ASCO Insight: Dr. Hope Rugo, breast medical oncologist

I’m Hope Rugo, a breast medical oncologist at the City of Hope Comprehensive Cancer Center, where I direct the Breast Medical Oncology division and the Women’s Cancers Program.

What is one innovation in oncology that isn’t reaching enough patients, and why?

I think we see a lot of areas, actually, where what we think is standard of care doesn’t translate into standard of care, even when not required but an option in clinical trials.

One of the most striking ones recently was the use of hormone therapy in patients with metastatic HER2-positive breast cancer, where several trials in a row, patients who had hormone receptor-positive HER2-positive disease received either the control or experimental therapy in these randomized trials that was HER2, and then the idea was that patients who had hormone receptor positive disease could take hormone therapy. But then a really small percentage of patients did, which was surprising because we’ve seen the efficacy of that combination. And I think that’s really an education issue about the importance of hormone therapy, that targeting HER2 alone is not the end goal, but you really want to control the whole disease. We see heterogeneity in these diseases where you really do want to target the different pathways.

We’re also seeing that, you know, understanding of the use of ovarian function suppression in premenopausal women with higher risk early stage hormone receptor positive breast cancer is very poor. And, you know, studies that have used gene expression tests to randomize patients to get chemo or not have really shown to me a shockingly low rate of ovarian function suppression use. And we now have even a new study from ASCO 2026 showing the importance of ovarian brain function suppression in these patients and that it can be used even instead of chemotherapy.

But women don’t like to go into menopause early. There are side effects. So the education here needs to be on managing side effects, the importance of treatment for the long term, and really partnering with the patient, with your entire team, and making sure that people aren’t feeling abandoned to their side effects.

What is one thing can the oncology community can do to bring care closer to underserved patients?

It’s hard to think of one thing that’s going to bring the best care to underserved patients, and I think the word underserved is very much defined by where people live and how health care is provided. So, for example, outside of the U.S., where it’s very much an insurance-based health care delivery system, you have to get approval, but then you have to get coverage from governments.

So, one thing I think internationally is to further, I think, emphasize the impact on patient outcome from having these drugs available earlier in the course of therapy. And that’s, I think, a whole cancer community issue where we – I mean, it’s facing economics.

I think in our country, in terms of bringing care to patients in underserved communities and patients who normally maybe don’t go into major medical centers, I think it’s empowering patients to ask questions, to be aware of their options, to provide educational information about that. And I think for our government to continue to allow these telemedicine visits where patients in far off communities can get the right advice for treatment to help oncologists who have seen patients with all different kinds of cancers in the management of their own cancers at home.