Clinical Advances in Hematology & Oncology

November 2020 - Volume 18, Issue 11

Letter From the Editor: Evolving Roles for Surgery, Systemic Agents, and Radiation

Richard R. Furman, MD


What is the role of surgery in the management of advanced epithelial ovarian cancer? This important question is explored in a review article in this month’s issue of Clinical Advances in Hematology & Oncology. Drs Alli Straubhar, Dennis S. Chi, and Kara Long Roche address the controversial roles of neoadjuvant chemotherapy in the primary setting and surgical cytoreduction in the recurrent setting. The review covers the timing of surgery, the best way to optimize surgical outcomes, the best approach to surgery, the use of hyperthermic intraperitoneal chemotherapy, and the importance of patient preference in treatment decisions. The authors conclude that “new inquiries should focus on maximizing the availability of safe and high-quality surgical debulking for the majority of patients.”

Our other review article highlights the role of antibody-based therapies in the treatment of multiple myeloma, which is in need of therapeutic strategies that possess highly selective mechanisms of action. Drs Cindy Varga, Johannes M. Waldschmidt, Sara Gandolfi, and Paul G. Richardson discuss the clinical value, significant potential, and possible limitations of anti-SLAM7 agents, anti-CD38 agents, and antibodies to other antigens in promoting longer overall survival among patients with this incurable disease. They also discuss the research on checkpoint inhibitors, bispecific T-cell engagers, and antibody-drug conjugates in multiple myeloma. 

Our hematology coverage continues with an interview with Dr Gautam Borthakur on evolving strategies for the management of core-binding factor AML. This form of leukemia is characterized by translocation 8;21, inversion 16, and a lower degree of mutational complexity than other AMLs. Fortunately, core-binding factor AML is highly sensitive to chemotherapy; patients have a good prognosis, with much higher remission rates than those seen in other types of AML. 

Moving on to melanoma, Dr Vernon Sondak discusses the use of molecular testing at the time of melanoma diagnosis. Can we skip the sentinel node biopsy in certain patients on the basis of the results of a molecular test? For Dr Sondak, the answer is no—it’s just not worth taking the risk of missing a positive biopsy result because of a false-negative molecular test result. That equation will change, however, if a validated test becomes available.

This issue also includes an interview with Dr Bridget F. Koontz, who addresses the role of radiation treatment in metastatic prostate cancer. On the basis of results in arm H of the STAMPEDE trial, she now considers irradiation to be a standard of care in men with low-volume, newly diagnosed metastatic prostate cancer. As for radiation to the metastases, that remains an area of debate. 

Finally, in “Beyond the Package Insert,” Dr Aditya Bardia takes a closer look at the antibody-drug conjugate sacituzumab govitecan-hziy, which recently received accelerated approval as a third-line or later treatment in patients with metastatic triple-negative breast cancer. Future trials will examine whether this agent can be used in first- or second-line treatment in these patients, or as neoadjuvant or adjuvant therapy in those with localized breast cancers.

May this issue provide you with helpful information that you can put to good use in your clinical practice. 


Richard R. Furman, MD