Oncology On The Go

The treatment paradigm for non–muscle invasive bladder cancer (NMIBC) has shifted considerably since the FDA established a formal definition of Bacillus Calmette-Guérin (BCG)–unresponsive disease, opening the door to a wave of new intravesical and gene therapies, according to Saum Ghodoussipour, MD.
In a conversation with CancerNetwork® on the Oncology On the Go podcast, Ghodoussipour, director of the Bladder and Urothelial Cancer Program at Rutgers Cancer Institute and associate professor of surgery at Robert Wood Johnson Medical School, discussed the distinction between real-world “BCG-exposed” disease and the FDA’s stricter, trial-oriented definition of BCG unresponsiveness. The agency’s definition accounts for persistent papillary disease, carcinoma in situ, or stage progression within specific timeframes following adequate BCG induction and maintenance.
Ghodoussipour walked through how the bladder-sparing armamentarium has expanded since 2020, when pembrolizumab (Keytruda) became the first novel agent approved for BCG-unresponsive disease. He detailed how nadofaragene firadenovec (Adstiladrin), nogapendekin alfa inbakicept-pmln (Anktiva), and TAR-200 (Inlexzo) have since given patients and clinicians a broader menu of options beyond radical cystectomy, each with distinct dosing schedules, response rates, and durability data drawn from single-arm trials.
He also addressed how a persistent global BCG shortage is reshaping treatment decisions, noting that some centers, including his own, have adopted third-dose maintenance schedules rather than full-dose, 3-year courses, informed by EORTC data showing no difference in progression or overall survival despite a modest reduction in recurrence prevention. Ghodoussipour further discussed how emerging comparative trials, such as the ECOG-led EA8212/BRIDGE trial (NCT05538663) evaluating BCG against gemcitabine/docetaxel combination therapy, may help resolve open questions around sequencing and allocation.1
On the surgical side, Ghodoussipour emphasized that radical cystectomy remains a guideline-recommended option for BCG-unresponsive disease and pointed to data from the CISTO trial (NCT03933826) suggesting that patient-reported quality of life may actually improve after cystectomy compared with prolonged bladder-sparing attempts.2 Still, he noted that improving risk stratification, using biomarkers such as circulating tumor DNA and the AI-driven Vesta Bladder test, may help identify which patients are the best candidates for continued bladder preservation.
“[NMIBC] has been booming the last few years,” Ghodoussipour said. “I'm fortunate to have been in such an exciting space because…it's getting better for our patients. But in order for us to reach the point where we can confidently and consistently cure these patients, we really got to get down to tumor biology.”
Throughout the conversation, Ghodoussipour underscored the importance of multidisciplinary collaboration among urologists, medical oncologists, and radiation oncologists as systemic therapies and checkpoint inhibitor combinations, including regimens studied in the phase 3 CREST (NCT04165317) and POTOMAC trials (NCT03528694), increasingly enter the BCG-naive and BCG-unresponsive settings.3,4 He also stressed that shared decision-making, better patient-reported outcome data, and continued discovery work into tumor biology will be essential to bring greater consistency to treatment sequencing in the years ahead.
References

1. Intravesical BCG vs GEMDOCE in NMIBC (BRIDGE). Clinicaltrials.gov. Updated July 17, 2026. Accessed September 9, 2026. https://tinyurl.com/w9axbzks
2. Gore JL, Wolff EM, Nash MG, et al. Twelve-month results from the CISTO study comparing radical cystectomy versus bladder-sparing therapy for recurrent high-grade non-muscle-invasive bladder cancer. J Clin Oncol. 2025;44(4):274-285. doi:10.1200/JCO-25-01324
3. Powles T, Shore N, Galsky M, et al. Sasanlimab in combination with bacillus Calmette-Guérin (BCG) in BCG-naive, high-risk non–muscle-invasive bladder cancer (NMIBC): Event-free survival (EFS) subgroup analyses based on disease stage from the CREST study. J Clin Oncol. 2025;43(suppl 17):4517. doi:10.1200/JCO.2025.43.16_suppl.4517
4. De Santis M, Redorta J, Nishiyama H, et al. Durvalumab in combination with BCG for BCG-naive, high-risk, non-muscle-invasive bladder cancer (POTOMAC): final analysis of a randomised, open-label, phase 3 trial. The Lancet. 2025;406(10516):2221-2234. doi:10.1016/S0140-6736(25)01897-5

In August 2026, the FDA granted accelerated approval to iberdomide (Zenbexus) in combination with daratumumab and hyaluronidase-fihj (Darzalex Faspro) and dexamethasone for patients with relapsed/refractory multiple myeloma. The agency’s decision represents the first approval of a CELMoD, a more potent, target-specific successor to immunomodulatory drugs (IMiDs), according to Surbhi Sidana, MD.
In a conversation with CancerNetwork®, Sidana, an associate professor of medicine at Stanford University, where she leads the myeloma cellular immunotherapy program and chairs the American Society of Hematology (ASH) Committee on Communications, discussed how this regulatory decision may impact the multiple myeloma paradigm. Additionally, she spoke about the potential next steps for the CELMoD class across different treatment lines and settings.
Considering iberdomide’s approval, Sidana described how clinicians have “an option that suits every patient,” although deciding on specific therapeutic strategies represents a different challenge. She detailed how iberdomide will fit alongside modalities like CAR T-cell therapies and bispecific antibodies by serving as a convenient option for patients who are older, frailer, or unable to travel to a center that offers immunotherapy. She also highlighted the potential to combine the CELMoD with other therapies as part of a “sandwich approach.”
Speaking about CELMoDs more broadly, Sidana discussed how the drug class will serve as a complement to CAR T-cell therapy and bispecifics as bridging therapy, maintenance therapy, and even as a post-relapse option. Looking ahead, she foresees CELMoDs gradually moving to the frontline setting, with ongoing trials assessing them in combination regimens for patients with newly diagnosed disease.
“This approval is a landmark approval for several reasons,” Sidana said. “Having [iberdomide] as an option, which is an oral drug and easy to give, is tremendous for our patients. Iberdomide is a CELMoD, which…I think of as IMiDs 2.0. They’re oral, they have a REMS program…and they’re given on a very similar schedule, but they’re more targeted…[with fewer] adverse effects.”
Sidana also highlighted an initiative from ASH named Fight4Hematology, in which members and hematologists from the organization are advocating to legislators and educating the public on the importance of continuing to fund blood disorder and hematology research.
References

FDA grants accelerated approval to iberdomide with daratumumab and hyaluronidase-fihj and dexamethasone for multiple myeloma. News release. FDA. August 13, 2026. Accessed August 31, 2026. https://tinyurl.com/38258auk

#Fight4Hematology Action Hub. American Society of Hematology. Accessed August 31, 2026. https://tinyurl.com/ms94frk9

Wellness and burnout are often treated as 2 ends of the same seesaw: add enough yoga, sleep, and time off, and the scale tips back toward balance. In this conversation, Daniel C. McFarland, DO, and Xiomara Rocha-Cadman, MD, argue that this framing misses what actually drives distress in oncology. Drawing on years of clinical and mentorship experience tracing back to Memorial Sloan Kettering Cancer Center, the 2 physicians distinguish wellness, an active, ongoing practice, from well-being, the broader emotional and psychological state it supports.
They contend that oncology-specific stressors, repeated exposure to uncertainty, suffering, and death within close patient relationships, are qualitatively different from generalized workplace burnout and do not respond well to generic stress-reduction advice alone. Both describe personal experiences in which psychological defenses masked their own accumulating grief until it surfaced unexpectedly: Rocha-Cadman’s composure gave way after a patient’s death near the holidays, and McFarland noticed an uncharacteristic uptick in humor during his first year as an attending. Their shared conclusion is that engagement with patients, not emotional withdrawal, is the more durable protection against burnout.
The discussion also touches on mentorship, including Rocha-Cadman’s influence on McFarland’s own career, the difficulty of sustaining reflective practices like Balint-style process groups without institutional buy-in, lingering stigma around physicians seeking mental health care, and the value of peer awareness and stable interdisciplinary care teams. They point to a well-documented but under-discussed pattern in which rates of burnout run higher among physicians than in many comparable professions, often because clinicians hesitate to ask each other the same sensitive questions they would ask patients. Both physicians close by framing compassion for colleagues as inseparable from compassion for patients, arguing that clinicians must look out for one another because no institution or government will do it for them.
McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY®. Rocha-Cadman is associate professor and chief of the Division of Psychiatry in the Department of Supportive Care Medicine at City of Hope.

In this episode of Oncology On the Go, CancerNetwork® spoke with Frank McCormick, PhD, about the arc of KRAS-targeted drug development over his 40-year career. He explained why KRAS was long considered “undruggable.” He walked through the origins of the National Cancer Institute’s RAS Initiative, which he helped lead starting in 2013, and how that effort produced several of the drugs now advancing through clinical trials for pancreatic cancer.
A central moment of the conversation centers on the phase 3 RASolute-302 trial (NCT06625320) data, which showed that daraxonrasib nearly doubled overall survival compared with standard of care in pancreatic cancer. McCormick described this as a turning point that transformed pancreatic cancer from a historically difficult indication into one now seeing a wave of new drug development.
McCormick also discussed his vision for cancer prevention. He described a roughly 20-year window between initiating KRAS mutations and clinical disease, and outlined a future in which a safe, well-tolerated KRAS inhibitor could be taken periodically to eliminate precancerous lesions before they progress, potentially preventing KRAS-driven cancers from developing at all.
Additionally, he addressed practical considerations for treating clinicians: the feasibility of moving RAS inhibitors into earlier lines of therapy, and the biology oncologists, pharmacists, and genetic counselors should understand about differing KRAS allele subtypes.
McCormick is a professor in the Helen Diller Family Comprehensive Cancer Center and holds the David A. Wood Distinguished Professorship of Tumor Biology and Cancer Research at the University of California, San Francisco (UCSF). He has researched KRAS for 40 years and helped lead the NCI RAS Initiative. He was recently named the inaugural recipient of the Stephenson Global Prize from the Stephenson Global Pancreatic Cancer Research Institute.
Reference

Daraxonrasib demonstrates unprecedented overall survival benefit in pivotal phase 3 RASolute 302 clinical trial in patients with metastatic pancreatic cancer. News release. Revolution Medicines Inc. April 13, 2026. Accessed August 19, 2026. https://tinyurl.com/44t5vh5d

In this second installment of their conversation on depression in oncology, Daniel C. McFarland, DO, and Boris Kiselev, MD, moved from diagnosis, covered in Part 1, into treatment. The discussion opened with the differential diagnoses that need to be ruled out before starting therapy: delirium, bipolar disorder, medical conditions such as endocrinopathies and severe anemia, and neurocognitive issues stemming from central nervous system involvement or dementia. McFarland and Kiselev outlined the specific red flags that should prompt an oncologist to bring in a mental health specialist rather than manage treatment alone, including suicidality, psychosis, and complex psychiatric histories.
From there, the conversation turned to how depression is categorized by severity using the PHQ-9 scale, and how that severity, along with patient preference and access to care, should guide the choice between lifestyle modification, psychotherapy, and pharmacotherapy. Kiselev introduced a simplified 4-drug toolkit for oncologists: 1 selective serotonin reuptake inhibitor, 1 serotonin and norepinephrine reuptake inhibitor, mirtazapine (Remeron), and bupropion, explaining how to match each option to a patient’s specific symptoms and adverse effect (AE) concerns.
The back half of their discussion served as a practical walkthrough for starting a patient on medication. They covered how to frame the conversation to reduce stigma, what to say about timelines for benefit, and specific dosing and titration guidance for each of the 4 core drugs. McFarland and Kiselev closed by highlighting the most common AEs to flag upfront, a real-world case illustrating why dose titration matters, and general guidance on how long patients typically stay on treatment.
McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Kiselev is a consult liaison psychiatrist at Atrium Health Carolinas Medical Center, an assistant professor in the Psycho-oncology Program in the Department of Supportive Oncology at Atrium Health Levine Cancer Institute, and an assistant professor in internal medicine.
00:02-02:24: Recap of the prior episode and framing for treatment
02:24-11:17: Ruling out other causes: delirium, bipolar disorder, medical conditions, and neurocognitive issues
11:49-15:17: Deciding when an oncologist can treat directly vs when to refer to a mental health specialist
15:45-23:01: Categorizing depression severity with the PHQ-9 and matching it to lifestyle, psychotherapy, or medication
23:46-26:05: Choosing between non-pharmacologic and pharmacologic treatment based on severity and access
26:05-35:49: Selecting a medication from a core 4-drug toolkit and preparing the patient to start it
37:30-48:30: Drug-specific dosing, titration strategy, and managing common adverse effects
50:37-51:59: How long patients typically stay on treatment and closing thoughts