Latest news with #MarkLewis
Wales Online
a day ago
- Sport
- Wales Online
Gavin Henson and former Wales stars to play on same side against Welsh club team
Gavin Henson and former Wales stars to play on same side against Welsh club team The event on June 21 aims to be a celebration of rugby Former Wales and British Lions player Gavin Henson playing for his local team Pencoed RFC last year (Image: Mark Lewis Photography ) A number of Welsh legends are set to pull on their boots once again - and it won't cost fans a penny to come and watch. Usk RFC are inviting a number of stars from years gone by to compete in two touch rugby matches this Saturday, as they celebrate the end of their 150th season. The club, who currently compete in League 2 East, are believed to have played their first match against Newport in 1874, and have played every season since with the exception of the period during the two World Wars. They are now set to honour and celebrate a century-and-half of history this weekend, with a host of big names set to get involved. Gavin Henson, Sam Parry, Lloyd Williams, Elliot Dee, Aaron Wainwright, Ryan Jones, Scott Baldwin and Bradley Davies are all among those set to take part in the club's 'Legends Day' celebrations. The 'Legends' team will take on the club's under-14s side for a 2pm kick-off, before facing Usk's first team straight after. Article continues below Gates will open at midday, and entry is free. Food stalls, including a hog roast, and various activities will be on offer, with any proceeds set to contribute to the club's support for two Tongan teenagers, whom they decided to sponsor last year. As committee member Ro Kulkarni explains: "One was 17 and one was 18, and both came here last year from very poor families. They've both come over and they're studying here and they're now getting an education. "They're Nico and David, who's known as Tongan Dai! "Everyone's pooled together to help these boys. They're like our children. And the best thing is they're both wonderful rugby players. "Their education costs around £9,000 a year. They have college fees and then you've got to pay for food, accommodation, travel. All the other things. So it's a serious amount of money to raise every year. But so many people have given their support. "There's a butcher in Abergavenny that gives them a bucket of meat every two weeks, some have donated them food and clothes, the Celtic Manor have helped give them a flat for them to stay. Another family put them up for a few weeks. "We've had great support from Toby Faletau's dad, Sione Tu'ipulotu, and Kepu Tuipulotu, who plays for Bath. So the Tongan community have been so supportive. "So to celebrate our 150th year we thought we'd do something really nice. Partly to raise money, but it's not just to raise money. It's about giving back." Kulkarni, who worked as team doctor for the Dragons for the best part of 10 years before leaving in 2017, says the event will also be a chance for youngsters to meet and greet some of the game's biggest names. "It's open for all," he added. "It's for kids and there will be lots of food stalls, face painting etc. The fire service are bringing a fire engine for the kids. So there's a lot going on. "The event has also been sponsored by Heineken, who have donated five barrels of beer for the event. Article continues below "It's a day for everyone to mingle. Kids can meet their heroes and have pictures taken, sign autographs. "It's a celebration of rugby."
BBC News
2 days ago
- Entertainment
- BBC News
Sand art: What is the best thing you have made at the beach?
The sun is shining, and the weather is warming some people that might mean dreaming of ice creams, playing outside or maybe a trip to the beach to make some sand man who knows all about that is Mark Lewis who has taken his hobby of sand sculpture to a new he made a giant pair of crocs out of sand for a competition in Dorset. Inspired by Mark we want to know what the best thing YOU have made at the beach is. Maybe it's a castle fit for a king or queen, a mermaid's tail made of sand, or something a bit different. Let us know in the comments below... Mark Lewis is one of many people who love making sand art, and his impressive sculpture of a giant pair of crocs has recently caught the eye of the public. Mark, who is a part-time church minister, creates intricate sand sculptures which take around seven hours to says his passion for sand art came from building sandcastles with his sons when they were younger. Since then he has created many incredible pieces including dragons, mermaid tails, Spongebob Squarepants, and a giant ice cream cone. For Mark the hobby is not only something he loves to do, but also something that he hopes will bring happiness to others. He said: "If I can put a little bit of joy into the world or put a smile on somebody's face, then it feels like a good thing to do."So, do you enjoy making sculptures on the beach? What has been your most ambitious or impressive design?Share your thoughts in the comments below.
Wales Online
4 days ago
- General
- Wales Online
Opposition to Cosmeston aqua park dismissed as 'malicious tripe'
Opposition to Cosmeston aqua park dismissed as 'malicious tripe' Vale of Glamorgan Council leader Liz Burnett has hit back at opposition to the controversial water park which has seen protestors gather to voice their concerns Hundreds of people joined a protest against the proposal to use the eastern lake at Cosmeston for a water park (Image: Mark Lewis ) A Welsh council leader has hit back at campaigners opposing controversial plans for a water park at Cosmeston Lakes. Vale of Glamorgan Council lead Liz Burnett said criticisms of the scheme are "malicious tripe" and "rubbish" spread by 'disinformation." Her comments come in a long response posted on Facebook following a protest at the lake on June 14 and heated debate and comment on social media. On June 14 hundreds of people formed a human chain around the lake where the water park is planned this summer, Opponents say the plans will cause harm to wildlife at the 100-acre Cosmeston Country Park as well as traffic chaos. There are also concerns about the park encouraging swimming, which is usually banned. The plan to move the popular Cardiff Bay Aqua Park to the eastern lake at Cosmeston was announced in May with an opening date set for July 5. A trial of the inflatable water course is set to last eight weeks over the summer months. The park is home to wildlife including water fowl and the endangered water vole. Opponents of the water park fear it will disrupt and potentially harm their habitats. Part of the park, although not where the aqua park would be, is a Site of Special Scientific Interest protecting rare plant and animal species. Posting her response to "naysayers" on her Facebook page the Vale of Glamorgan Council leader said she wanted to set the record straight. She wrote: "There is a fair amount of rubbish being spread at present, sadly much appears to be deliberate, so I thought I'd provide some clarification." Vale of Glamorgan Council leader Lis Burnett (Image: WalesOnline/Rob Browne ) Sign up for our free daily briefing on the biggest issues facing the nation sign up to the Wales Matters newsletter here. Article continues below The council leader said she has been "personally attacked by a Vale 'expert' who doesn't even appear to know what wildlife is in Cosmeston" and posted a video of a baby water vole which she said shows it is not bothered by the noise of the aqua park being set up, nor of barking dogs at the lake. "I would not consider anything that might have a negative impact on the park," Cllr Burnett added. She explained the Vale of Glamorgan Council was approached to allow the trial of the aqua park and how it will prove "much needed income for the park", although she did not say how much cash it will bring in. The plan has also had positive feedback from young people, she claimed. On concerns about water quality safety the council leader's statement insisted the council agreed the scheme subject to water quality monitoring by the company running the aqua park as well as the Vale's owns environmental health department and an independent ecological review and agreement by Natural Resources Wales. "The Aqua Park operator also carried out under water surveys. Only once they were all in place was agreement given. It has been alleged that it was not discussed by cabinet nor scrutiny and rushed through by emergency powers. That is malicious tripe and is being dealt with separately," Cllr Burnett's statement added. The aqua park has previously been located at Cardiff Bay (Image: South Wales Echo ) She said the suggestion for the water park trial was discussed by senior councillors at cabinet on March 6 and by the scrutiny committee five days later before being discussed again by cabinet on March 20. She said recordings of all these meetings are available online. To further allay concerns she added that the aqua park will be based on a tiny section of the park's eastern lake where wildlife is already used to noise from visitors. On concerns over swimming safety she added that "it's only unsupervised swimming that is not allowed" currently. The eastern lake at Cosmeston Counrty Park (Image: Mark Lewis ) Cllr Burnett's remarks were described as "tone deaf" by South Wales Central MS Andrew RT Davies, who said Cllr Burnett's comments "highlighted a lack of understanding of residents' genuine concerns" and that the council had not listened to park users. Article continues below He said the scheme was "completely unsuitable for a quiet location like Cosmeston Lakes", adding: 'It's perfectly reasonable to raise concerns about nature and impacts on the environment and local community. There was no need for Cllr Burnett to lash out. 'She could have made her points constructively, but instead chose to make a series of allegations against those campaigning against the aqua park, and question their motives."
Wales Online
6 days ago
- General
- Wales Online
Cosmeston Lake campaigners form human chain in protest over aqua park 'tragedy'
Cosmeston Lake campaigners form human chain in protest over aqua park 'tragedy' 'It's just a crazy idea. The thought of it makes me feel really upset' Peaceful protesters formed a human chain (Image: Mark Lewis ) Hundreds of people gathered together to make a human chain around a beautiful Welsh lake where there are plans to set up a controversial water park. On Saturday morning people from the Vale of Glamorgan displayed their concerns that the plans could cause parking chaos and harm wildlife at Cosmeston Country Park. Plans to move the Cardiff Bay Aqua Park to the eastern lake at the park were unveiled in May with an opening date set for July 5. A trial of the inflatable water course is set to last eight weeks over the summer months. Cosmeston Country Park covers 100 acres of land in Penarth, with an abundance of wildlife habitats, including that of the critically endangered water vole. Part of the park is a Site of Special Scientific Interest ensuring the protection of the rare and diverse plant and animal species that live there. With this in mind protesters came together in the hope that they can prevent the council going ahead and facilitating the water park - which they say is highly inappropriate for Cosmeston. Hundreds of people turned up (Image: Mark Lewis ) Vale of Glamorgan Council has previously said the aqua park would be a "great addition" to the site, and said there is "appetite locally" for the proposals. Article continues below WalesOnline went along to speak to some of the campaigners about why they decided to show their support on Saturday. Mark Rosomon was there with his wife Amanda. The 64-year-old said: 'We are here today because we are residents of Penarth. We have been for more than 30 years. Cosmeston is known for its beauty and peace (Image: Mark Lewis ) 'We believe this park is of great importance. It's been about 50 years old in the making and they want to scrap all that for the sake of making a few quid to help the council out. 'By the numbers here today you can see that people are against this water park. They've told us for years that the water is unsafe to swim in. 'It belongs to the people and it should remain belonging to the people for their personal enjoyment.' People are concerned for the wildlife (Image: Mark Lewis ) He said the couple's concerns are environmental, particularly the potential impact it may have on animals as well as more cars coming into the area. They want the decision to be reversed (Image: Mark Lewis ) 'All the [plans] will do is bring more people in from outside the area and we already don't have the infrastructure - it's going to increase the traffic,' he said. 'Already at the moment we can't move around Penarth and there is no parking. 'We came here today on our bicycles purely to come to this protest to show our support. We often walk our dog here. Even though we live in the town we walk to Cosmeston via the railway track that is there for pedestrian use. 'With all the pedestrianisation, why do we want to be bringing more and more vehicles into this area that is already crammed?' Mark and Amanda hold the fish and duck shaped signs (Image: Mark Lewis ) Elsie Phillips from Penarth and Kathie Thomas from Barry brought with them a huge poster that read: 'Stop the aqua park." Elsie, 70, said: 'It's a tragedy for the wildlife at Cosmeston. It's going to ruin the peaceful aspect of the whole park. It's just a crazy idea. The thought of it makes me feel really upset.' Kathie, 69, added: 'I'm here because I appreciate nature. I've always lived in Barry and I use Cosmeston a lot and I am really fed up with the council because they just do not listen. 'They seem to be deaf to any objection, so I want to do my bit. I don't usually do anything like this but I do think this is a really important cause. 'I think they are looking for money regardless. I don't think they are thinking of improving facilities here. I am pleased with the turn out but I would like it if more people were here.' Elsie is far left of the sign and Kathie is on the far left (Image: Mark Lewis ) Barry Action for Nature members Claire Curtis, Robert Curtis and Rebecca Glasson said they are not against aqua parks, but believe it would be inappropriate to bring one to Cosmeston. They said they enjoy watching birds at the park and that it would put them off wanting to visit - as well as possibly discouraging such birds to nest there. Claire, 61, said: 'We are members of Barry Action for Nature and the aqua park being here at Cosmeston is completely the wrong place. 'We aren't against aquaparks but somewhere else, not here. This is a country park for nature and peace and we are totally against it being located here. 'It makes me feel angry because you come here for the nature and the peace and quiet and for family time and to be able to enjoy this beautiful park. It's totally the wrong place. 'We understand that the council does need to try and make money where it can because things are really tight at the moment but this is not the right place and nature has to come before money on this occasion.' Claire, Robert and Rebecca (Image: Mark Lewis ) Robert, 60, said: 'I feel so frustrated, it's such a wonderful place. People come here for the silence, the solitude and peacefulness of it all and they're going to take that away. 'Inevitably nature will then disappear for such a wonderful site. It goes against everything we should be doing to support nature.' Locals believe it is inappropriate to have the water park at Cosmeston (Image: Mark Lewis ) Rebecca Glasson added: 'It's classed as a conservation area and I worry about the impact, the disturbance to wildlife and nesting birds aren't going to nest around here with so much noise.' Anne Turnbull and her husband Steve were also present. Anne, 63, pointed out that part of the country park is a Site of Special Scientific Interest (SSSI). In Wales it is strongly discouraged and often prohibited to build on these. She said she believes they have gotten around this because the water park is considered temporary. Anne and Steve also disagree with the plans (Image: Mark Lewis ) She said: 'This is a SSRI. They got around it because you are not allowed to put any permanent development even within the vicinity of, let alone in an SSRI. They got around it by saying it's temporary. 'The council were judge and jury. It's going against every grain that you could put something in temporarily for the next 10 years. There was a letter sent out a few years [ago] saying that you can't build in an SSRI - and they found a way around it.' Marc Harris is a local nature writer who was invited to the protest to read an extract from his book 'South and West Wales. Its Wildlife, People and Places'. Marc Harries (Image: Mark Lewis ) He was invited after he shared a picture on social media of one of Cosmeston's beautiful water voles eating an apple. He said: 'I put a post on Facebook of a photo I took of a water vole and got a lot of likes because they're cute. The cute water vole enjoying an apple at Cosmeston (Image: Marc Harries ) 'I write about nature and I've written about Cosmeston and Barry Island, so they invited me to read an extract from my book. 'It's important to me because it's completely the wrong place for an aqua park. I'm not against aqua parks at all, but it is the wrong place because of the detrimental effects it will have on wildlife. 'I do hope it is stopped. I think the council has made a wrong decision and they should retract it.' Vale of Glamorgan Council and Aqua Park Cardiff has been approached for comment. Cllr Bronwen Brooks, deputy leader and cabinet member for sustainable places at the council, previously said: "The Aqua Park will be another great addition to the already fantastic offer at Cosmeston Country Park as the council continues to promote sustainable tourism and leisure activities in the area. "Consultation with residents through the Council's placemaking work has shown there is appetite locally - particularly among young people - for more varied leisure activities, and the re-introduction of water-based activities at Cosmeston will help us to ensure that our Country Parks are for everyone. "Trying new things is at the heart of what we do as an ambitious Council, and this pilot could also enable further income opportunities for our Country Parks – especially in supporting the re-wilding and conservation work already underway at Cosmeston. "The Vale of Glamorgan Council has worked with a number of partner agencies to ensure that the lake is safe for Aqua Park visitors to enjoy – including a detailed programme of water testing work." Connor James, founder of Aqua Park Cardiff, previously said: "We're thrilled to bring Aqua Park Cardiff to Cosmeston Lakes by partnering with The Vale of Glamorgan Council. "The Country Park is a fantastic venue for our exciting watersport experience, perfect for supervised adventure and family fun. With an exciting new course of obstacles, we can't wait to welcome visitors to our incredible new home. "We are also really excited to be playing our part in giving people and families much-needed access to active outdoor experience, in a controlled and supervised environment to help boost their physical and mental well-being." Article continues below
Medscape
13-06-2025
- Health
- Medscape
Teamwork in Oncology Spotlighted at ASCO
This transcript has been edited for clarity. Mark A. Lewis, MD: Hello. I'm Dr Mark Lewis, director of Gastrointestinal Oncology at Intermountain Health in Utah. Joining me today is Dr Stephanie Graff, director of the Breast Oncology Program at Brown University Health's Cancer Institute, and co-leader of the Breast Cancer Translational Research Disease Group. Today, we would like to talk to you about the latest updates from the 2025 ASCO Annual Meeting. Stephanie, it's a true joy to sit down with you. I always look forward to ASCO. I sometimes explain to my patients that it's like the Super Bowl of oncology, and I don't think that's hyperbolic. It's the largest meeting of the year. One of the true advantages is getting to network with people like you, but also — I don't know about you — I get a real tangible sense of progress, and I often tell my patients, 'Listen, I'm going to go to this meeting. I don't want to over-promise and underdeliver, but I think there's a real chance that I'll bring back something new that might affect your care.' There are the big four tumor types in oncology, breast, lung, [gastro intestinal (GI), and genitourinary]. You practice above the diaphragm, and I practice below the diaphragm. As we might talk about in the Venn diagram, I think we overlap. I'm just curious what's exciting you at this meeting? Stephanie L. Graff, MD: In breast oncology, there's been a large amount of really exciting news. One of the ASCO plenary sessions, which we haven't heard yet, is SERENA-6, which will be looking at camizestrant with circulating tumor DNA (ctDNA). That'll be exciting. We're getting updates on overall survival with the INAVO120 regimen. We saw this morning that it improved survival, which is great. We also are going to be seeing data looking at trastuzumab deruxtecan in HER2-positive breast cancer in the first line and then other data looking at targeted therapies for things like PI3 kinase. Our first oral [abstract] PROTAC, Dr Hamilton presented today, also showed improvement in progression-free survival. Many things like that are exciting and certainly starting to change practice. Pembrolizumab and sacituzumab [are] changing practice in first-line metastatic triple-negative breast cancer. There's so much and it's a really great breast oncology ASCO. Lewis: I'm so glad to hear that. There are a couple areas I think that we definitely overlap. I'm curious to get your thoughts on ctDNA. My sense as a GI oncologist is that it is a very prognostic biomarker, but it is not always demonstrably predictive. My real reservation in using it, to be honest with you, is: Number one, I don't think it entirely supplants our traditional clinical pathologic understanding. For instance, as a GI oncologist, if I think someone has high-risk stage III colon cancer and their initial postoperative ctDNA is negative, I'm not entirely going to abandon my approach to their adjuvant therapy. Also thinking about it as a patient, we're sometimes telling these people that they have literal subclinical disease. You can make the argument, 'Well, why wait until cells aggregate to the point that you can see them as an actual tumor on a scan?' On the other hand, I worry sometimes about the psychological impact of ctDNA. As you said, we'll hear about SERENA-6 tomorrow. I think that's a really interesting study in the sense of letting patients be aware of emerging ESR1 mutations that are conferring resistance to aromatase inhibition. I'll be really curious to see the outcome of that study and whether that's a meaningful change for the patient, because I think we sometimes actually underestimate the psychological weight. Graff: It's interesting. In breast oncology, we've benefited from a wealth of patient advocacy, driving a wealth of progress, funding, and advancing science, which has been really beneficial in our field. We actually have done research looking at how the psychological impact affects how patients handle disease. I think that, historically, you can imagine a time in medicine when people thought, 'Oh, those sweet little girls, we shouldn't weigh them down with the worry about cancer.' That has borne out to not be true. When we think about telling people the results of a mammogram that needs additional imaging or biopsy, or that they have dense breast tissue or that their mammogram needs additional follow-up in 6 months, none of those things actually increase or decrease a patient's worry. Lewis: Interesting. Graff: What helps is just open and honest communication. I think what's more important is that we empower physicians and oncologists with the tools to actually understand what these tests mean and how to communicate effectively with patients about them. I think patients are going to be worrying about the fact that they have cancer. Good test or bad test, that patient knows the next test might not be the same. Good test or bad test, their cancer could have a different outcome down the roadway. They're going to worry. I don't have cancer and I worry. I worry about my kids. I worry about my house. I worry about the weather. We all worry. I think that just having the tools to explain what's going on is probably the most powerful thing that we can do. Lewis: That is such a wonderful anecdote to literal and figurative paternalism, and you're absolutely right. We already have these points of apprehension in patient care and diagnostics, and I think ctDNA potentially adds to that, but we can use the same methods of counseling that we've used for all these other tools. That's so well said. I also wanted to tell you — and I really, really mean this — that I view breast medical oncology as aspirational for the rest of solid tumor oncology. When you were mentioning trastuzumab deruxtecan earlier, one of my most vivid memories from ASCO meetings of any year was the plenary session where DESTINY-Breast04 was presented. I remember being part of the standing ovation for that trial, even though I don't treat breast cancer anymore, because I thought, 'Wow, we are really making progress in biomarker-driven care.' The other reason I view you as aspirational is we are not yet at that standard in GI oncology, at least, where it's a foregone conclusion that we would know all the biomarkers that we need to know. One of the interesting conversations I have with patients now is on pathologists as our silent, or at least unseen, partners. I think you would agree that you would almost never treat a patient with metastatic disease without knowing ER, PR, and HER2 status. Meanwhile, over in GI oncology, I'm sometimes having to ask for these things to be done that would be relevant to my patients, say KRAS mutations or BRAF mutations. To me, it seems like it should be as reflexive for me as it is for you as a breast cancer oncologist. What I'm getting at here, too, is this is back to how we have conversations with patients. I think patients need to understand, again, that biomarkers are a huge part of how we personalize their care, even though they might never actually meet their pathologists. Again, I just wanted to tell you, because I don't often get to sit with you, that the way that breast cancer oncologists — and to your own point, patient advocates — have kind of pushed things forward, it's a rising tide that lifts all boats. I often use your field as an example of where we should be. Graff: It's ironic because I have maybe the opposite perspective. As a breast oncologist, I feel like, here we are in 2025 with all these amazing genomic ctDNA and RNA assays, and we're still using ER, PR, and HER2, which is — spoiler alert — literally dumping ink on slides, right? It's immunohistochemistry. Our thoracic oncology colleagues are using true genomic-driven care to look at ROS1 , EGFR , and all these different things to say, based on this profile, this is what you're going to get. We're like, well, we have to wait for that ER to come back. I'm a little bit jealous that some fields have more genomic-driven care than breast does, but you're right. Breast was definitely a pioneer in biomarkers. DESTINY-Breast04 is an interesting example because, if anything, it shows that the biomarker doesn't matter, right? Trastuzumab deruxtecan is a HER2 antibody, and as it turns out, it works great for HER2-positive disease, but it also works great for HER2 not-so-positive disease. DESTINY-Breast06 now includes ultra-low, which is zero with just a little bit of fuzzy in the background. We're seeing that maybe we're not getting our biomarkers right after all. Lewis: So well said. I remember thinking about the effect in ultra-low and thinking, man, how strong is this bystander effect? If the chemo payload is being delivered to barely present HER2 receptors, it must be really potent indeed. I often think that we're actually putting a large amount of credence in what our pathologists tell us. For instance, like you said, immunohistochemistry is very qualitative, sort of semi-quantitative. Again, with things like PD-L1, it's funny how we all have sour grapes to other tumor types. Thinking about continuous variables, we can always debate the appropriate cutoff. Pathologists have actually warned us at this very meeting. I remember Anirban Maitra standing up and saying, 'Listen, you guys need to realize, as pathologists, the number that we give you for PD-L1 expression, for instance, that's our impression on that day, on that slide. You really shouldn't take it to be gospel truth.' Again, I think we're still finding our way with that. Graff: We've seen, in breast oncology, a presentation at this meeting looking at if that's the forefront for AI, right? Is that where artificial intelligence is going to be able to augment our ability, because again, we heard in the opening session that AI should be a tool that is an agent to advance human skills. If AI can help augment the eye of the pathologist, enhance the skills of the microscope, and move HER2 zero to HER2 ultra-low with more accuracy than the naked eye or more robustly in global centers where access to those stains aren't as readily available, then AI is advancing care for everyone equitably around the globe: the same global population that's participating in these trials and bringing them to our patient population. Back to biomarker-driven care, I think it just comes back down to patient communication. All of these tests take time. Even in breast oncology, sometimes my patients have to wait. They have to wait for ESR1 . It's a mechanism of resistance. I don't have it until their disease progresses and I can send that test out. That means that sometimes they have to have some patience while we wait and make sure that they're a candidate for the right therapy at the right time. That requires partnership with a bunch of people on my team. The staff that draw the blood and the mail room staff that ship it out to the right team. I'm so thankful that I have a huge wealth of people that make the cancer center work. Lewis: So well said. I often tell my patients that oncology is a team sport. Graff: Yes. Lewis: I think the last thing I wanted to say is that you and I have talked a little bit about the pace of progress as a wonderful problem to have. I'm curious, [going] off your comment about sort of global equity, how do you feel like that plays out in sort of clinical trial design? Graff: The breast oncology community discussed this today as some data were revealed. An interesting problem that we're starting to have in breast cancer is the rapidity of new agents relative to the rapidity of trial accrual. This means that, if it takes a year to design a trial and get regulatory approval, and then another year to accrue and then another year to read out results, by then there have been 27 new drugs added, right? I think we had 25 regulatory approvals last year in the US, or something like that, in oncology. Whatever the standard-of-care control arm was in the study 3 years ago when that trial was designed is laughable. I'm going to use the example of second-line HR-positive breast cancer. We have two problems. Problem number one is that the standard control arm is fulvestrant. When many of these trials were accruing in 2020 and 2021, that was the standard of care. Now, we have ESR1-targeting agents. We have PI3 kinase-targeting agents. We have data that extending a CDK4/6 inhibitor is efficacious. We have evidence for earlier trastuzumab deruxtecan for patients that maybe aren't so endocrine sensitive. We can always extend everolimus into that space. There's all this other stuff, including oral SERDs. There are so many different directions we can go. I don't even remember what all I've listed [to] at this point. We're getting the next generation of medicine, but they're still being compared to fulvestrant. Lewis: Right. Graff: We're looking at these results, saying, 'Well, great, you beat that drug we used back in the late 1900s.' Lewis: Right. Yes. Graff: Now, I think that another problem is that global angle, which is that not all of those new drugs, although almost all of these trials are global trials, they're accruing these from international countries. Not all of the regulatory agencies have approved them internationally. Not all of the payers have approved them internationally because they meet different benchmarks around the globe. Lewis: Yes. Graff: That standard-of-care arm isn't available as we advance. Again, trial design gets complicated because if we want the control arm to be the US standard of care, and that's different than the German standard of care, the Indian standard of care, the Kenyan standard of care, or the Argentinian standard of care; then we have to make sure that they're connected with that standard of care. We have to make sure that they're comfortable delivering that standard of care and figure out what that really looks like. Lewis: I think where I completely agree with you is you have to walk before you can run. It's really exciting to see the sophisticated assays like ctDNA, but I'm sitting here thinking, based on your comments, I can't even guarantee that I'll have mismatch repair protein status in my patients with colon cancer. Again, we have to take this in a stepwise fashion. You're right that, for all the excitement that we understandably and should feel at meetings like this, we do have to temper our enthusiasm a little bit and be practical in the real world. I have to say, Stephanie, it's just a delight to sit with you. I think you really are a true exemplar of shared decision making. Again, it really, at the end of the day, doesn't come down to the primary site. Yes, you're a breast oncologist. Yes, I'm a GI oncologist. A rising tide lifts all boats, and I think, as we also heard this morning, there's a difference between irrational exuberance and unjustified optimism, and then there's legitimate hope. At least what I feel at these meetings, and I strongly suspect you do too, is legitimate hope for our patients. Graff: I agree. Lewis: With that, we'll close. Again, thank you for joining us. We hope this was a helpful summary of what we've been hearing today at the ASCO 2025 Annual Meeting. Thank you.
