Eric Nadler, MD

“[Sarcomas] run the gamut, like many things in oncology, from these isolated and easy to diagnose [cases] to very challenging to diagnose problems [that] even spread into the metastatic picture.”

Eric Nadler, MD, MPP, a medical oncologist and medical director of US Oncology Health Informatics and Internet Technology, discussed the inherent complexity of diagnosing sarcomas, underscoring their heterogeneous nature and diverse clinical presentations.

Sarcomas are rare malignancies that may arise in a variety of anatomic locations, often complicating initial recognition. Nadler noted that many cases are first identified in the abdomen or pelvic region, where they may be encountered by gynecologists or gynecologic oncologists. This highlights the importance of interdisciplinary collaboration in both diagnosis and treatment planning. Less commonly, sarcomas may present in the thoracic cavity or other body sites, adding to the diagnostic variability.

One of the central challenges in diagnosing sarcomas lies in their broad biological spectrum. These tumors can range from lesions that are indolent and clinically manageable to highly aggressive malignancies capable of local invasion and widespread metastasis. They may also present as multifocal disease, further complicating the diagnostic and therapeutic approach. This heterogeneity requires careful pathologic review and, frequently, expert consultation at specialized centers to ensure diagnostic accuracy.

Nadler emphasized that the diagnostic process often extends beyond the initial histopathologic assessment. Imaging studies, molecular profiling, and multidisciplinary review are frequently required to differentiate between benign and malignant lesions, as well as to determine the extent of disease. Given the diverse natural history of sarcomas, misclassification can have significant consequences for treatment selection and outcomes.

He also highlighted the importance of contextualizing sarcomas within the broader framework of oncology. Unlike many more common solid tumors, sarcomas defy a uniform treatment paradigm and require highly individualized strategies. This includes not only systemic therapies, but also surgical and radiation-based interventions tailored to the disease site, histologic subtype, and clinical behavior.

Nadler concluded by noting that the complexity of sarcoma diagnosis reinforces the necessity of specialized expertise and multidisciplinary collaboration. Gynecologic oncologists, radiologists, surgeons, and medical oncologists must work closely to establish accurate diagnoses and guide treatment decisions. Recognizing the variability in presentation and biology is essential to improving patient outcomes, particularly as new diagnostic tools and therapeutic options continue to evolve.

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Eric Nadler, MD, MPP, discusses the inherent complexity of diagnosing sarcomas.

Dr Nadler on the Inherent Complexity of Diagnosing Sarcomas

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the impact of immunotherapy in squamous non—small cell lung cancer (NSCLC).

In this patient population, the addition of immunotherapy has significantly improved response rates from what was previously seen with chemotherapy alone, Nadler says. Overall survival (OS) is being prolonged in unprecedented fashion, even when immunotherapy is used as second-line treatment. However, it appears that giving chemoimmunotherapy in the frontline setting is more effective because not all patients are fit enough to receive immunotherapy in the second-line setting, Nadler notes.

It may seem as though immunotherapy is readily available, but recent data show not all patients can get it in the second-line setting. Moreover, the benefit with immunotherapy is seen across PD-L1 subgroups. While the progression-free survival in the PD-L1—negative group is not impressive by itself, there is a clear OS benefit in that population, says Nadler.

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the impact of immunotherapy in squamous non–small cell lung cancer.

Dr. Nadler on the Impact of Immunotherapy in Squamous NSCLC

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the IMpower131 study in stage IV squamous non—small cell lung cancer (NSCLC).

The IMpower131 trial was designed similarly to that of the KEYNOTE-407 study except that patients receiving carboplatin were randomized to either paclitaxel or nab-paclitaxel (Abraxane). The other difference between IMpower131 and KEYNOTE-407—–the study that led to the FDA approval of pembrolizumab (Keytruda) plus chemotherapy in this setting––was that patients weren’t allowed to crossover. These patients were able to receive second-line immunotherapy, Nadler notes.

Moreover, patients experienced a benefit in progression-free and overall survival benefit with the addition of atezolizumab (Tecentriq) in IMpower131. However, PD-L1 nonexpressers did not do quite as well with chemoimmunotherapy; the response rates were lower. Nadler notes that patients with PD-L1 less than 1% tend to derive less benefit from immunotherapy. Atezolizumab plus carboplatin and paclitaxel/nab-paclitaxel is not yet FDA approved or used routinely, but more mature data may change that, says Nadler.

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the IMpower131 study in squamous metastatic non–small cell lung cancer.

Dr. Nadler Discusses the IMpower131 Study in Squamous NSCLC

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the role of PD-L1 in patients with squamous non—small cell lung cancer (NSCLC).

Benefit from the combination of pembrolizumab (Keytruda) plus carboplatin and paclitaxel/nab-paclitaxel (Abraxane) may be markedly different in patients with low versus high levels of PD-L1 expression. However, Nadler notes, every patient with metastatic squamous NSCLC should receive this regimen in the frontline setting regardless of PD-L1 status. In October 2018, the FDA approved the regimen in the frontline setting. The choice of whether to administer paclitaxel or nab-paclitaxel is up to the discretion of the treating physician, adds Nadler.

As more data emerge looking at the role of tumor mutational burden in predicting immunotherapy response, it may become apparent that some patients with low PD-L1 expression should not receive this regimen upfront. For the time being, every patient should be treated with this regimen. Though, it is unclear if that will continue to be the case moving forward, Nadler concludes.

Eric S. Nadler, MD, medical oncologist, Baylor University Medical Center, medical director, US Oncology Health Informatics and Internet Technology, discusses the role of PD-L1 in patients with squamous non–small cell lung cancer.

Eric S. Nadler, MD

Articles

Dr Nadler on the Inherent Complexity of Diagnosing Sarcomas

Dr. Nadler on the Impact of Immunotherapy in Squamous NSCLC

Dr. Nadler Discusses the IMpower131 Study in Squamous NSCLC

Dr. Nadler Discusses Role of PD-L1 in Squamous NSCLC