In today’s episode, we spoke with Anthony Chi, MD, a staff pathologist; Monica Peravali, MD, a medical oncologist; and Archana Jadhav, MD, a medical oncologist, all faculty at the Mid-Atlantic Permanente Medical Group in Maryland.

In our exclusive interview, Drs Chi, Peravali, and Jadhav discussed the practical advantages and clinical implications of implementing in-house next-generation sequencing (NGS) testing for patients with non–small cell lung cancer (NSCLC). The conversation focused on how internal molecular testing platforms can improve turnaround times, optimize tissue stewardship, reduce costs, and enhance quality control across the diagnostic and treatment continuums.

Chi explained that performing NGS internally eliminates delays associated with specimen transportation and external laboratory accessioning, significantly shortening turnaround times. He also highlighted Kaiser Permanente’s decision to implement a molecular platform distinct from those commonly used by outside vendors, allowing for reduced tissue input requirements and faster processing times. According to Chi, internal testing also gives pathology teams greater oversight of specimen use, enabling more strategic tissue conservation for future immunohistochemical (IHC) staining, repeat molecular analyses, or additional biomarker testing.

The panel emphasized the importance of close coordination between pathology and oncology teams in maximizing tissue adequacy, particularly in small biopsies and cytology specimens. Chi described educational initiatives implemented within pathology departments to encourage judicious use of IHC stains and preserve tissue for downstream molecular testing. He also outlined specimen-handling workflows in which tissue is divided into separate cassettes to prioritize molecular analysis and still supporting diagnostic evaluation.

Jadhav discussed the oncologist’s role in ensuring adequate tissue acquisition, emphasizing proactive communication with pathologists and interventional radiologists. She noted that when clinicians anticipate limited tissue yield, such as in pleural fluid cytology specimens, they often promptly arrange additional biopsies to avoid delays in treatment initiation and ensure comprehensive genomic profiling can be completed efficiently.

The discussion also addressed optimal timing for comprehensive genomic profiling in NSCLC. Peravali explained that Kaiser Permanente routinely performs NGS across all disease stages, including early-stage disease, due to increasing use of neoadjuvant chemoimmunotherapy approaches and the need to identify actionable biomarkers that may influence treatment selection. Although in-house testing serves as the primary platform, she noted that send-out testing remains important in select situations, including cancers of unknown primary origin, clinical trial enrollment, and discordant or clinically suspicious cases requiring additional confirmation.

As molecular reports become increasingly complex, the panel highlighted the importance of interpreting co-mutations, variants of unknown significance, and emerging biomarkers within a broader clinical context. Peravali explained that although variants without current therapeutic relevance may not immediately affect treatment decisions, repeat biopsies and serial NGS at disease progression can reveal newly actionable alterations as therapeutic options evolve.

Chi further emphasized the growing importance of newly approved biomarkers, including HER2 and c-MET alterations, in NSCLC. He described how pathology teams actively monitor FDA approvals and National Comprehensive Cancer Network (NCCN) guideline updates to identify new therapeutic opportunities for previously profiled patients. In some cases, archived tumor specimens are revisited for additional IHC testing when emerging therapies become clinically relevant.

The conversation also highlighted the value of multidisciplinary collaboration and tumor board discussions in complex diagnostic scenarios. The speakers described how integrated molecular analysis can help distinguish separate primary lung tumors from metastatic disease, resolve diagnostically challenging cases involving uncommon metastatic presentations, and support more confident staging and treatment decisions.

Finally, the panel underscored that successful implementation of precision oncology workflows depends on seamless collaboration among pulmonologists, pathologists, oncologists, interventional radiologists, and molecular laboratories. Early test ordering, centralized communication systems, and multidisciplinary case review were identified as key components of efficient, patient-centered care that can accelerate diagnosis and improve treatment planning for patients with lung cancer.

From Discovery to Delivery: Charting Progress in Gynecologic Oncology, hosted by Ursula A. Matulonis, MD, brings expert insights into the most recent breakthroughs, evolving standards, and emerging therapies across gynecologic cancers. Dr Matulonis is chief of the Division of Gynecologic Oncology and the Brock-Wilson Family Chair at the Dana-Farber Cancer Institute, as well as a professor of medicine at Harvard Medical School, both in Boston, Massachusetts.

In this episode, Dr Matulonis was joined by Meghan E. Shea, MD, an attending medical oncologist and ambulatory medical director and disease program leader for medical oncology at Beth Israel Deaconess Medical Center in Boston. Together, they explored the current landscape of cervical cancer, from the urgent need for expanded vaccination and screening to the evolving role of immunotherapy and antibody-drug conjugates (ADCs) across disease settings.

Dr Shea opened by addressing the epidemiology of cervical cancer, noting that despite decades of progress, rates are now plateauing and rising among women under 50 years of age. She identified 3 interrelated drivers of this trend: declining rates of routine gynecologic screening, inconsistent uptake of human papillomavirus (HPV) vaccination, and persistent high-risk HPV infections, particularly HPV 16 and 18, which are responsible for most cases.

The conversation then turned to the effect of immunotherapy on cervical cancer treatment. Dr Shea traced the evolution of pembrolizumab (Keytruda) from its initial 2018 approval as a single agent in recurrent/metastatic disease to its more recent integration into the frontline setting. The phase 3 KEYNOTE-A18 trial (NCT04221945) demonstrated that adding pembrolizumab to standard weekly cisplatin-based chemoradiation significantly improved outcomes for patients with locally advanced disease. Although responses to immunotherapy, when they occur, are often durable, Dr Shea acknowledged that response rates remain lower than anticipated for a virally driven malignancy, underscoring the need for novel combinations and a deeper understanding of resistance mechanisms. Drs Matulonis and Shea both agreed that immunotherapy combined with ADCs represents one of the most compelling directions for the field, with phase 2 data for sacituzumab tirumotecan plus pembrolizumab generating interest ahead of anticipated phase 3 results.

On the ADC front, Dr Shea reviewed the 2 agents in this class that are currently FDA-approved for cervical cancer. Tisotumab vedotin-tftv (Tivdak) offers the advantage of biomarker-independent use, though its requirement for ophthalmologic monitoring at every treatment visit creates real-world access challenges outside major academic centers. Trastuzumab deruxtecan-nxki (Enhertu), approved in the HER2 immunohistochemistry 3+ setting based in part on the results of the phase 2 DESTINY-PanTumor02 trial (NCT04482309), has generated robust response rates but is most likely to benefit patients with adenocarcinoma. Dr Shea also highlighted additional targets under investigation, including Trop-2, Nectin-4, and B7-H4, with multiple phase 3 trials ongoing in both the frontline and recurrent settings.

The discussion closed with a look at the locally advanced disease landscape, where the NRG Oncology cooperative group is conducting a phase 3 trial to evaluate whether integrating the neoadjuvant carboplatin/paclitaxel regimen from the INTERLACE trial (NCT01566240) with the pembrolizumab-based regimen from KEYNOTE-A18 can further improve outcomes and reduce the morbidity associated with brachytherapy. Dr Shea expressed optimism about this question, citing preliminary experience suggesting that neoadjuvant chemotherapy may reduce the need for invasive radiation techniques.

In today’s episode, we spoke with Michael J. Mauro, MD, an attending physician at Memorial Sloan Kettering Cancer Center in New York, New York.

In our exclusive interview, Dr Mauro discussed the vast assortment of TKIs available for the treatment of patients with chronic myeloid leukemia (CML). In addition to breaking down numerous different TKIs that he turns to in clinical practice and their accompanying data, Mauro also dissected the November 2025 FDA approval of generic dasatinib (Phyrago) tablets for patients with CML and acute lymphoblastic leukemia. More specifically, Mauro outlined what this approval means for patients who need concomitant gastric acid–reducing agents like proton pump inhibitors.