Dr. Joyce Habib - Hematology / Oncology

17/05/2026

The FDA just approved trastuzumab deruxtecan (Enhertu) for 2 new indications in early HER2+ breast cancer

DESTINY-Breast05: T-DXd decreased the risk of recurrence by 53% compared to T-DM1 (3-year iDFS 92.4% vs. 83.7%) in high-risk patients with residual disease after neoadjuvant therapy. While OS data are immature, KATHERINE showed a nearly identical iDFS benefit with T-DM1 over trastuzumab (HR 0.50) that ultimately translated into OS benefit, giving us strong reason to expect the same here. The key safety concern: ILD occurred in 9.6% of patients, including 2 deaths which in the curative setting deserve some thought.

DESTINY-Breast11: T-DXd→THP improved pCR over ddAC→THP (67.3% vs. 56.3%), with the largest benefit in HR-negative disease (ΔpCR 16.1%). However, limitations exist: pCR (not EFS/OS) was the primary endpoint, EFS data are very immature.

So who gets what?

Adjuvant T-DXd (DB05): Best for high-risk residual disease inoperable at presentation or persistent nodal disease (ypN1–3) after neoadjuvant therapy.
Adjuvant T-DM1: Remains appropriate for lower-risk residual disease (operable, ypN0)
Neoadjuvant T-DXd-THP (DB11): Compelling for HR-negative disease. Standard neoadjuvant chemotherapy is still preferred for HR-positive disease, smaller pCR benefit, and preserves T-DXd for RD

The "what's left at recurrence?" question remains the field's biggest unresolved challenge

29/04/2026

The phase 3 ROSELLA trial, with final results presented in April 2026 at the Society of Gynecologic Oncology Annual Meeting, studied a drug called relacorilant (brand name Lifyorli) combined with chemotherapy (nab-paclitaxel) in 381 women whose ovarian cancer had stopped responding to platinum-based chemotherapy — a particularly difficult situation where treatment options have historically been very limited.

Who was in the trial? Women with advanced ovarian cancer that had come back and stopped responding to platinum chemotherapy, and who had already received up to 3 prior treatments including a drug called bevacizumab.

What did the trial find? When results were first presented at a major oncology conference in 2025, the combination showed a statistically significant but modest improvement in how long women lived without their cancer growing: 6.5 months compared to 5.5 months with chemotherapy alone. At the time, some wondered whether this one-month difference would translate into meaningful survival benefit. The answer came in April 2026: the survival benefit far exceeded what those initial results suggested.

Women receiving the combination lived on average 16 months, compared to 11.9 months with nab-paclitaxel alone. Perhaps even more striking: at 18 months, 45% of women in the combination group were still alive, compared to just 27% in the nab-paclitaxel-alone group. In a disease where survival is often measured in months, nearly doubling the proportion of women alive at 18 months is a meaningful and hopeful result.

Was it well tolerated? Yes. One of the most important findings was that adding relacorilant did not make treatment harder to bear. Side effects were no worse than chemotherapy alone, with no new safety concerns identified. The most common side effects — low blood counts, fatigue, and nausea — were those already expected from the chemotherapy component.

Why did survival improve so much more than expected? This is one of the most scientifically interesting aspects of the results. Relacorilant works by blocking a receptor in cancer cells called the glucocorticoid receptor, which cancer cells can use to resist chemotherapy. By blocking this pathway, relacorilant appears to make cancer cells more sensitive to treatment — and crucially, this effect may not stop when treatment ends. The trial also measured how long women lived before their cancer progressed a second time, after subsequent treatments. This also improved significantly, and importantly, both groups received similar treatments after the study drug was stopped. This tells us the benefit was not simply due to better second-line treatment choices — it was something relacorilant did to the cancer itself, making it more vulnerable to future treatments as well.

The addition of relacorilant to nab-paclitaxel led to significantly longer overall survival in patients with platinum-resistant ovarian cancer, without the need for biomarker selection. The findings support relacorilant plus nab-paclitaxel as a potential new standard treatment option for patients wi...

21/04/2026

A landmark moment in oncology.

The Phase 3 RASolute 302 trial just delivered results that will be talked about for years.

Daraxonrasib (RMC-6236) — an oral, once-daily RAS(ON) multiselective inhibitor — nearly DOUBLED median overall survival in previously treated metastatic pancreatic cancer:

📊 13.2 months vs 6.7 months with standard chemotherapy
📊 HR 0.40 (p

21/07/2025

💥 40% of cancers are preventable. 40%!

That’s not a guess. It’s well documented.
40% of all cancers in adults over 30 could be avoided through simple lifestyle changes.

Let that sink in.
And the best part? You’re probably already doing some of it—without even realizing it.

A study published by the American Cancer Society in CA: A Cancer Journal for Clinicians found that modifiable risk factors like smoking, poor diet, physical inactivity, excess weight, alcohol use, and UV exposure were responsible for over 713,000 cancer cases and 262,000 deaths in the U.S. in 2019 alone.

🔗 Full study here:
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21858
🔟 10 Things You Can Do to Lower Your Cancer Risk:

🚭 Don’t smoke – to***co is still the #1 preventable cause of cancer.

⚖️ Maintain a healthy weight – especially around the belly.

🚶 Be active – aim for at least 30 minutes of movement most days.

🥗 Eat a balanced, plant-forward diet – more fruits and veggies, less processed meat.

🍷 Limit alcohol – even small amounts can raise your risk.

🌞 Protect your skin – use sunscreen, avoid tanning beds.

💉 Get vaccinated – HPV and hepatitis B vaccines prevent infection-linked cancers.

🧪 Keep up with screenings – like colonoscopies, mammograms, Pap smears.

🧴 Avoid toxic exposures – such as radon, asbestos, and diesel fumes.

😴 Sleep well, manage stress – chronic stress can lead to harmful habits over time.

🌟 Bottom line:
Preventing cancer isn’t about being perfect.
It’s about making better choices, more often.
Every small change adds up—whether it’s walking more, quitting smoking, or swapping soda for water.

👥 Share this post.
Someone you love might need this reminder:
Cancer prevention is real—and it starts today.

In 2018, the authors reported estimates of the number and proportion of cancers attributable to potentially modifiable risk factors in 2014 in the United States. These data are useful for advocating ...

24/06/2025

https://www.facebook.com/share/p/1CDgmmkVTP/?mibextid=wwXIfr

For years, the message to breast cancer survivors was clear: be careful with your arms. Don’t carry groceries with the affected side. Don’t lift more than a few pounds. Don’t even think about picking up a dumbbell.

Well, it turns out we’ve been selling women short.

A new study published in JAMA Network Open in May 2025 is turning that old fear on its head. It shows that—when done gradually and under supervision—resistance training is not only safe after breast cancer surgery, it may actually help prevent or improve one of survivors’ biggest concerns: lymphedema.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835176

Yes, you read that right. Lifting weights may help reduce swelling.

Let’s Talk About the Fear

Lymphedema—swelling in the arm caused by lymph node removal or damage—is one of the most dreaded side effects of breast cancer surgery. It’s painful, chronic, and deeply frustrating. So, for decades, women were told to avoid anything that might make it worse. That included lifting weights.

But the science has changed. And this new study adds to a growing body of research proving that strength training doesn’t worsen lymphedema. In fact, in many cases, it actually improves arm fluid balance.

What the Study Showed

The researchers followed 115 women aged 24 to 71 who had completed breast cancer treatment and participated in a 3-month progressive weight-lifting program. They trained three times a week. The goal? Build muscle, slowly and safely.

And the results were impressive:
📍Not a single participant experienced worsening of lymphedema symptoms.
📍For women who’d had lymph nodes removed, their affected arm actually improved in terms of fluid levels.
📍Lean muscle mass went up in both arms (including the “at-risk” one).

In other words: lifting didn’t hurt—it helped.

This Isn’t Just About Muscles

This isn’t the first study to suggest this. Back in 2010, a randomized trial found that women who lifted weights after breast cancer surgery were less likely to develop lymphedema. The risk dropped dramatically—by as much as 70%—in those who had five or more lymph nodes removed.

And beyond lymphedema, strength training brings all the usual benefits: stronger bones, better metabolism, improved mental health, and, let’s be honest, the confidence that comes from knowing you can carry your own damn groceries again.

But—And This Is Important—It’s All About How

Let’s be clear: this is not about grabbing the heaviest kettlebell you can find and going rogue at the gym. The success of this approach lies in how it’s done:
📌Start low, go slow: Resistance should build gradually.
📌Use proper form: A trainer familiar with cancer recovery can help.
📌Wear compression: For those at risk, wearing a sleeve during workouts adds protection.
📌Watch for changes: Pay attention to swelling, tightness, or discomfort.

This is about listening to your body while trusting that it’s capable of doing hard things again.

The Bigger Picture

Too often, the message after breast cancer is one of fragility. You’re told what not to do. What to avoid. What to fear. But this study—like others before it—tells a different story. A story of resilience, strength, and recovery that doesn’t require you to shrink from life, but to grow back into it—stronger.

So yes, you can lift again. In fact, you should.

16/06/2025

The results of the CHALLENGE trial, published in the New England Journal of Medicine this month, represents a key milestone in the field of exercise oncology. For many years, data from observational cohort studies have consistently shown that exercising on a regular basis following a cancer diagnosis is associated with decreased risk of recurrence and death. However, with observational studies, we can never be 100% sure that the benefits we’re seeing are from the exercise itself or from other things on the side known as “confounders”. For example, cancer patients who exercise regularly also tend to weigh less, eat better and have other healthy habits compared to sedentary patients. So, it's difficult to know for sure whether the reduction in cancer-related recurrence and death we see in exercising patients is caused by the exercise itself and not others things like a lower BMI, better diet or other healthy habits. This is why confirmation of observational data is always needed, typically in the form of a randomized controlled trial where researchers can control for these confounders.
And this is where the CHALLENGE trial comes in. It is the first randomized controlled trial ever published confirming results we have seen in observational studies. Exercise does indeed decrease the risk of cancer recurrence and death in cancer patients.
In this trial, researchers took 889 patients with stage II-III colon cancer who had completed surgery and adjuvant chemotherapy and assigned one group of patients to a structured exercise program over 3 years (Intensity equivalent to 45-60 minutes of brisk walking 3-4 time per week or 25 to 30 minutes of jogging 3 or 4 times) whereas the other group was offered health education advice without exercise.

Compared to the “no exercise” group, more patients assigned to the exercise program:
o Were cancer-free at 5 years: 5-year disease-free survival was 80% in the exercise group vs. 74% in “no exercise” group
o Lived longer over the next 8 years: 8-year overall survival was 90% for the exercise group compared to 83% for the “no exercise” group.
• Had improved fitness levels and better quality of life

What is remarkable about results of this study is that the benefit in terms of disease-free or overall survival is on-par, if not better, with what we typically see with adjuvant chemotherapy. In addition, the survival benefit could not be explained by other factors (weight loss or less belly fat) than just exercise.

Exercise after curative-intent treatment and chemotherapy should be recommended to all patients with colon cancer and it’s likely that patients with other types of early-stage cancer, such as breast, prostate or endometrial cancer, derive significant survival benefit from exercise as well.

26/05/2025

To answer questions about the previous Facebook post regarding the risk of cancer associated with radiation exposure from imaging studies:

1- What is the estimated risk of cancer caused by radiation exposure from a single CT scan?

It is estimated that exposure to a dose of radiation equivalent to 1 Sievert = 1000 mSv increases your risk of developing cancer by around 5%. However, the risk starts going up even at lower doses of radiation exposure, starting at 200 mSV in adults and at 50-100 mSV in children

10/05/2025

Exposure to radiation from computed tomography (CT) scans can increase the risk of developing cancer later in life. This is because high dose radiation can cause DNA damage in the human body which may potentially turn normal cells into cancerous cells over time. The risk is proportional to the cumulative radiation dose, so this means that the more CT scans you get in your life, the higher your risk will be for developing cancer later in life. Children and adolescents are much more susceptible to radiation-induced cancer compared to adults, which means that children or adolescents who undergo several CT scans over many years are at significantly increased risk compared to adults with the same radiation exposure.
The type of radiation-induced cancers also varies between children and adults. Radiation exposure in adulthood increase the risk of developing leukemia, lung or colorectal cancer whereas in children, it is estimated that breast, lung and thyroid cancers will be the cancers diagnosed later in life.
Radiation exposure from CT scans was thought to be responsible for 2% of all cancers in the US more than a decade ago. Fast-forward, and with widespread and increasing CT scan use, this updated study published in JAMA, reports that risk has increased to 5%. This will likely continue over time. The relevance of these results is not only applicable to the US population, but it also extends to worldwide populations particularly for those in the Middle East where guidelines and regulation to limit unnecessary CT scans does not exit.

This risk model projects how many future cancers in the United States could result from annual computed tomography examinations.

01/03/2025

On January 17, 2025, the FDA approved Datopotamab deruxtecan-dlnk, Dato-DXd, (Datroway) for hormone receptor positive (HR+), HER2-negative metastatic breast cancer (MBC) following endocrine-based therapy and 1-2 prior lines of chemotherapy based on results from the TROPION-Breast01 Ph3 study. Then on January 27, it was announced that Trastuzumab-deruxtecan, T-DXd (Enhertu) was approved in the 1st line setting after progression on endocrine-based therapy in HER2-low and ultralow HR+ MBC based on results from the DESTINY-Breast06 Ph3 study. This builds on Enhertu’s prior approval as 2L chemotherapy based on efficacy data from DESTINY-Breast04.
With now 3 ADCs approved (Enhertu, Datroway and Trodelvy), where does the newcomer fit in the treatment paradigm of HR+/HER2- MBC?
To answer this question, it’s important to analyze TROPION-Breast01data in light of the efficacy and safety data as well as mechanisms of action and resistance of its 2 other competitors
Key points from these data:
- In the trials leading to their approval, Enhertu, Trodelvy and Datroway were compared to physician’s choice of chemotherapy and not head-to-head
- The 3 ADCs share a similar mechanism of action. DXd, the payload of Datroway and Enhertu and SN38, the payload of Trodelvy inhibit topoisomerase activity) and/or target (Datroway and Trodelvy target TROP2 receptor on BC cells). Because of this, cross-resistance occurs. Several retrospective studies have shown that trodelvy’s activity is modest at best in HR+/HER2-low MBC patients who already received and progressed on Enhertu. We don’t have data reporting on the activity of Datroway following Enhertu, but it’s likely that similar cross-resistance mechanisms exist limiting Datroway’s efficacy post-Enhertu.
- The pivotal ADC trials were conducted in different patient populations, DESTINY-Breast04 and TROPION-Breast01 included somewhat of a similar HR+ patient population (In both trials, 60% of patients had only 1 prior line of chemotherapy in the metastatic setting) and with the limitations of cross-trial comparison, PFS benefit with Enhertu appears to be far superior to that of Datroway. Even if the OS data end up being positive for Datroway, Enhertu’s approval in the 1st line chemo setting in HER2-low and ultralow breast cancer has made it an unchallenged contender and Datroway may find its small niche in the 2nd line setting in the small proportion of patients who are not HER2-low or ultralow
- Datroway’s finds its real competition in the later-line setting (3L+) with Trodelvy. With a more appealing toxicity profile (particularly BM suppression and neutropenia) and low rates of drug-related pneumonitis, Datroway will likely dominate the market share for 3L+ in HR+ MBC if the eagerly awaited, TropionBreast01 OS data are positive

My two cents:
- Enhertu’s has become the de facto 1-2 chemo choice in HR+/HER-low and ultralow MBC, and differentiating HER2 0 vs HER2 ultralow has become of bane of our pathologists’ existence
- Datroway currently finds its market share in 2L setting in the small proportion of HR+MBC patients who are truly and consistently HER2 0 and may outperform trodelvy’s current market share in the 3L+ setting if TropionBreast01 OS data are positive. However, questions on the actual efficacy of either drug post-Enhertu and how to recognize patients who are likely to experience significant PFS benefit from either drug post-Enhertu remain unanswered.

On January 17, 2025, the Food and Drug Administration approved datopotamab deruxtecan-dlnk (Datroway, Daiichi Sankyo, Inc.), a Trop-2-directed antibody and topoisomerase inhibitor conjugate, for adult patients with unresectable or metastatic, hormone receptor (HR)-positive, human epidermal growth fa

13/06/2024

The J&J lawsuit has received widespread media coverage and an analysis of the Sister Study cohort published last month in the Journal of Clinical Oncology lends credence to the fact that frequent and prolonged ge***al talc powder use may put women at higher risk of developing ovarian cancer and this goes up with more frequent and/or longer use at a younger age (20s-30s)
https://ascopubs.org/doi/abs/10.1200/JCO.23.02037?journalCode=jco
Prior studies reporting on this association have been criticized for having significant recall bias, particularly studies conducted after 2014 when lawsuits against the company first became public. In a nutshell, women with ovarian cancer may be more likely to report any ge***al talc powder use because they know from the media that it could have caused their disease whereas women without ovarian cancer may not report talc powder use as thoroughly or at all, leading to an incorrect overestimation of the association. This is one of the arguments put forth by the company to dispute the claim. However, the study the authors found that the association persisted even with a large degree of incorrect exposure reporting by women included in the Sister Study, meaning that this association is more likely than not to be true.
What the study also shows, and this has not gained as much media attention as it should, that the use of vaginal douching products for a prolonged period of time seems to be equally associated with the risk of developing ovarian cancer down the road. Although some douches contain only water or vinegar, other commercially available products may contain hormone-disrupting chemicals and volatile organic compounds, such as phthalates, parabens, and bisphenols, which may exert a carcinogenic role.
Given these findings, it's important that all women particularly those in their 20s and 30s are educated about the potential risk of ovarian cancer with regular ge***al talc powder use or douching, with the hope that if they stop using these products now this might potentially prevent cancer down the road.

Johnson & Johnson agreed to pay $700 million to settle a lawsuit by 42 U.S. states and Washington D.C. alleging it misled consumers about the safety of its baby powder made with talc. A recent study found use of talc is linked to ovarian cancer. The company did not admit any wrongdoing and maintains...