Oncology On The Go

In this second installment of their conversation on depression in oncology, Daniel C. McFarland, DO, and Boris Kiselev, MD, moved from diagnosis, covered in Part 1, into treatment. The discussion opened with the differential diagnoses that need to be ruled out before starting therapy: delirium, bipolar disorder, medical conditions such as endocrinopathies and severe anemia, and neurocognitive issues stemming from central nervous system involvement or dementia. McFarland and Kiselev outlined the specific red flags that should prompt an oncologist to bring in a mental health specialist rather than manage treatment alone, including suicidality, psychosis, and complex psychiatric histories.
From there, the conversation turned to how depression is categorized by severity using the PHQ-9 scale, and how that severity, along with patient preference and access to care, should guide the choice between lifestyle modification, psychotherapy, and pharmacotherapy. Kiselev introduced a simplified 4-drug toolkit for oncologists: 1 selective serotonin reuptake inhibitor, 1 serotonin and norepinephrine reuptake inhibitor, mirtazapine (Remeron), and bupropion, explaining how to match each option to a patient’s specific symptoms and adverse effect (AE) concerns.
The back half of their discussion served as a practical walkthrough for starting a patient on medication. They covered how to frame the conversation to reduce stigma, what to say about timelines for benefit, and specific dosing and titration guidance for each of the 4 core drugs. McFarland and Kiselev closed by highlighting the most common AEs to flag upfront, a real-world case illustrating why dose titration matters, and general guidance on how long patients typically stay on treatment.
McFarland is the director of the Psycho-Oncology Program at Wilmot Cancer Center and a medical oncologist who specializes in head, neck, and lung cancer, in addition to being the psycho-oncology editorial advisory board member for the journal ONCOLOGY. Kiselev is a consult liaison psychiatrist at Atrium Health Carolinas Medical Center, an assistant professor in the Psycho-oncology Program in the Department of Supportive Oncology at Atrium Health Levine Cancer Institute, and an assistant professor in internal medicine.
00:02-02:24: Recap of the prior episode and framing for treatment
02:24-11:17: Ruling out other causes: delirium, bipolar disorder, medical conditions, and neurocognitive issues
11:49-15:17: Deciding when an oncologist can treat directly vs when to refer to a mental health specialist
15:45-23:01: Categorizing depression severity with the PHQ-9 and matching it to lifestyle, psychotherapy, or medication
23:46-26:05: Choosing between non-pharmacologic and pharmacologic treatment based on severity and access
26:05-35:49: Selecting a medication from a core 4-drug toolkit and preparing the patient to start it
37:30-48:30: Drug-specific dosing, titration strategy, and managing common adverse effects
50:37-51:59: How long patients typically stay on treatment and closing thoughts

In a cobranded episode between Oncology On the Go, hosted by CancerNetwork®, and the American Society for Transplantation and Cellular Therapy’s (ASTCT) program ASTCT Talks, Terri Lynn Shigle, PharmD, BCOP, hosted Vinita Pai, PharmD, MS, BCPPS, who spoke about the use of CAR T-cell therapy for pediatric patients, focusing on acute lymphoblastic leukemia (ALL). After a brief overview of progress in the cellular therapy field and pediatrics’ first and only FDA-approved CAR-T product since 2017, their discussion explored the following:
·      Review of real-world practice and outcomes in ALL
·      Pediatric practical challenges including logistics, leukapheresis and lymphodepletion chemotherapy
·      Strategies for managing cell therapy toxicities in pediatric patients
·      Considerations for survivorship and long-term toxicities
·      Gaps in pediatric care and future directions
The discussion highlighted the unique challenges of treating pediatric patients, paucity of data, and need for continued exploration of cellular therapy treatment not only in ALL, but other underlying diagnoses. 
Shigle is a clinical pharmacy specialist in the Stem Cell Transplantation & Cellular Therapy Department at The University of Texas MD Anderson Cancer Center. Pai is an associate clinical professor in the Division of Pharmacy Practice and Science at The Ohio State University.
Reference

O'Leary MC, Lu X, Huang Y, et al. FDA approval summary: tisagenlecleucel for treatment of patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia. Clin Cancer Res. 2019;25(4):1142-1146. doi:10.1158/1078-0432.CCR-18-2035

In the newest edition of Oncology On the Go, Joshua Richter, MD, and Marco Davila, MD, PhD, spoke about the current multiple myeloma treatment landscape and highlighted practical considerations for administering CAR T-cell therapy to patients. Their discussion touched upon several critical subtopics ranging from optimizing operational and referral workflows to dismantling barriers to treatment access in rural settings.
When it comes to navigating the multiple myeloma treatment algorithm, both hosts emphasized early evaluation to determine patient suitability for CAR T-cell therapy, which may help identify those who are most likely to experience the greatest responses with minimal toxicity. Regarding the question of sequencing different modalities, Richter pointed to data demonstrating the utility of administering CAR T-cell therapies prior to bispecific antibodies.
Acknowledging that the average patient enrolled on a clinical trial may not align with what is typically seen in real-world practice, the hosts discussed “reassuring” data that those who do not meet certain eligibility criteria may nevertheless benefit from CAR T-cell therapy. Additionally, on the topic of maintaining an effective referral relationship between community oncologists and CAR-T centers, Davila noted that academic cell therapy clinicians may have an incumbent responsibility to consider how to improve access to treatment and make it easier for others to refer patients to care.
“CAR T-cell therapy is now deeply entrenched in the world of relapsed multiple myeloma [and] soon to be likely entrenched in the newly diagnosed world. These are therapies that I think we're all going to need to embrace whether it's from an academic standpoint or a community standpoint,” Richter concluded. “Having that ongoing communication back and forth, especially as the field is moving so quickly, is absolutely key in providing optimal care for our patients.”
Richter is an associate professor of Medicine in the Division of Hematology and Medical Oncology at The Tisch Cancer Institute, as well as the director of Multiple Myeloma at the Blavatnik Family - Chelsea Medical Center at Mount Sinai. Davila is the senior vice president and associate director for Translational Research, a professor of Oncology, chief of Lymphoma/Multiple Myeloma Service, and Rustum Family Endowed Chair in Translational Research at Roswell Park Comprehensive Cancer Center.

At the 2026 National ICE-T Conference in Orlando, CancerNetwork® sat down with a variety of expert researchers and clinicians to discuss the latest developments in immune effector therapy across different hematologic oncology populations. Sessions at the meeting covered practical considerations for integrating CAR T-cell therapies, bispecific antibodies, and other modalities into the treatment of those with multiple myeloma, lymphoma, and other hematologic malignancies.
First, Benjamin Diamond, MD, an assistant professor of Clinical Medicine, a member of the Sylvester Myeloma Institute, and a member of the Myeloma Genomic Lab at the University of Miami Miller School of Medicine, spoke about his presentation reviewing bispecific antibodies for the management of multiple myeloma. In his session, Diamond stated that bispecific T-cell engagers are altering the landscape of multiple myeloma care and will eventually become an option in the frontline setting. With many products to choose from, Diamond emphasized sequencing these novel therapies wisely and stressed aggressive infection prophylaxis as a mandatory facet of care.
Next, Tiba Al Sagheer, PharmD, BCOP, BCACP, a pharmacy quality improvement coordinator for transplant and cellular therapy at Miami Cancer Institute of Baptist Health South Florida discussed her presentation focused on defining new thresholds for monitoring and mitigating toxicities associated with CAR T-cell therapy. She described considerations for balancing early toxicity intervention against the risk of blunting efficacy depending on the specific CAR T-cell product used during treatment. Ultimately, she noted that that there is still no definitive answer or threshold for initiating prophylaxis for toxicity associated with CAR T, and that differentiating between immune effector cell (IEC)–associated hemophagocytic lymphohistiocytosis (HLH)–like syndrome (IEC-HS) and cytokine release syndrome (CRS) represents an ongoing challenge in the field.
Finally, Nikesh N. Shah, MD, and Carlos Silva Rondon, MD, shared their perspectives on a debate regarding the roles of bispecific antibodies and CAR T-cell therapies in relapsed/refractory follicular lymphoma. In his presentation, Shah, a hematologist-oncologist at Tampa General Hospital who specializes in hematologic malignancies, including aggressive lymphomas and acute lymphoblastic leukemia, took the position that bispecific antibodies should be used prior to CAR T-cell therapy for most patients, although both treatments have utility in the field. Silva Rondon, a hematologist, oncologist, and bone marrow transplant specialist at Moffitt Malignant Hematology and Cellular Therapy at Memorial Healthcare System/Memorial Cancer Institute in Pembroke Pines, advocated for CAR T-cell therapy during the debate but acknowledged that both modalities can make up a complementary strategy for overcoming relapsed/refractory follicular lymphoma.
References

Diamond B. Bispecific antibodies for the management of multiple myeloma. Presented at the 2026 National ICE-T Conference; July 18, 2026; Orlando, FL.

Sagheer TA. Thresholds and therapeutics: a precision approach to CAR T toxicity management. Presented at the 2026 National ICE-T Conference; July 18, 2026; Orlando, FL.

Shah N. Debate: bispecific antibodies vs CAR-T in follicular lymphoma. Presented at the 2026 National ICE-T Conference; July 18, 2026; Orlando, FL.

Silva C. CAR-T cell therapy for relapsed follicular lymphoma. Presented at the 2026 National ICE-T Conference; July 18, 2026; Orlando, FL.

Following the FDA approval of allogeneic regulatory T cell–containing immunotherapy with hematopoietic stem and progenitor cell (HSPC) and T cells-vldq (Tregzi; Orca-T), CancerNetwork® spoke with Wendy Stock, MD, about what this decision means for the treatment of patients undergoing hematopoietic stem cell transplantation for different hematologic malignancies. Additionally, she discussed how this option fits into the treatment landscape alongside other options like posttransplant cyclophosphamide (PTCy) and other next steps for improving outcomes associated with matched donor transplants.
Stock reviewed findings from the phase 3 Precision-T trial (NCT05316701) that supported the approval of Orca-T, noting that the data appeared to be “effective across all populations” for patients with acute myeloid leukemia, acute lymphoblastic leukemia, high-risk myelodysplastic syndrome (MDS), and mixed-phenotype acute leukemia. Furthermore, she detailed what adoption of Orca-T might look like on an operational level, described the agent’s ability to reduce the risk of graft-versus-host disease, and emphasized referring patients early to transplantation.
The approval, Stock said, marks the beginning of potentially allowing “higher-risk populations to move forward with the knowledge that it is possible to undergo transplant safely.” She noted that the FDA’s decision may inspire the field of transplant graft engineering to look more carefully at other options that might further improve transplantation outcomes.
“Over the last 10 years, we have had incredibly exciting, still-to-be-tweaked methods for improving outcomes for patients undergoing transplant, which is such an important procedure for curing or [achieving] long-term survival for patients with acute leukemias and high-risk myelodysplastic syndromes,” Stock said. “This is a big advance, and it needs to be studied further, including comparisons with other major improvements in the world of transplant, such as PTCy.”
Stock is the Anjuli Seth Nayak Professor of Medicine, cochair of the Leukemia Committee for the National Cancer Institute–supported Alliance for Clinical Trials in Oncology, and coleader of the Clinical and Experimental Therapeutics Research Program at the University of Chicago Medicine Comprehensive Cancer Center.
References

FDA approves allogeneic regulatory T cell-based immunotherapy with HSPC and T cells-vldq for use in matched donor hematopoietic stem cell transplantation for adults with hematologic malignancies. News release. FDA. June 30, 2026. Accessed July 15, 2026. https://tinyurl.com/38s3wznr

Meyer EH, Salhotra A, Gandhi AP, et al. Orca-T vs allogeneic hematopoietic stem cell transplantation (Precision-T): a multicenter, randomized phase 3 trial. Blood. 2026;147(11):1168-1177. doi:10.1182/blood.2025031313