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SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

  • 1.  SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-03-2025 17:34
    Edited by Shelley Hwang 06-09-2025 15:57

    Click Reply on the right-hand side to post a question or continue the conversation. 

    Can you explain how or why you initially chose neuro-oncology as your professional focus? 



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    Shelley Pressley
    Society for Neuro-Oncology
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  • 2.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-12-2025 11:28

    Dear Dr. Wen, what are some lessons that you have learned over the years about designing and conducting clinical trials? Are there different lessons you learned from running Phase I versus Phase 2 or 3 trials?



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    Jasia Mahdi
    Baylor College of Medicine
    Houston TX
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    Original Message


  • 3.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 11:35

    Thanks so much for your question.

    I think the issues are different between phase 1 and later stage trials.

    For phase 1 studies some of the main issues are the strength of the scientific rationale and preclinical data to justify a phase I trial. Many times we study agents that do not have very strong scientific rationale and borderline preclinical data. These agents in hindsight were probably not worth evaluating. In additon to the phase 1 dose finding study it is important to consider a surgical window-of-opportunity (WOO) study once the recommended phase 2 dose is determined to ensure the drugs penetrate across the BBB to both enhancing and non-enhancing areas and also to determine if there is adequate PD. The WOO with vorasidenib is a good example of such a study. PMID: 36823302.

    Working with a good biostatistician is critical.

    A major decision is whether to move from phase 1 to phase 2 or 3 and will depend on the signal from phase 1 and also hopefully data from the WOO trial.

    Many phase 2s especially single arm studies in first line are rarely informative. They would be more useful if single arm studies had external control arm data or are randomized. That is the incentive to develop trials like INSIGhT and GBM AGILE that tries to use a shared control arm and Bayesian adaptive randomization to improve the efficiency of the trial and require fewer patients.

    Again, collaborating with biostatistical colleagues is critical



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    Patrick Wen
    Dana-Farber Cancer Institute
    Boston MA
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    Original Message


  • 4.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-13-2025 14:13

    Hi Dr. Wen,

    Would love to have your thoughts on the following, if there is time!

    1. What personal motivations or experiences drove you to specialize in neuro-oncology, and how have those shaped your approach to patient care and research?
    2. Early in your career, how did you navigate tough decisions about balancing clinical practice with research, and what advice would you give to someone like me making similar choices?
    3. Can you share a time when a difficult case or patient interaction profoundly influenced your perspective or decision-making in neuro-oncology, and how it impacted your career?
    4. What personal strategies have you used to stay resilient and avoid burnout, and how can early-career clinicians adopt similar approaches?


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    Alireza Mansouri
    Penn State Health
    Hershey PA
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    Original Message


  • 5.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 12:06

    Thanks so much for your questions Alireza. Hope you are doing well.

    1. When I was a resident in neurology there was no neuro-oncology program but I felt so sad for the cancer patients with neurological problems and wanted to do what I could to help them. Eventually my focused moved away from neurologic complications of cancer more to brain tumors but the underlying motivation is the same. These are such devasting diseases and all the research I have tried to do has been motivated by trying to find something better to help them. I see patients still two days a week and see all the pain and suffering drives what I do. It helps me focus on work that will make a real difference to them, rather than work that will just generate papers.

    2. Balancing clinical work and research is always a challenge. When I started out I didn't have a mentor and my funding was based on clinical work. As a result I had a large clinical load and was not very productive academically. It is invaluable to have a mentor who can help provide advice on how to navigate these challenges. Now with my junior faculty I try to make sure they have enough protected time to for the first few years so that they can establish their research projects and hopefully get grants or other funding that will help buy down their clinical time.

    For a surgeon it may help to do research that utilizes your access to tissue such as WOO trials or if you are doing a lot of SRS, doing research in those areas.

    3. I don't have a specific case but early in my career I wanted to do everything for the patients and would treat them aggressively, including use of many off-label medications. Over time I have come to realize that at the end of life it is important maximize quality, and that aggressive therapy with very little chance of benefit but with real likelihood of toxicity is usually not the best option for most patients.

    Another area that I struggle with is what to tell patients about their prognosis. I have had patients who ask for their prognosis and say they want as much detail as possible but when I tell them the rough numbers they become devastated and in retrospect they had not really wanted to know the specifics. Gauging what a pateint really wants to know remains a real challenge.

    4. Burnout is very common is neuro-oncology, as it is in much of oncology and other areas of medicine. I am not sure I am a good example of someone who has developed a good strategy to avoid burnout since I work most days. I try to exercise regularly which helps with the stress. I also find that traveling for meetings/talks has helped since it provides small breaks from patient care and day to day challenges.



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    Patrick Wen
    Dana-Farber Cancer Institute
    Boston MA
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    Original Message


  • 6.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-13-2025 18:41

    Thank you for participating in this AMAA Dr. Wen! I was wondering:

    1. What have you done or attempted to do in your career, either academically, clinically, or professionally, that in hindsight you wish you hadn't pursued or wish you said no to?
    2. How have you chosen what to prioritize in your academic career to avoid becoming over extended? 


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    Jacob Young
    University of California, San Francisco
    San Francisco CA
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    Original Message


  • 7.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 12:19

    Thanks so much Jacob for your questions.

    1. Early in your career you are eager to do everything and one common problem is agreeing to do too much. There are many reviews/chapters/books that is retrospect took a lot of work and time that would have been better spent on other things.

    There are many trials that I have participated in that in retrospect I should not have. Initially you want to be involved everything and it is hard to turn these opportunities down. But ultimately we want to do research that will make a real difference for our patients. There have been many studies that I took part in that I felt were of questionable value but went along. I am now much more selective and will not do trials unless I really feel that they are strong scientifically. 

    2. I am unfortunately not a good person to ask advice from on being focused and prioritizing appropriately but I am getting better. Ultimately it is dependent on what you care most about. Those are the areas you should focus on. I also found over time that there are things that I am not good it (e.g. reviewing grants) so I have cut back on that, as well as projects that take a lot of work but makes little difference (e.g editing books or writing for books that no one will read) and I have largely stopped doing those things.



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    Patrick Wen
    Dana-Farber Cancer Institute
    Boston MA
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    Original Message


  • 8.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-17-2025 13:09

    Dear Dr. Wen, I would be interested to hear your insights on the following:

    1. What is one of the most significant lessons you have learned through your experience developing and translating novel therapies for glioblastoma?

    2. In your view, what are the most promising directions or emerging trends in the future of brain tumor therapeutics?



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    Scott Johnson
    Southwestern University
    Georgetown TX
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    Original Message


  • 9.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 12:39

    Thanks so much for your questions.

    I have unfortunately been involved in many negative studies but one success was helping with the development of vorasidenib. I learned a lot from that experience and benefited greatly from interactions with wonderful colleagues both at other academic institutions and at Servier. The target seemed like a very good one but there were really no good preclinical models. An important step in the development of that drug was the window-of-opportunity (WOO) surgical trial that showed that the drug crossed the BBB and achieved good concentrations in the tumor and achieved >90% reduction in 2 HG. This study gave confidence that the drug was doing what it was supposed to and led to the iNDIGO trial. We should be doing many more of these trials in neuro-oncology.

    2. There are a number of areas that hold promise.

    With immunotherapies the most promising are the cellular therapies, including CAR T cell. There is still a lot of work to be done but there are now small subsets of patients that derive prolonged benefit. Hopefully vaccines, viral therapies, novel checkpoint inhibitor and agents targeting the immunosuppressive microenvironment will eventually pan out but it remains unclear whether the concept of converting cold tumors into hot tumors will be viable.

    There is of course a lot of interest in cancer neuroscience and it will be interesting to see if therapies directed at the new targets suggested by this research will produce meaningful benefit.

    The problems with heterogeneity and plasticity make it unlikely that single agent small molecule inhibitors will be very effective except for rare tumors with mutations such as BRAFv600E. Whether combinations will be better or even tolerated remains to be seen. However, there is a lot of interest in other targeted therapies like antibody drug conjugates and radioligand therapy that may have better potential if they can cross the BBB. Potentially combining them with focused ultrasound may improve delivery.



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    Patrick Wen
    Dana-Farber Cancer Institute
    Boston MA
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    Original Message


  • 10.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 10:53

    Gracias por permitir que participemos en esta sesion de preguntas.

    Deseo saber que recomendaría Dr. Wen para países de bajos recursos economicos es muy dificil como especialista en diagnostico, trabajar con la nueva clasificación de tumores de la OMS, pero hacemos nuestro mejor esfuerzo usando inmunohistoquimica, alguna recomendación para nosotros? Me gustaría saber su punto de vista



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    Ana Polanco
    Medical Doctor, Pathologist
    Hospital Nacional de Niños Benjamin Bloom
    San Salvador
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    Original Message


  • 11.  RE: SNO's Ask Me 'Almost' Anything Session with Dr. Patrick Wen: Post Your Questions and Answers In this Discussion Thread!

    Posted 06-18-2025 12:52

    Thank you for allowing us to participate in this question session.I would like to know what Dr. Wen would recommend for low-income countries. It is very difficult as a diagnostic specialist to work with the new WHO tumor classification, but we do our best using immunohistochemistry. Do you have any recommendations for us? I would like to know your point of view.

    Thank you for your question. Providing access to testing, as well as therapies, to all brain tumor patients in all countries is such an important issue. Unfortunately, I don't have easy answers to this but it is something that as a field we need to do much more work on.

    IHC can be useful for the majority of brain tumor patients. NGS is nice to have but is primarily relevant for the 10% of gliomas with non-canonical IDH mutations and detection of CKKN2A/B loss. It is rarely useful for identifying treatment targets. For glioblastomas it would really be relevant for the rare tumors with BRAFV600E mutations and the even rarer NTRK fusions. For most other targets it is probably not very important until there are drugs that actually work for these targets.

    Closer collaboration between centers that have resources with centers that have limited resources would be helpful so that is those cases that need more detailed testing can be sent to the centers that have the resources to help.



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    Patrick Wen
    Dana-Farber Cancer Institute
    Boston MA
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    Original Message


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