Key Highlights in Ovarian Cancer From ASCO 2025
Stephanie Gaillard, from Johns Hopkins School of Medicine, Baltimore, Maryland, begins with the ROSELLA trial of relacorilant plus nab-paclitaxel vs nab-paclitaxel alone in patients with platinum-resistant ovarian cancer. The results showed improved progression-free survival (PFS) and overall survival (OS) in this difficult-to-treat population.
Next, she discusses the TRUST trial in advanced ovarian cancer, comparing radical upfront surgical therapy followed by chemotherapy with neoadjuvant chemotherapy followed by surgery, followed by further chemotherapy. Although PFS was improved by upfront surgery, OS was not, leaving the treatment sequence open to question.
Dr Gaillard then reports on an updated survival analysis from the OVATION-2 study of intraperitoneal IMNN-001 plus neoadjuvant chemotherapy in newly diagnosed advanced epithelial ovarian cancer. The approach achieved impressive OS, alongside the previously reported PFS benefit.
Finally, she reports on a phase 2 study of pembrolizumab and lenvatinib in recurrent or persistent clear cell ovarian carcinoma. The combination showed encouraging response rates and PFS in a population known to be highly resistant to chemotherapy.
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Fast Company
5 minutes ago
- Fast Company
Why urban designers should think like doctors
What if buildings and neighborhoods were planned with health and climate risks in mind, just like businesses use financial data to guide their decisions? What if public health and real estate weren't at odds, but instead coauthors of a healthier, more equitable urban future? That's the bold premise of Architectural Epidemiology, a new book that offers a radical rethinking of the relationship between place and health. Written by architect and public health expert Adele Houghton and Dr. Carlos Castillo-Salgado, an epidemiologist, the book introduces a place-based framework for aligning real estate investment with public health goals—using the tools of epidemiology to guide design decisions that affect buildings and the way they engage the surrounding city. At its core, architectural epidemiology is not a metaphor. It's a methodology. Diagnosing places like patients Just as a doctor might diagnose a patient based on symptoms and environmental exposures, Houghton and Castillo-Salgado's framework helps designers, developers, and policymakers diagnose the health of a place. The process begins by gathering publicly available health and climate data—rates of asthma, heat exposure, housing-cost burden, chronic illness, and more—and dialing into the specific needs of any real estate project boundary. These place-based insights then inform customized development strategies tailored to local needs. This isn't a one-size-fits-all checklist. It's a locally calibrated, equity-centered approach that asks: What are the most urgent public health and climate concerns in this neighborhood? And how can this project become part of the solution? Two case studies from the book, one in the South Bronx and another in East London, show how this approach plays out in the real world. Toxic infrastructure to health-first housing The South Bronx is one of New York City's most environmentally burdened neighborhoods. Residents face compounding public health concerns, including high rates of obesity, diabetes, heart disease, and pediatric asthma—conditions tied directly to chronic exposure to air pollution, extreme heat, and poor housing conditions. Infrastructure like solid waste transfer stations, natural gas plants, and a daily flow of more than 750 diesel trucks has left a lasting environmental footprint. Three projects demonstrate how health-driven interventions play out in real life. Arbor House, a 124-unit LEED Platinum affordable housing development, took an indoor-focused strategy. With no regulatory leverage to reduce nearby traffic or emissions, the project team instead designed a protective shell: a high-performance building envelope, mechanical exhaust and ventilation systems, low-VOC materials, and a no-smoking policy. These features directly addressed local respiratory and cardiovascular risk data, providing a sanctuary of clean air in a polluted context. The Eltona, another LEED Platinum project by the same developer, built on these strategies but also benefited from its location within the Melrose Commons urban renewal zone. This area, guided by a community-authored plan, introduced pedestrian-prioritized streets and small green spaces to break up heat and pollution hot spots. This sort of coordinated planning can push health equity beyond the building envelope. The Peninsula represents an even bolder intervention: transforming a former juvenile detention center into a mixed-use anchor of community well-being. Once all phases are complete (anticipated in 2026), the project will deliver 740 units of affordable housing, a wellness center, daycare, supermarket, light industrial space, and a workforce development hub—all aligned with the long-standing Hunts Point Vision Plan. Created through a collaborative effort between local government and community groups, the plan calls for cleaner air, economic opportunity, and access to green space without displacing existing residents. This multiscalar transformation wouldn't have been possible without partnership. The development team committed to providing both affordable and middle-income housing, as well as commercial and industrial spaces aligned with local needs. The local government played a convening role, confronting outdated zoning and building codes to enable community-led regeneration. And community groups acted as watchdogs and visionaries—documenting health inequities, advocating for residents' needs, and ensuring decades of disinvestment didn't translate into displacement. From industrial blight to inclusive growth In East London's Hackney borough, Gillett Square shows how long-term, community-led urban design can build resilience without triggering displacement. Residents here also face elevated risks from exposure to traffic-related air pollution, unsafe pedestrian conditions, and mental health stressors, particularly among children and the elderly. Climate concerns such as extreme temperatures compound vulnerability, especially in a borough with high poverty rates and a large renter population. The project began in the 1980s as part of a broader, three-pronged effort to reduce crime, create economic opportunity for women- and minority-owned businesses, and preserve affordability in the face of rapidly rising property values. Organized by Hackney Co-operative Developments, a community interest company, this initiative has grown over 40 years into a model of place-based health equity. Unlike top-down redevelopment, the transformation of Gillett Square unfolded through continuous negotiation among residents, developers, and the local government. A former parking lot became the square itself. Adjacent buildings were renovated to create 30 affordable workspaces and 10 retail units prioritized for local startups and cultural groups. The existing street-facing storefronts remained intact, maintaining the character and economic rhythms of the block. During construction, current tenants were temporarily relocated—but not displaced—a rare feat in most urban redevelopment narratives. The built environment improvements weren't just aesthetic or economic. The renovated Bradbury Works building added insulation, operable windows, and improved ventilation to respond to extreme temperatures and indoor air quality concerns. It was also designed to accommodate a future rooftop solar array. Elsewhere on the square, an old factory became a jazz club. Another was converted into a mixed-use building with social housing and office space. Each adaptive reuse project layered with health-promoting elements such as natural light, passive ventilation, and energy efficiency. Importantly, these design moves responded to both immediate and long-term public health concerns identified in the architectural epidemiology framework: exposure to air pollution, heat vulnerability, mental health stressors, and pedestrian safety risks. The health situation analysis for the neighborhood emphasized the need for strategies that reduced the risk of obesity, mental health issues, and traffic-related injury, many of which were tackled by fine-grained, community-rooted design rather than by sweeping interventions. Gillett Square's evolution also depended on progressive land use policy and community engagement over time. The local government enabled critical rezonings: converting the parking lot into a plaza, allowing mixed-use development, and permitting the installation of small retail kiosks. The development team, operating as a nonprofit social enterprise, prioritized community interests. And community groups, many of which had been active in Hackney for decades, fought to ensure that the square's benefits didn't come at the expense of its existing residents. In a borough where 75% of residents are renters, and poverty rates among children and the elderly are among the highest in the U.K., the stakes of gentrification are high. Gillett Square proves that design can support resilience without fueling displacement—and that longevity, not speed, can be a hallmark of justice-oriented urban development. These case studies show that health equity can be the foundation, not a by-product, of urban development. By aligning investments with public health and climate data, Architectural Epidemiology offers a road map for building places that protect and uplift communities. This framework identifies community needs and guides community residents, developers, and designers to solutions that create value for both stakeholders and shareholders.
Medscape
5 minutes ago
- Medscape
Neoadjuvant vs Adjuvant Immunotherapy in Colon Cancer
The results of the phase III ATOMIC trial fired another volley in the ongoing debate over adjuvant vs neoadjuvant immunotherapy for patients with locally advanced colon cancer. But experts are divided about which treatment plan is the best. Adjuvant immunotherapy plus chemotherapy has yet to square off against neoadjuvant immunotherapy in a head-to-head trial. Even if that trial doesn't happen, post hoc analyses of ATOMIC and the neoadjuvant NICHE-2 studies may clarify whether a one-size-fits-all approach is appropriate and help determine which patients benefit more from one approach over the other, according to Christopher Lieu, MD, an investigator in the ATOMIC study. The ATOMIC study showed that adding adjuvant immunotherapy to standard-of-care chemotherapy following resection reduced the risk for disease recurrence or death by 50% compared with chemotherapy alone in the 355 patients with stage III colon cancer with mismatch repair deficiency (dMMR), who received adjuvant atezolizumab along with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) chemotherapy, providing those in the pro-adjuvant camp with important data. In addition, 3-year disease-free survival (DFS) was 86.4% with the combination compared with 76.6% with chemotherapy alone. The results of this trial were presented at the American Society of Clinical Oncology (ASCO) 2025. 'These data established this combination as a new standard treatment for patients with stage III colon cancer and deficient mismatch repair,' said study author Frank A. Sinicrope, MD, during a press conference at the meeting. 'We regard this as a highly impactful study that will change clinical practice, and it actually represents the first immunotherapy adjuvant study in colon cancer.' In NICHE-2, patients were given neoadjuvant ipilimumab or nivolumab followed by surgical resection. At 3 years, 100% of all 111 patients treated with ipilimumab and nivolumab prior to surgery were recurrence-free, according to a presentation at last year's annual meeting of the European Society for Medical Oncology (ESMO). The DFS beat the prespecified success threshold of 93%. Adding Immunotherapy The standard treatment for stage III colon cancer, regardless of dMMR status, is surgical resection followed by FOLFOX chemotherapy. However, about 15% of patients with stage III colon cancer have dMMR and display resistance to chemotherapy, providing a rationale for adding immunotherapies to standard treatment. 'These tumors are unable to repair their DNA and therefore accumulate mutations that trigger an immune response that is ineffective due to immune checkpoint proteins. Therefore, the use of immune checkpoint inhibitors is very attractive in this setting,' Sinicrope said during the press briefing. Sinicrope is professor of medicine and oncology, and coleader of the Gastrointestinal Cancer Program at Mayo Clinic in Rochester, Minnesota. Adjuvant Immunotherapy The ATOMIC trial is significant because it demonstrates improved DFS with the addition of immunotherapy to standard chemotherapy treatment, improving outcomes for patients with this type of locally advanced cancer over standard care. There are several rationales for adding immunotherapy following surgical resection. For example, staging relies on tumor appearance on CT scan, said Lieu, who is the codirector of Gastrointestinal Medical Oncology at the University of Colorado Cancer Center in Aurora, Colorado. There are patients with dMMR or microsatellite instability-high (MSI-H) colon cancer that appear to have stage I or II disease on their CT scan. 'In those patients, starting with immunotherapy first may not be the best idea because after a stage I or II colon cancer is resected, they don't require any further therapy because of the low risk of recurrence,' he said. 'If you think it is an early-stage cancer based of radiographic findings, you could cut out the cancer and then only offer chemotherapy and immunotherapy if it is unexpectedly stage III. I think that there's certainly rationale for that,' he continued. Other arguments for adjuvant immune checkpoint inhibitors, like atezolizumab, with chemotherapy include synergy between cytotoxic and immune mechanisms and systemic insurance against micrometastatic spread. It also avoids the potential for rare immune complications from upfront immunotherapy that could delay surgery. 'I don't think that [giving all patients neoadjuvant treatment] is the answer. If you think that they have stage I or stage II colon cancer at the beginning, then you might end up hurting them with upfront immunotherapy,' said Lieu. Neoadjuvant Immunotherapy The standard treatment for stage III colon cancer, regardless of dMMR status, is surgical resection followed by chemotherapy, FOLFOX and capecitabine and oxaliplatin (CAPOX) are two of the most common regimens. However, chemotherapy can be hard on patients, making neoadjuvant immunotherapy that can reduce or eliminate the need for post-surgical chemotherapy very attractive. The data from the NICHE-2 trial support the efficacy of neoadjuvant immunotherapy. 'The data strongly suggest that neoadjuvant immunotherapy is better than adjuvant immunotherapy and that chemotherapy for dMMR colorectal cancer has limited activity,' said Michael J. Overman, MD, Associate Vice President of Research for the MD Anderson Cancer Network in Houston, in an interview. 'Thus, I am a believer that neoadjuvant is the preferred approach for dMMR localized cancers.' Lieu said neoadjuvant immunotherapy might be more appropriate for more aggressive disease. 'What we discuss in our multidisciplinary clinic is that if these patients are diagnosed prior to surgery and particularly if they have aggressive features…those are some of the patients that I really would consider for neoadjuvant therapy,' he said. 'While it's high-risk disease, there could be some benefit to down-staging the patient, so that there isn't a positive margin. If there's pathologic complete response…and you don't have to give adjuvant chemotherapy, most people would consider that to be a win.' Overman noted that 'a big open area relates to whether the goal of neoadjuvant therapy should be operation or no operation. Likely both approaches can be done and that would be up to patient and physician.' However, 'with a nonoperative approach, we still have unknowns regarding disease assessment and surveillance for neoadjuvant therapy.' Patient-Specific Care In the absence of data from a head-to-head trial of the two approaches, a patient-specific approach may be the appropriate strategy, Lieu suggested. 'If I had a take home message, it's just that it's clear that these patients really require multidisciplinary discussion before an operation,' he said. Molecular testing has an important role to play as well, said Lieu. 'It speaks to the importance of doing biomarker testing for MMR, MSI, or both. Alarm bells should be ringing as soon as [either or both come] back positive; it should make everyone think for a second and make sure we have the right plan for the right patients.' Sinicrope reported several relationships, including with Eli Lilly, Guardant Health, Roche Holdings AG, Ventana Medical Systems, and Woven Health Collective. Lieu reported relationships with Amgen and Genentech.
Wall Street Journal
6 minutes ago
- Wall Street Journal
The Medicare Pullback Is Here
Many seniors enjoy the perks that come with Medicare Advantage. But those extras—like dental coverage and free gym memberships—are being scaled back. Insurers are cutting benefits and exiting from unprofitable markets, and Wall Street is cheering them on. Once rewarded by investors for rapid expansion in the lucrative privatized Medicare program, companies are now being applauded for showing restraint amid rising medical costs and lower government payments.
