in preventing, identifying, and managing key toxicities. Dr. Lisberg outlines pulmonary risk assessment and ILD monitoring strategies. Dr. Rugo provides breast cancer–specific risk considerations and treatment‑modification guidance. NPs Castronovo and McDonald emphasize patient education, symptom triage, and practical toxicity‑management workflows. Drs. Sunshine and Pasricha explain ocular toxicity mechanisms, evaluation, and coordination between oncology and ophthalmology.

Key themes include proactive monitoring, multidisciplinary collaboration, patient‑centered education, and personalized dose‑modification strategies. The program is designed to support oncology clinicians in translating evolving ADC safety data into evidence‑based clinical practice.

This OncLive Peer Exchange featured Drs. Julia Rotow, Ticiana Leal, Estelamari Rodriguez, and Ignacio Wistuba discussing optimal care strategies for patients with ROS1-positive non-small cell lung cancer. Key topics included comprehensive testing importance incorporating DNA and RNA next-generation sequencing to avoid missing actionable fusions, understanding that circulating tumor DNA serves as a useful adjunct but cannot replace tissue-based testing for definitive diagnosis.

The discussion highlighted significant therapeutic evolution from first-generation agents like crizotinib with limited central nervous system activity to modern selective inhibitors like taletrectinib offering remarkable durability with progression-free survival exceeding 45 months. Central nervous system activity emerged as critical, allowing systemic therapy to replace radiation in many patients and significantly impacting long-term outcomes.

Safety profiles differ substantially between agents, requiring clinician familiarity with unique toxicity patterns for optimal patient management. The panelists emphasized that while ROS1 fusions are rare, occurring in 1% to 2% of patients with non-small cell lung cancer, identifying these alterations transforms patient outcomes with potential for sustained disease control and excellent quality of life lasting many years.

Panelists discuss the evolving management of metastatic castration-sensitive prostate cancer, with a focus on how patient complexity, long-term survivorship, and emerging evidence are shaping treatment intensification strategies. They explore practical considerations that inform selection of androgen receptor pathway inhibitors, review data from both clinical trials and real-world studies, and share perspectives on optimizing tolerability and quality of life in everyday practice.

Evolving Treatment Sequencing and Practical Management in Advanced Renal Cell Carcinoma features expert discussion led by Dr. Sumanta (Monty) Kumar Pal, with insights from Ulka N. Vaishampayan, MD; Vincent Xu, MD; Alan Tan, MD; and Matthew T. Campbell, MD. Together, the panel examines how advanced RCC is managed across the disease continuum, from risk stratified frontline decision making and evolving adjuvant strategies to second line sequencing. The program emphasizes real world interpretation of progression, thoughtful integration of newer regimens, and practical toxicity management to support individualized, long term patient care.