Canadian Oncology Today

Antibody-Drug Conjugates in Breast Cancer: Current Landscape and Future Targets

Jennifer Leigh, MD, Arif Ali Awan, MD — Thu, 14 Aug 2025 00:00:00 +0000

Antibody-drug conjugates (ADCs) have transformed therapeutic options for patients with breast cancer, delivering targeted cytotoxic agents with enhanced efficacy, albeit with systemic toxicity. Since the approval of trastuzumab emtansine in 2012, the ADC landscape has rapidly expanded to include agents targeting HER2, TROP-2, and other novel targets. Currently, four ADCs are approved in breast cancer, showing clinical benefit across HER2-positive, HER2-low, hormone receptor (HR)-positive and triple-negative subtypes. Trastuzumab deruxtecan has demonstrated superior outcomes compared to earlier HER2-targeted ADCs and is the preferred treatment in multiple settings. Anti-TROP-2 ADCs, such as sacituzumab govitecan and datopotamab deruxtecan, have provided improvements in progression-free survival in both triple-negative and HR-positive/HER2-negative disease. Ongoing research is exploring additional targets, such as HER3, Nectin-4, B7-H4, and CD166, with several promising candidates showing efficacy in early phase trials. As ADCs move into earlier lines of therapy and combination regimens, understanding optimal sequencing, toxicity management, and cost considerations will be essential. This review summarizes the current ADC landscape in breast cancer and highlights future directions for this rapidly evolving therapeutic class.

Perioperative Treatment Strategies for Lung Cancer in 2025: A Paradigm Shift

Ramy Samaha, MD, Jonathan Spicer, MD, Normand Blais, MD — Thu, 14 Aug 2025 00:00:00 +0000

Perioperative management of resectable non-small cell lung cancer (NSCLC) has evolved significantly with the integration of immune checkpoint inhibitors and targeted therapies. This review synthesizes current evidence from key clinical trials, highlighting the improved survival outcomes achieved with neoadjuvant and perioperative chemoimmunotherapy in oncogene-wildtype NSCLC, as well as adjuvant tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)‑ and anaplastic lymphoma kinase (ALK)-altered tumours. While neoadjuvant immunotherapy has demonstrated high pathological response rates and long-term survival benefits, perioperative strategies may offer added value in selected subgroups. The ADAURA and ALINA trials have established adjuvant osimertinib and alectinib as new standards of care in oncogene-driven disease. Unresolved questions remain regarding optimal treatment sequencing, duration, and patient selection. Emerging tools such as circulating tumour DNA and artificial intelligence hold promise for refining risk stratification and guiding individualized treatment approaches.

Treatment of Neuroendocrine Tumours: Approach of GEP-NETS

Nathalie Baudoux, MD , Mustapha Tehfe, MD, MSC — Thu, 14 Aug 2025 00:00:00 +0000

Neuroendocrine tumours (NETs) represent a rare entity, with various anatomic primary tumour sites, three different grades, a functional or non-functional status, and differences in somatostatin receptor expression, making NETs a heterogeneous disease. The management of these tumours is challenging and varies from a simple watch-and-wait strategy to more complex multi-modality treatment combinations. The choice of treatments depends on the previously mentioned factors. NETs most frequently arise from the gastro-entero-pancreatic (GEP) tract. The article reviews the classification, diagnosis, and staging of well-differentiated GEP-NETs, and discusses different therapeutic options.

Management of Stage I–II Testicular Germ Cell Tumours: Current Treatment Paradigm and Future Perspectives

Thu, 14 Aug 2025 00:00:00 +0000

Testicular cancer is the most common solid tumour in males aged 15–44 years, with an estimated 1,300 new cases in Canada in 2024. Over 90% are germ cell tumours (GCTs) originating from spermatocyte precursors, with most arising in the testes. Risk factors include cryptorchidism, gonadal dysgenesis, genetic syndromes such as Klinefelter syndrome, family history, and possibly cannabis use.

This review summarizes the evidence‑based diagnosis and management strategies of clinical stage I (CSI) and II (CSII) testicular GCTs used at the Princess Margaret Cancer Centre (PM), highlighting potential clinical pitfalls and future directions.

Small-Cell Lung Cancer: Integration of Radiation and Immunotherapy for All Stages

Nathalie Daaboul, MD, FRCPC — Thu, 14 Aug 2025 00:00:00 +0000

Small cell lung cancer is an aggressive cancer with a poor prognosis. New treatment paradigms have developed with the incorporation of new therapies in the last few years, aiming to improve patient survival. Some emerging therapies include the addition of immunotherapy to chemotherapy. This article provides a practical review of the current and upcoming treatment options for SCLC in both limited and extensive stages, focusing on integrating radiation and immunotherapy.