Vanderbilt-Ingram Cancer Center will host “The Future of Lung Cancer Care,” a one-day educational event scheduled for May 8 from 8:30 a.m. to 2:30 p.m. at the Nashville Marriott at Vanderbilt University.
The conference will focus on recent improvements in patient outcomes and survival resulting from early detection, advanced imaging, minimally invasive procedures, and breakthroughs in targeted and immune-based therapies. Those improvements have resulted in the five-year survival rate nearly doubling over a decade, according to the State of Lung Cancer report from the American Lung Association.
The conference will feature nationally and internationally known experts.
Daniel Sterman, MD, director of the Multidisciplinary Pulmonary Oncology Program at New York University Langone Health, will speak about “Interventional Pulmonology: Bronchoscopically Delivered Treatment of Early Lung Cancer.”
Mohamed Shanshal, MBChB, assistant professor of Medicine in the Division of Hematology and Oncology at Vanderbilt Health and clinical director of Thoracic Oncology, will address “Medical Oncology: Integrating Immunotherapy, Targeted Therapy, and Beyond.”
Joseph Mammarappallil, MD, PhD, associate professor of Radiology and cardiothoracic imaging specialist at Duke University School of Medicine, will discuss “Interventional Radiology: Imaging-Driven Precision and Local Control.”
Several Vanderbilt Health lung cancer experts will also speak.
Discussion topics include advances in early detection and diagnostic precision, breakthroughs in minimally invasive biopsy and surgical techniques, the expanding role of targeted therapy and immunotherapy, evolving approaches to survivorship, and supportive care. The conference is open to families, caregivers, clinicians, trainees and anyone interested in lung cancer care. Physicians who attend the conference may claim 7.0 AMA PRA Category 1 credits toward continuing medical education.
A recent multi-institutional study led by physician-scientists at Vanderbilt Health found that there are certain types of stromal cells called fibroblasts that contribute to the invasion and progression of aggressive thyroid cancer. This work, published in the journal JCI Insight, defines the types of stromal cells (which make up certain types of connective tissue) present in thyroid tumors and identifies specific fibroblasts that appear to contribute to cancer cell invasion.
Understanding the danger posed by these cancer-associated fibroblasts (CAFs), which promote cancer growth, metastasis and treatment resistance, will allow for the development of targeted drugs to combat cancer in patients for whom surgical intervention was not effective.
Vivian Weiss, MD, PhD
The paper’s senior author, Vivian Weiss, MD, PhD, associate professor of Pathology, Microbiology and Immunology, credited the collaborative effort between numerous institutions for yielding results that show promise for the future of understanding thyroid cancer progression. In addition to Vanderbilt Health, researchers from Johns Hopkins Medicine, MD Anderson Cancer Center and the University of Washington School of Medicine contributed to the paper.
“This type of study is groundbreaking in the field and wouldn’t have been possible without the fantastic coordination of multiple centers,” said Weiss. “And within our team at Vanderbilt Health, collaboration between pathologists, endocrinologists, oncologists, surgeons and bioinformaticians was paramount to support this work.”
Matthew Loberg, PhD, a physician-scientist trainee in the Weiss Lab, was the study’s lead author, and eleven other Vanderbilt-affiliated trainees contributed to the research.
In thyroid cancer, indolent tumors, or those that usually respond well to standard treatment, can progress to become aggressive. The study created one of the first large thyroid cancer single-cell sequencing atlases made up of cells from 81 patient samples, spanning both indolent and aggressive variants. It also leveraged a unique cohort of patient samples with spatial transcriptomics, which uses spatially bar-coded genomic data, to assess stromal changes across spatial progression of tumors from indolent to aggressive. The researchers used multiplex immunofluorescence to spatially confirm protein expression of genes and location of cell subtypes.
Ryan Belcher, MD, MPH
“We can use single-cell sequencing to identify the genes being expressed on a tumor specimen and combine these data with spatial transcriptomics to see where those genes actually are,” said Ryan Belcher, MD, MPH, associate professor of Otolaryngology-Head and Neck Surgery and one of the study’s co-authors. “You can see the leading edges of invasion and recognize whether a cancer specimen has aggressive features.”
The study analyzed 28 spatial transcriptomic samples of thyroid cancer including rare anaplastic thyroid cancer tumors from adult patients, the most lethal type of thyroid cancer, as well as samples from pediatric papillary thyroid cancer. One of the next steps in the research will be to compare the information gathered from adults and translate it to understand the treatment of children who suffer from thyroid cancer.
“We want to understand better why pediatric patients end up presenting with more aggressive features such as lymph node and lung metastasis, and this type of study will help us understand that better,” said Belcher. “This type of research has been done with other tumors, such as breast or lung cancer, but it had never really been done with a large cohort of thyroid cancer patients. … To us, it’s a stamp of how important our research in pediatric and adult thyroid cancer is at Vanderbilt Health and at Monroe Carell Jr. Children’s Hospital at Vanderbilt as one of the leading institutes in thyroid cancer research in the country.”
Belcher added that while this research may not save a life tomorrow, the answers it seeks to provide in the long term can very much help families down the road.
“Thyroid cancer can recur, so there’s hope for the creation of drugs that can treat the cancers associated with CAFs,” he said. “And that may be an option for patients of any age whose thyroid cancer comes back, as well as any future family members who suffer from it.”
Weiss said that this study underscores how seriously Vanderbilt Health takes every facet of patient care, from the research that lays the foundation for future treatment to the moment it is administered to save a life.
“This paper was made possible by dozens of physician-scientists at Vanderbilt and beyond, each of whom plays an important role in working toward lifesaving care beyond just the operating room,” said Weiss. “Vanderbilt is known for its creative and collaborative culture. We make the biggest discoveries and advances when we work together as a team.”
“We’re not just here to do a patient’s surgery; we’re here to perform game-changing research because we care about this disease process and making it better,” added Belcher. “This is all we think about. It’s our passion.” This research was supported by the National Institutes of Health (grants R35GM122516, R01CA244188, R01CA272875, K12CA090625, K08CA240901, F30CA281125, T32GM007347, U01CA294527 and R01DK103831), American Society of Cytopathology, American Thyroid Association, V Foundation for Cancer Research, Children’s Cancer Research Fund, American Cancer Society, Petrick Thyroid Cancer Research Fund, Johns Hopkins Cancer Convergence Institute, and Sidney Kimmel Cancer Center at Johns Hopkins.
This is a de-identified MRI scan from the REDCap database depicting numerous discrete lesions including fourth ventricle, thalamus, midbrain, cerebellum, brainstem and spine, highlighting the disseminated disease. (image courtesy/Michael Dewan, MD)
Pediatric-type, low-grade gliomas (PLGG) are the most common central nervous system (CNS) tumor in children, but in rare cases the tumors spread — known as disseminated pediatric low-grade gliomas (DPLGGs) — which leads to increased morbidity and mortality.
Researchers, led by Michael Dewan, MD, MSCI, compiled an international cohort of more than 260 DPLGG patients from 39 sites and 13 countries to study why low-grade brain tumors behave aggressively, as well as to identify the causative genetic alteration. Study findings were recently published in Neuro-Oncology.
“Our findings will help predict which children are at an elevated risk of developing disseminated low-grade gliomas as well as serve as a guide toward a more effective, personalized treatment,” said Dewan, associate professor of Neurological Surgery and Pediatrics at Monroe Carell Jr. Children’s Hospital at Vanderbilt and one of the study’s senior authors.
This is a de-identified MRI scan from the REDCap database depicting numerous discrete lesions including fourth ventricle, thalamus, midbrain, cerebellum, brainstem and spine, highlighting the disseminated disease. (image courtesy/Michael Dewan, MD)
“Not all childhood brain tumors that look low-grade act the same,” he said. “This study expands our understanding of the clinical, pathologic and molecular features of this challenging disease. We found that when these tumors spread early or widely — especially in young children — outcomes are worse, but newer, targeted drugs work better than standard chemotherapy for many patients.”
Study findings inform prognosis and treatment decisions, particularly by supporting the earlier use of targeted, less-invasive therapies that may enhance survival and reduce treatment toxicity for children.
“This research improves our clinical and biological understanding of this rare disease, provides insights for improving patient care, and directs future clinical trials and basic science research,” said Dewan.
Vanderbilt Health and Bertis, an artificial intelligence-driven proteomics-based precision medicine company, have announced a joint research and co-development collaboration. The endeavor marks a significant milestone in oncology by advancing the convergence of AI, spatial biology and translational cancer research.
By integrating Vanderbilt Health’s Molecular AI Initiative capabilities with Bertis’ proprietary deep proteomics and AI-enabled target discovery technologies, the collaboration will build an advanced, spatially resolved dataset to identify novel therapeutic targets and predictive biomarkers.
Traditional target discovery often relies on bulk tissue analysis, which loses the critical context of how cells are organized within a tumor. Vanderbilt Health’s Molecular AI approach changes this paradigm by employing sophisticated computational spatial analysis to generate high-resolution spatial molecular maps. This AI-driven spatial biology allows researchers to visualize and decode the complex architecture of the tumor microenvironment, specifically identifying how tumor, immune and stromal (connective tissue) cells interact in biologically and therapeutically relevant regions. By mapping the precise locations and spatial relationships of these cells, the Molecular AI platform can isolate the key cell populations responsible for treatment response or resistance.
These advanced spatial insights are then integrated with Bertis’ cutting-edge proteomics capabilities. While Vanderbilt Health maps the critical spatial context, Bertis will conduct deep proteomic and metabolomic profiling, applying its proprietary AI-enabled computational models to prioritize the most viable, druggable targets.
Tae Hyun Hwang, PhD
The initial focus of this joint research will be on HER2-low tumors (cancers that express low levels of the growth-promoting protein HER2), a historically challenging clinical area, with the potential to expand into additional tumor types based on data outcomes and joint scientific discussions. By layering spatial context over proteome-level data, the teams aim to pinpoint cell surface proteins that are uniquely positioned for emerging therapeutic modalities, including antibody-drug conjugates and cell-based therapies.
This sophisticated AI-driven spatial multimodal and deep proteomics pipeline is spearheaded by Tae Hyun Hwang, PhD, professor of Surgery, founding director of Molecular AI Initiative and director of AI Research in the Section of Surgical Sciences at Vanderbilt Health. Hwang also co-leads gastric cancer atlas efforts within the National Cancer Institute-funded Human Tumor Atlas Network (HTAN) and is spearheading international HTAN collaborations with South Korea’s National Cancer Center.
Highlighting the clinical necessity of this integrated approach, Hwang said, “Identifying therapeutic targets and understanding treatment response require a precise view of proteins, spatial context and tumor biology. By combining Vanderbilt Health’s Molecular AI and spatial analysis capabilities with Bertis’ proteomics and AI-enabled target discovery platform, this collaboration is designed to generate high-confidence therapeutic targets and predictive biomarkers that can support future translational research and therapeutic development.”
Bertis is led by co-CEOs Dong-young Noh and Seung-man Han, who emphasized the collaboration accelerates the global reach of their platform.
“Collaborating with Vanderbilt Health, a leading U.S. academic medical center with strong expertise in Molecular AI, spatial biology and cancer research, is highly meaningful and reflects the growing global recognition of Bertis’ technological capabilities,” Han said. “Through this collaboration, we aim to expand the role of AI-driven proteomics in drug discovery and identify therapeutic targets that may open new possibilities in oncology.”
When colorectal adenomas — polyps that can develop into colon cancer — are removed during a colonoscopy, patients look for guidance about when to have another colonoscopy to look for new growths.
Current surveillance guidelines emphasize polyp characteristics, but a new study led by Vanderbilt Health researchers demonstrates that demographic factors also influence colorectal adenoma recurrence. Their findings, reported in the journal JAMA Network Open, underscore the need for surveillance strategies that factor in polyp characteristics and population-specific risk profiles, as well as variation over time.
Colorectal cancer is the second most common cause of cancer-related death in the United States, according to the National Cancer Institute. Removing precancerous polyps during colonoscopy procedures significantly reduces the burden of colorectal cancer. But about 30% of patients who have a colorectal adenoma removed will develop recurrent adenomas, putting them at increased risk for developing cancer.
Xingyi Guo, PhD
“The current guidelines for surveillance after polyp removal stratify recurrence risk primarily based on polyp characteristics including size, histology and number,” said Xingyi Guo, PhD, associate professor of Medicine in the Division of Epidemiology and co-corresponding author of the new study. “The guidelines universally neglect demographic variables such as race, sex, family history, age and obesity, and may therefore be inadequately addressing population heterogeneity in recurrence risk and timing.”
The researchers, led by Guo and co-corresponding author Zhijun Yin, PhD, associate professor of Biomedical Informatics, conducted a retrospective cohort study using Vanderbilt Health electronic health records for about 3.5 million patients.
Zhijun Yin, PhD
They identified a study group of 59,667 adult patients who had an initial colonoscopy with polyp removal between January 1990 and July 2024, and up to 25 years of follow-up. About 29.5% of the patients experienced adenoma recurrence within five years.
The researchers evaluated associations between recurrence and demographic variables: race and ethnicity, sex, obesity (body mass index greater than 30), family history of colorectal cancer or polyps, and age at time of initial adenoma (younger than 50 versus 50 and older). They examined associations with adenoma features including histology, size, number and dysplasia (abnormal cell structure).
Among their notable findings:
High-grade dysplasia had the largest association with early (less than five years) adenoma recurrence, but not with mid- (five to 10 years) or late-term (10 or more years) recurrence.
Villous histology exhibited a biphasic pattern: an early elevation and late-term resurgence in recurrence risk.
Obesity conferred persistent risk across all surveillance intervals.
Female patients with high-risk adenomas had marked late-term risk, exceeding male patients.
Colorectal adenoma recurrence demonstrated distinct heterogeneity over time, rather than constant risk.
The researchers noted that the study cohort’s predominantly non-Hispanic white population (87.2%) may limit generalizability of the findings, and other factors that could affect risk like socioeconomic status and lifestyle exposures (e.g., tobacco and alcohol use, physical activity and diet) were not consistently available in health records and could not be included in the analysis.
“Our findings suggest that both histopathologic and demographic factors show time-dependent associations with adenoma recurrence, supporting a shift toward dynamic and individualized surveillance strategies,” Yin said.
Usman Ayub Awan, PhD, epidemiology postdoctoral fellow, and Qingyuan Song, PhD, computer science and biomedical informatics graduate student, are co-first authors of the JAMA Network Open study. Guo, Yin and Wanqing Wen, MD, MPH, research professor of Medicine in the Division of Epidemiology, are co-senior authors of the study. The research was supported by the National Cancer Institute (grants R01CA297582 and R01CA269589).
Vanderbilt-Ingram Cancer Center has treated its first patient in a newly launched therapy program that magnifies the power of a person’s natural defense system against tumors.
Tumor-infiltrating lymphocyte (TIL) therapy involves isolating the white blood cells from a tumor after it is surgically removed, expanding the magnitude of those cells in a laboratory, and then infusing them back into the patient to elicit a more powerful counterattack. The highly personalized treatment is currently approved for patients with advanced stages of melanoma whose tumors have grown despite immunotherapies and/or targeted therapies.
The patient who received the therapy in late January has melanoma that has spread to the bone, abdomen, liver and brain despite multiple lines of other treatments. A team of clinicians harvested white blood cells from a tumor in the patient’s liver, then shipped them to a laboratory where they were supercharged before being infused back into the patient, who is being monitored. Additional patients are scheduled to receive TIL therapy. Vanderbilt-Ingram launched the program as a standard of care service line after previously treating patients with TIL therapy in clinical trials.
“The mission of Vanderbilt Health is to get treatments that are cutting-edge to the patients who need them the most,” said Olalekan Oluwole, MBBS, MPH, associate professor of Medicine and a hematologist who specializes in cellular therapies. “Some of these patients have exhausted prior standard of care options.”
About a third of patients who receive TIL therapy respond to it.
“On the surface that doesn’t sound like a lot, but the great thing about TIL therapy is when it does work, it can lead to long-term durable response. It can keep right on working for years or even indefinitely,” said Douglas Johnson, MD, MSCI, professor of Medicine and clinical director of melanoma, who holds the Susan and Luke Simons Directorship.
Establishing the TIL program required assembling a team of multidisciplinary clinicians trained to handle the care needs of patients while simultaneously handling the logistics of getting their white blood cells shipped to a laboratory.
Sarah Moseley, BSN, RN, the coordinator for immune effector cell and gene therapy patient care, led that process. She described the process of navigating care for patients who receive TIL therapy, which involves surgeons, oncologists, hematologists and specialized nurses.
“I am with the patient from start to finish,” Moseley said. “Once a patient is identified by Dr. Johnson, he immediately gets me involved. The patient has to be approved by our cell therapy team and our surgery team as well as Dr. Johnson to make sure that they’re a good candidate. The next step is the insurance process, which is probably the hardest part because this is a new and expensive therapy. It is a detailed process involving our financial team, our managed care team and us nurses as well.”
The nurses serving as patient care coordinators also include Leslie Mader, BSN, RN, OCN, and Brittney Baer, BSN, RN.
“I or one of my nurse colleagues go to the surgery, and we transport the specimen from the operating room to the processing lab, where a courier picks it up,” Moseley said. “Without the specimen, there is no product for the therapy. It has to be done quickly, and it must be done right every time. Then we get the patients set up for cell infusion after about five to six weeks.”
The launch of the TIL program is the latest achievement in cellular therapies for Vanderbilt-Ingram, which is an international leader in the field. The cancer center offered clinical trials for therapies, which became standards of care, most notably CAR-T, which is shorthand for chimeric antigen receptor T-cell therapy. Vanderbilt-Ingram established an outpatient protocol for patients to receive CAR-T and treats more patients with this immunotherapy than any other provider in the state. It is offering clinical trials to expand the treatment for additional types of cancer and to make it more easily accessible to patients.
“The launch of our TIL program represents a natural and important evolution of Vanderbilt-Ingram’s leadership in cellular therapy,” said Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology, professor of Medicine and director of Vanderbilt-Ingram Cancer Center. “Building on the infrastructure, clinical expertise and multidisciplinary coordination established through our CAR-T program, we are now able to offer another highly personalized immunotherapy to patients with otherwise limited options. Our goal is not only to deliver these complex therapies safely and effectively, but also to continue advancing the science so that more patients, across more cancer types, can benefit in the years ahead.”
Clinicians with the cellular therapy team built the TIL program on the foundation of the CAR-T program. However, there are major differences between these treatment modalities. With CAR-T, immune cells are reengineered to attack cancer from the T cells in a patient’s blood. With TIL therapy, white blood cells are taken from a patient’s tumor and are then multiplied so they can stage a better counterattack against cancer.
Currently, CAR-T is approved by the Food and Drug Administration only for certain blood cancers. TIL therapy is approved only for advanced melanoma when patients have not responded to other treatments. However, clinical trials are underway to expand the therapies for other types of cancers.
Vanderbilt Health recently performed its 100th histotripsy, a noninvasive procedure in which highly focused ultrasound waves are directed at liver tumors to destroy cancer without ever making an incision.
The recipient, Aaron Davis of Cleveland, Tennessee, had just celebrated his 52nd birthday days before the procedure and was surrounded in the Vanderbilt University Hospital operating room by a surgical team he’s come to greatly admire.
Sekhar Padmanabhan, MD, assistant professor of Surgery, performed the procedure, in which a tub of water held over Davis’ abdomen served as the medium through which the ultrasound waves passed. In histotripsy, the focused ultrasound energy causes small gas bubbles in the tissue to rapidly expand and contract. This process forms a “bubble cloud,” forcing the targeted tumors to be liquified while avoiding damage to other tissue.
“Histotripsy is a novel procedure, but one that shows a great deal of promise,” said Padmanabhan. “Thanks to generous philanthropic support, we’re building a world-class program to continue offering this technology to patients who can benefit from a noninvasive surgical option that yields excellent results.”
Vanderbilt-Ingram Cancer Center is among the first institutions to offer histotripsy. Appealing to patients for its noninvasive nature, it avoids many of the traditional drawbacks of surgeries that use incisions, including pain management.
“When I had my liver resection, that was some of the worst pain I’ve ever felt in my life,” said Davis. “And I’m allergic to many pain medications, too. Being able to get put to sleep for surgery and wake up without the pain of having my abdomen cut open changes everything.”
Davis had previously been in Padmanabhan’s care to receive a hepatic artery infusion pump, which successfully delivered high doses of chemotherapy to his liver while minimizing toxicity to the rest of his body. And although the cancer returned, Davis knew he was in good hands with Padmanabhan and Kristen Ciombor, MD, MSCI, associate professor of Medicine in the Division of Hematology and Oncology, who eventually helped him settle on histotripsy as the best option to treat his latest recurrence of cancer.
“The doctors at Vanderbilt-Ingram Cancer Center changed my life,” said Davis. “Having a care team who knew exactly what I needed and recognized that a newer procedure could help me has given me hope that I can continue fighting cancer.”
Kristen Ciombor, MD, MSCI, left, with Sallie Bailey (courtesy/Sallie Bailey)
When Sallie Bailey’s husband, John Bailey, was diagnosed with cholangiocarcinoma (bile duct cancer) in July 2018, the news came as a shock. Just months earlier, his physical appearance showed no difference.
The first sign was subtle: jaundice in one eye. The jaundice quickly spread throughout John’s entire body, the point at which he and Sallie met with Benjamin Womack, MD, associate professor of Clinical Medicine. Despite the care of Womack, Patrick Yachimski, MD, MPH, professor of Medicine, and Kristen Ciombor, MD, MSCI, associate professor of Medicine, John passed away in November 2018, only four months after his diagnosis.
“Until the jaundice appeared, there were no symptoms,” Sallie recalls. “It’s a silent disease, and by the time it’s detected, it’s often too late.”
John was more than a patient at Vanderbilt-Ingram Cancer Center. He was a man with a passion for good food and wine. A talented chef, he worked in San Francisco, Chicago, France, and Washington, D.C., before retiring from professional kitchens. Even then, he continued creating memorable meals for family and friends and sought out locally owned restaurants and new wines to enjoy. His welcoming smile made everyone feel special, and he loved traveling, especially to California wine country.
After moving to Nashville in 2011, Sallie and John chose Vanderbilt Health for their care because they valued being part of a teaching hospital. That decision connected them to a team of experts who provided compassionate care during an incredibly difficult time. Sallie’s experience inspired her to take action. Today, she supports research led by Ciombor and Yachimski, hoping to help scientists detect cholangiocarcinoma earlier and slow its progression.
John Bailey, a retired chef, enjoyed spending his retirement in Nashville with wife Sallie. (photos courtesy/Sallie Bailey)
“Ultimately, I hope researchers will find a way to treat the cancer so that it isn’t a death sentence,” Sallie says. “Dr. Yachimski and Dr. Ciombor have both told me their goal is to work themselves out of a job. I admire and support that goal.”
Through her gifts, Sallie honors John’s legacy in a deeply meaningful way. Her support helps researchers pursue earlier detection methods, develop treatments that slow disease progression, and improve quality of life for patients. It also fuels innovation in clinical trials and provides hope for families facing rare cancers like cholangiocarcinoma. Every contribution moves science closer to a future where this diagnosis is no longer a death sentence.
“Particularly for a rare tumor type such as cholangiocarcinoma, contributions like Sallie’s propel our understanding of the molecular underpinnings of these tumors forward and set the stage for future therapeutic advances,” Ciombor said. “Philanthropic support such as Sallie’s provides critical resources at a time when patients with cancer need better treatment options more than ever.”
Learn more about supporting cancer research and making a gift by clicking here.When making a gift, please write in the comment field that you’d like your donation to support cholangiocarcinoma initiatives.
Vanderbilt Health investigators have received a grant from AstraZeneca to lead a multisite, randomized controlled trial aimed at refining the standard of care when using robotic bronchoscopy combined with three-dimensional imaging to obtain lung samples for malignancy assessment and gene sequencing.
“Recent advances in minimally invasive bronchoscopic techniques have improved the diagnostic yield, particularly for peripheral pulmonary lesions, and in the recent VERITAS trial, we demonstrated that navigational bronchoscopy can achieve a diagnostic accuracy of around 79%,” said Fabien Maldonado, MD, MSc, professor of Medicine and Thoracic Surgery and director of Interventional Pulmonology at Vanderbilt Health. “That is statistically comparable to transthoracic needle biopsy, which is around 74% accurate.”
Fabien Maldonado, MD, MSc
“Because of the proven success of navigational bronchoscopy, we now want to determine whether or not the rapid, on-site evaluation (ROSE) of biopsy material remains a necessary step. We’ll test the hypothesis that this advanced bronchoscopy procedure done without ROSE guidance is non-inferior to bronchoscopy with ROSE. This could have immediate patient care implications, potentially shortening procedure time, improving specimen quality and avoiding complications from additional, unnecessary biopsies.”
ROSE has been the standard of care for decades in navigational bronchoscopy, but it adds time, cost and may paradoxically result in lower quality specimens. It can also lead to complications from unnecessary biopsies motivated by unclear intraprocedural results. With modern techniques such as robotic bronchoscopy with cone-beam CT technology, which is rapidly becoming the standard of care, the need for ROSE needs to be studied, said Maldonado, who holds the Pierre Massion Directorship in Lung Cancer Research.
The development of better biopsy approaches is driven by the fact that lung cancer kills more than 130,000 Americans annually, and survival depends on early diagnosis, which requires biopsy to be definitive. Current approaches make accurate biopsy challenging or even impossible for many hard-to-reach lesions.
These modern bronchoscopy techniques extend the range of bronchoscopes and the ability to access lesions reliably and safely throughout the lung, including in the peripheral zone, said study co-investigator Rafael Paez, MD, MSCI, assistant professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine.
The Advanced Robotic Techniques and Rapid Onsite Evaluation for Minimally Invasive Diagnosis and Next-Generation Sequencing (ARTEMIS) trial will be conducted at Vanderbilt Health and nine other United States medical centers. Expected enrollment will be 440 adults who are scheduled for a navigational bronchoscopy for the evaluation of a pulmonary lesion. Participants will be randomized to have the procedure with the addition of ROSE or to have the procedure without ROSE.
The primary objective is to assess the diagnostic yield of robotic bronchoscopy with and without ROSE for peripheral lung lesions. A secondary objective is to compare the adequacy of malignant tissue samples for next-generation sequencing (NGS) between the two intervention strategies.
ROSE involves the immediate microscopic assessment of biopsy specimens, typically performed by a cytotechnologist or cytopathologist, to confirm the adequacy of biopsy samples obtained during a bronchoscopy for the diagnosis of malignancy. This has also been an important step in the past to ensure sufficient tissue is obtained for NGS to identify genetic mutations to guide treatment decisions, said Maldonado.
A 2023 Rapid On-site Evaluation Practice Variability Appraisal survey of interventional pulmonologists revealed significant variation in ROSE utilization. Of the 137 respondents, 88% reported ROSE availability, while time constraints (28%), availability of cytology (22%) and scheduling conflicts (20%) were the most reported barriers to ROSE utilization.
“Additional motivation for determining if ROSE use and non-ROSE use yield similar outcomes during diagnostic procedures is that ROSE is historically poorly reimbursed and uses considerable hospital resources,” Maldonado said. “Our findings will guide interventional pulmonologists in optimizing workflow and technology during robotic bronchoscopy, aiming to maintain the nearly 80% diagnostic yield seen in trials like VERITAS, thus improving patient care as we evaluate pulmonary lesions.”
Hematologists with Vanderbilt-Ingram Cancer Center have published strategies for implementing outpatient treatment programs for bispecific antibodies, an immunotherapy that can cause adverse reactions.
The recommendations, published recently in JCO Oncology Practice, detail a comprehensive overview of the potential risks, treatment options for dealing with reactions, prophylactic protocols to prevent them from occurring, and the roles of an interdisciplinary care team within an outpatient program. The team at Vanderbilt-Ingram has expertise in outpatient care models for immunotherapy treatment because Vanderbilt-Ingram was among the first in the nation to establish outpatient protocols for another personalized immunotherapy, CAR-T.
Bispecific antibodies (BsAb) utilize engineered antibodies, molecular spikes, which bind to both cancer cells and immune cells, activating a patient’s T cells to attack hematologic malignancies. With CAR-T (chimeric antigen receptor T-cell therapy), T cells are harvested from a patient, then reengineered to recognize and destroy cancer cells before being infused back into the patient’s body. Both therapies can elicit strong immune responses with complications that pose risks, including cytokine release syndrome, a potentially life-threatening reaction that can damage healthy tissues and organs.
For this reason, the BsAb and CAR-T therapies typically require inpatient monitoring, which can be an economic and logistical burden for both patients and hospitals.
“Bispecific antibodies are a major advance in the field of cancer immunotherapy,” said the article’s corresponding author, Bhagirathbhai Dholaria, MBBS, associate professor of Medicine. “This class of drugs is available off the shelf, which makes them ideal for utilization in the community settings. In this article, we have provided a comprehensive framework to establish an outpatient bispecific antibodies program, especially for community practices, which do not have an already established CAR-T program. Our strategy has the potential to greatly reduce the logistical and financial burden during step-up dosing of bispecific antibodies while maintaining safety of the patients.”
The protocols suggested are for seven BsAb therapies that have been approved by the Food and Drug Administration for non-Hodgkin lymphoma and multiple myeloma. They address potential complications, including cytokine release syndrome, infections, cytopenia, tumor flare reactions, and immune effector cell-mediated neurotoxicity syndrome.
The authors noted that while outpatient programs for CAR-T were established before bispecific antibodies, CAR-T poses higher risks for adverse reactions. Their recommendations prioritize early recognition and intervention for these complications, particularly in the first cycle of treatment with BsAb when most cytokine release syndrome events are likely to occur.
The paper provides an infrastructure and workflow guide for how clinicians can work with patients to implement monitoring and address care needs. They also stress the importance of educating both patients and family/friend caregivers about proper protocols for remote monitoring.
The article’s additional authors are Kian Rahbari, MD, and Raul del Toro Mijares, MD, Kathryn Kennedy, RN, Leslie Mader, RN, Salyka Sengsayadeth, MD, Reena Jayani-Kosarzycki, MD, James Jerkins, MD, Andrew Jallouk, MD, Tae Kon Kim, MD, Shakthi Bhaskar, MD, Vivek Patel, MD, Brittney Baer, RN, Sarah Moseley, RN, David Morgan, MD, Bipin Savani, MD, Adetola Kassim, MD, Muhamed Baljevic, MD, and Olalekan Oluwole, MD.
