In this special episode of "On the Edge of Breakthrough: Voices of Cancer Research," Sumanta (Monty) Kumar Pal, M.D., F.A.S.C.O., sits down onsite at the 2026 American Society of Clinical Oncology (ASCO) Annual Meeting with three City of Hope leaders to discuss the research drawing attention across the global oncology community. Alan Bryce, M.D., Kristin Higgins, M.D., and Joseph Mikhael, M.D., share findings they are watching most closely and what those developments could mean for patients and the future of cancer care.
Alan Bryce, M.D., Chief Clinical Officer, City of Hope Cancer Center Phoenix, discusses promising prostate cancer research that may help doctors treat some patients earlier and more effectively. He explains how a new combination approach around the time of surgery could help keep cancer from spreading and open the door to more treatment options.
Kristin Higgins, M.D., Chief Clinical Officer, City of Hope Cancer Center Atlanta highlights encouraging progress in lung cancer driven by treatments tailored to specific genetic changes. She also discusses an important challenge: some people who develop lung cancer may not fit the profile current screening programs are built to catch.
Joseph Mikhael, M.D., Professor in Clinical Genomics and Therapeutics Division at TGen, explores how quickly treatment is evolving in multiple myeloma. He shares why newer immune-based therapies are generating excitement and how simpler approaches now in development could make advanced treatment more accessible. For him, the pace of change means new options are reaching patients faster than ever.
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Full Transcript
Dr. Monty Pal:
I'm Dr. Monty Pal from City of Hope and this is On the Edge of Breakthrough, Voices of Cancer Research. Each episode we bring you the minds behind the science, the stories behind the data, and the breakthroughs that could change everything. Let's dive in. Welcome everyone. I'm thrilled to be at ASCO 2026 with some luminaries at City of Hope. We're gonna be diving deep into several of the best abstracts on the domains of myeloma, lung cancer, and prostate cancer. Here with me today are three leaders at our various institutions within City of Hope. I'm gonna have each one of them introduce themselves. Alan, why don't we start with you?
Dr. Bryce:
Thanks for having me. Um, Alan Bryce. I'm a medical oncologist specializing in prostate cancer. I'm also the chief clinical officer at City of Hope at, uh, in Arizona, uh, and a professor of molecular medicine at TJ.
Dr. Monty Pal:
Awesome. Thanks for being here. Kristen.
Dr. Higgins:
I'm Kristen Higgins and I'm a radiation oncologist and chief clinical officer at City of Hope, Atlanta, and a professor in the Department of Radiation Oncology.
Dr. Monty Pal:
Excellent. Joe.
Dr. Mikhael:
Great to be with you today, Joe Mikhael. Uh, I'm a myeloma physician of the privilege of being a professor in the division of clinical genomics and therapeutics at Tejin.
Dr. Monty Pal:
Alan, we're, we're gonna start with you and just by way of background, you know, Alan, you've come to City of Hope from the Mayo Clinic, you know, really a phenomenal leader there already and you're championing our efforts at our city of Hope Phoenix site. Thank you for that. You have a longstanding history in prostate cancer. I still remember that moment at ASCOGU, uh, being a Jew medical oncologist myself where you presented the data for Rucaparib, but you had that magical investigator moment where you flashed that last slide with your journal paper. Very exciting.
Dr. Bryce:
Always feels good.
Dr. Monty Pal:
So, so tell me at this ASCO meeting, what, what's been really exciting for you?
Dr. Bryce:
Yeah, it's been a good meeting for, uh, for prostate cancer. We, of course, the first plenary presentation at this year's ASCO was a prostate paper from Mary Allen Taplin, the perioperative use of apalutamide and ADT in men with high risk prostate cancer undergoing prostatectomy. Really nice results. It's a, uh, very large study, over 2,000 patients powered to look at metastasis-free survival, also to look at time to next therapy. Um, very unusual in the prostate world that we have studies this big. Also, you know, we have a long history of small phase twos that are looking at neoadjuvant therapy, but this is a definitive phase three and it was positive for an improvement in metastasis-free survival and a three-year delay in time to subsequent systemic therapy, which is ADT, right? So, so by doing a year of perioperative therapy, you know, we saw a ninefold increase in the pathologic complete response, uh, by adding apalutamide to ADT and you see a three-year improvement in metastase-free survival.
You know, th- this, I think, will certainly become an option for men with high-risk localized prostate cancer. So,
Dr. Monty Pal:
So I've gotta ask you, I mean, as medical oncologists, we're always witness to this debate between urologists and radoncs, right? Yeah. And you can certainly- <laugh> Absolutely. I'll be careful. Uh, uh, but, you know, certainly this is probably gonna add some fuel to that fire, right? So what do you think it means for that decision initially between radiation and surgery?
Dr. Bryce:
Absolutely. I mean, th- this is where the debate's gonna come in. So, so the med-oncs role often ends up being as the neutral arbiter, right? The patient meets with rad-ox, the patient meets with urology, the patient says, "I don't know what I wanna do. Can I meet with the med-on?" Um, and then they'll come to my clinic. Um, so, you know, we talked through the different side effect profiles of the options, right? With radiation, you know, less risk of, uh, impact on, um, erectile function, l- less risk of impact on urinary function. Um, with surgery, you know, the, the idea has always been, well, you generally aren't gonna do ADT, although these results would now say you probably would, so it changes that conversation. Um, you also say with surgery, well, you get the pathology and you can always radiate later, but there's a push and pull, right?
And, and the urologists and the radoncs have very strong opinions about this, right? Uh, you know, the, that dataset's no good. My dataset's better and back and forth and it's a never ending debate. Um, so this'll add another data set to that debate should be shared decision making, right? Patients have different prioritization of which toxicities they worry more about, which, uh, you know, which, uh, ADT they wanna go on because the radiation would be with ADT in this scenario of the patients on this study, probably be two years worth. Um, so lots of different variables patients have to work through and this decision often can take them several weeks, right, as they consider options. And it just got, you know, maybe a little bit more complicated, but maybe a little bit more clear from the strength of the data. Uh, but I, I, I have already seen in the two hours since that presentation a very active Twitter debate going on or extubate going on.
So there's very strong opinions coming out fast and furious right now. It'd be interesting to see, uh, you know, how the, uh, how the 15 rounds of this heavyweight fight go.
Dr. Monty Pal:
Indeed, I saw that Twitter debate forming even before the data was presented today. It was very exciting. Yeah. Uh, Kristen, I'm gonna turn to you for a second. So, you know, when I heard about your recruitment, the city of Hope, it actually coincided when I also heard about your plenary presentation at ASTRO, right, presenting, uh, some really compelling data for chemo RT with the rotezo. And as it turns out, I think that data was just published in JCO day, right? It was. It was. And congratulations on that. It's
Dr. Higgins:
Cute. It was negative, but you know what? It was, it was still impactful and an important paper so, um, and it was, it was a great opportunity to lead that trial and, you know, it was important to show that small cell lung cancer patients can be recruited rapidly. We recruited this trial in three years the last randomized trial in that space took 10 years to recruit. We did it during the pandemic and now there's so much more drug development in small cell lung cancer, which is really exciting for our patients.
Dr. Monty Pal:
And that takes us from your plenary presentation to this year's ASCO plenary presentations. I feel like it's always a big year for lung cancer, which is terrific, right? Yes. Uh, but tell me about which abstracts really caught your eye this year.
Dr. Higgins:
Yeah. So I really enjoyed the, uh, Liberto 432 presented by Jonathan Goldman at the plenary session and that was a randomized phase three trial for early stage lung cancer, stage 1B through three with RET positive, uh, mutations and that's about just 2% of patients with non-small cell lung cancer. Um, but they randomized those patients to cell percatinib for three years, um, versus placebo and they had a significant improvement in ef- event-free survival. The hazard ratio was like 0.17, um, and it again just drives home that personalized medicine works in early stage lung cancer and we have to do biomarker testing on every patient so we identify these people and that we can give them the best therapy. Um, Dr. Lovely, our own City of Hope, um, disease team leader for the lung cancer team did the discussion and she did a remarkable job. It was really patient centered and it was great to hear her thoughts.
One thing that she brought up that I think is really important is how do we identify these patients that have these RET mutations because these patients are many times asymptomatic and they're not coming in with symptoms and we have to have a better lung cancer screening strategy for non-smokers because many of these, you know, onco- oncogene-driven mutations are in patients that have never smoked and right now they don't qualify for lung cancer screening. So she really, I think, pointed out an, an unmet need and really an area that we need to improve upon for our patients.
Dr. Monty Pal:
Y- you know, I loved her discussion and it was just such an honor. I actually have to brag here for a moment. I ran the selection committee for our thoracic chief and- mm-hmm. ... you know, Christine was such a phenomenal hire. And, and to see her on the ascoplenary stage just a couple of months later was, I think, a huge win for the organization.
Dr. Higgins:
Yeah, it makes me so proud.
Dr. Monty Pal:
Indeed, indeed. You know, Joe, I'm gonna move on to you. Uh, this is a really exciting time in myeloma as it, you know, has been for many, many years. I remember as a fellow, you know, treating with doublet therapy and this advanced triplets, I think that, you know, quadruplets are now part of the vernacular and maybe quintuplets down the line. You, I saw that you published, uh, with ASCO, uh, some, uh, living guidelines for myeloma. Can you tell us a little about that?
Dr. Mikhael:
Yeah. So we, so I had the privilege back in 2019 actually of leading the first ever myeloma guidelines for ASCO. Um, you know, other organizations have created guidelines, even our sort of international myeloma working group, the myeloma nerds of the world, you know? Yeah. But we really wanted to be able to bring it to the greater oncology community. Over 70% of myeloma patients are treated in the community as opposed to the, you know, true academic center because these patients are older, they're more nested within the community and often the community oncologist is taking care of all the solid tumors we just heard about and a tiny little bit of myeloma. So we did that back in 2019 and as you've commented, it really i- has been a field that's exploded over the last several years. So we just published the second set of those guidelines in February of this year, JCO, um, and that was a challenge to produce because as you've noted, we've gone from doublets to triplets to quadruplets and, you know, making a selection of relapsed myeloma now is like the cheesecake factory menu, you know?
I mean, it's incredibly complicated and incredibly detailed. But one of the things that came out of it, what, what ASCO is beginning to do, um, is to create these living guidelines. And the concept is in almost all malignancies now, but in particular in diseases like myeloma where the world is changing month to month, I mean, the approvals that we're seeing is, is really at a, at a tremendous pace that instead of just having these major guidelines published every six or seven years, that they have a living component to them that, uh, a cohort of the individuals who are on the guidelines team continue to review the data on a month by month basis. And we've just done our first update to it led by, uh, Rahul Benerji from, uh, the Hutch. And so it was really exciting to see that even in those few months between February to May, um, we've seen a change in those, in those guidelines.
Dr. Monty Pal:
Well, if you're up for it, I think we have time for a second round of, you know, kind of exciting abstracts. I'm gonna actually ask you to lead in maybe with what you saw in myeloma that was really exciting to you here at ASCO 2026.
Dr. Mikhael:
You know, I remember the days when, honestly, myeloma was not a big player at the ASCO world. Um- Yeah. ... and we would come here to, uh, partially enjoy the city of Chicago <laugh> and to be with our solid two or colleagues, but really in all phases of myeloma in, you know, or newly diagnosed, which includes smoldering myeloma and early relapse and late relapse, we actually had a series of remarkable abstracts. But the ones that really caught my attention were in the relapse setting. Okay. Uh, probably the most influential abstract here was called the MAGESTECH-9 study also published, uh, on the day it was presented in the New England Journal, which is using one of the, the drugs that we have now as a bispecific antibody, teclistamab, but using it by itself in a randomized phase three trial versus the dealer's choice of triplets that we typically have in relapse and a dramatic difference, uh, between the two.
Um, and, and although we have now just recently a series of, uh, bi- biospefic antibodies available in late relapse, this is now being used in one to three prior lines of relapse. And so we think this is gonna very quickly change our practice where now in early relapse we're gona have this great but challenging scenario a little bit like Alan described when there's, you know, lots of, of data to support going to CAR T-cell therapy, going to a biospec antibody, going to an antibody drug conjugate and all these other triplets that we have. So this definitely be great for patients. Uh, the other abstract that I'll quickly mention that had significantly fewer patients was by no means a phase three randomized trial, but even with six initial patients evaluated was of tremendous interest to the myeloma community. It was the first update in the first in vivo CAR-T trial in multiple myeloma presented by Joey Ho from Australia.
And what's really remarkable about this process is instead of obviously the usual, uh, process we have of ex vivo CAR-T where we collect T-cells, we manufacture them to obviously express the, uh, uh, the, uh, receptor to go after a specific antigen and myeloma, typically BCMA, several weeks later reinfuse them. This is a system where it's all done in vivo. So it reduces the need to, uh, collect T-cells. It reduces the need to give, uh, lymphodepleting chemo before the T-cells are reinfused. So it was considerably less toxic to patients. Uh, the timing, uh, was, was remarkable because it could be done immediately without that delay and remarkably, all six patients achieved MRD negativity in the first month of treatment. So obviously we need more follow up. There was one patient with time that, that had a relapse, but, um, for me, as you know, I've done a, a lot of work and, uh, continue to do a lot of work in health disparities and myeloma being the most disparate cancer within the African American community in particular access to CAR-T has been a challenge.
I mean, it's wonderful at City of Hope. We have a massive CAR-T program that reaches out to people across the country, but there is still a tremendous disparity in access at all levels, particularly within the African-American and Latino American population. And I don't want to jump the gun too far, but this concept of in vivo CAR-T could significantly improve our ability to take the T-cell technologies that we're working with to greater masses of people within the community and even internationally. So this is really a, a remarkable time for us in multiple myeloma, and we hope with time at, as in vivo CAR-T and even alloCAR-T, um, makes its way into the field that this will allow this great technology to be greater, uh, to have greater accessibility, uh, to those who have historically not been, uh, given access to these great treatments.
Dr. Monty Pal:
How brilliant. You know, I'll highlight something you said again, which is that, I mean, City of Hope's CAR-T program is just absolutely phenomenal, led by Steve Foreman, Elizabeth Buddy. I mean, the group has just made incredible strides. I know that we're working on getting CAR-T out to our various centers across the country. You know, maybe Alan, I could lean on your first sort of an update on where CAR-T stands across the netterprise.
Dr. Bryce:
Yeah. So in, in, uh, city of Arizona, we have CAR-T available. We have a fully accredited, uh, transplant program. So we're accredited for CAR-T for allogeneic, uh, au- autologous transplants. We have CAR-T clinical trials open as well. So, um, it's, uh, it's at our hospital in Goodyear, Arizona, which is kind of the southwest corner of the Phoenix metropolitan area. Um, so we're, we're up and running. Uh, it was, uh, it was a really fast build. We went from a, a brand new program to full accreditation and about three years of testament to the physicians we have there in Arizona, the ends of the sport of, of our, uh, transplant team in, in Duarte.
Dr. Monty Pal:
Awesome. So, so just to be fair, since Joe got to highlight two abstracts, I'm gonna allow you to pick one more. What else really enticed you at ASCO this year, Alan?
Dr. Bryce:
Yeah. I mean, well, we, we have, you know, a, a second abstract was presented that's also a, a New England, uh, concomitant publication. So that's the TALEPER study of talazoparib with enzalutamide and ADT in, as first-line therapy in metastatic hormone-sensitive prostate cancer, uh, presented by our friend and fantastic study. Uh, certainly I expect that to be practice changing as well. I expect it to, you know, be something that would lead to FDA approval. It'd be shocking if it wasn't. It's, it's great results. Um, this builds on the PARP inhibitor story. I mean, we know PARP inhibitors are infe- are very effective in HRR mutated prostate cancer. Uh, as with other studies, you know, most of the, the, the biggest part of the benefit is definitely in the BRCA2 population, which is the, the largest proportion of patients. Hazard ratio in that population is 0.35, you know, absolute gangbusters.
Um, but there's activity in other genes as well and BRCA1, ATM, some activity in CDK12 that's especially intriguing, which we had also seen in the talus operative MCRPC study. So it'll be a great new addition to, uh, our options in the MHSPC space and, you know, this hormone sensitive space is getting very, very crowded now. So, you know, I, I, I think, you know, we really are at the, the era now where we should be thinking about precision treatment in prostate cancer patients. Full upfront profiling is critically important so that we can really get patients into the proper swim lanes and get them onto the right kind of treatment pathways.
Dr. Monty Pal:
So it's so wild, because I think about when you and I were in training and docetaxel is just coming to the fore, right? I mean, it, times-
Dr. Bryce:
Yeah.
Dr. Monty Pal:
... times have really changed, haven't they? It,
Dr. Bryce:
It, it's, it's been a long road, yes. We're, we're, we're catching up to, uh, our lung colleagues and our myeloma colleagues in the sheer number of trials and drugs we have and it's a, it's a very different day than when we were in training.
Dr. Mikhael:
Well, we have it on record that he said he's catching up to myeloma. <laugh> For the record, want to ensure that that's a- Still very clear. Yeah. Love you, Al.
Dr. Monty Pal:
I love it. Kristen, we're gonna give you the final word. Pick an abstract for us. What else enticed you at this meeting?
Dr. Higgins:
Well, I will just make the comment, uh, we were a little bit light on radiation data, which is fine. Radiation oncologists are only a couple thousand of the 40,000 people that are here at ASCO, but it's obviously very important as a radiation oncologist to be very much immersed in what's happening in this systemic therapy landscape. I really enjoyed the long-term update of the CROWN study that was presented on Friday. Um, it showed median PFS has not even been reached with lorlatinib, uh, compared with crizotinib in ALK-mutated non-small cell lung cancer patients. And that is really exciting to see our patients are achieving long-term survival. It was so different when I first started in this field 15 years ago and to just really see the power of targeted therapy in these small subsets of lung cancer is really, really exciting and we're going to have long-term survivors now lung cancer and we can start shifting to other areas of focus, um, that we haven't really done survivorship that just hasn't been a focus on lung cancer because our patients haven't survived.
So it's kind of a new day for us. Yeah,
Dr. Monty Pal:
You know, it's funny, I saw those curves and I remember thinking to myself, gosh, we always talk about a truck driving through these Kaplan-Meier curves, right? And here it's not that just the truck goes a block or two, it's going for several miles, right? I mean, it, it's really, uh, a major extension in survival for these patients. I, Alan, Kristen, Joe, I can't thank you enough for taking time out of your busy ASCO schedule to join me. Thank you for this wonderful update on abstracts.
Dr. Higgins:
Our pleasure. Thank you.
Dr. Monty Pal:
Thanks for tuning in to On the Edge of Breakthrough. See you next time for more insights from the front lines of cancer research and care.