PVRoundup Podcast

Drs. Liu and Scott review second-line treatments of small cell lung cancer following first-line maintenance treatment, including platinum rechallenge and other post-platinum agents.

Drs. Liu and Scott offer their perspectives on maintenance therapy in patients with small cell lung cancer, discussing the rationale, different approaches, as well as the associated benefits and challenges.

A large meta-analysis in The Lancet found clopidogrel superior to aspirin for long-term secondary prevention in coronary artery disease, reducing major cardiovascular events by 14% without added bleeding risk. The REBOOT trial in NEJM showed no benefit of beta-blockers in post-MI patients with preserved ejection fraction, and even potential harm in women on high doses, prompting reevaluation of routine use. Finally, a phase 2 trial in JAMA Internal Medicine showed daily azelastine nasal spray reduced COVID-19 incidence by 67% and shortened illness duration, though larger studies are needed to confirm its prophylactic role.

Drs. Chaichian and Dall'Era explore the “treat to target” approach in lupus, including key targets like DORIS remission and lupus low disease activity state.

Drs. Dall'Era and Chaichian discuss earlier use of targeted biologics for treating lupus.

The FDA has endorsed vibration-controlled transient elastography as a surrogate endpoint for MASH trials, marking the first non-invasive alternative to liver biopsy. A Japanese cohort study linked breakfast skipping and late dinners to higher fracture risk, with combined habits raising risk by nearly 25%. Finally, a global meta-analysis suggests shingles vaccination reduces major cardiovascular events by ~16–18%, though most evidence is observational.

Drs. Chaichian and Dall'Era review the updated guidelines for the treatment and management of SLE in children and adults.

Drs. Fava and Petri discuss emerging therapies in systemic lupus erythematosus, including treatments for lupus nephritis and cutaneous disease.

Drs. Petri and Fava review non-invasive biomarkers in systemic lupus erythematosus, including urine proteomics.

Drs. Petri and Fava discuss updated guidelines for the screening, treatment, and management of lupus nephritis.

The FDA has approved a generic version of liraglutide injection, expanding access to obesity treatment by lowering costs and broadening eligibility across adults and adolescents, though safety monitoring remains essential. A JAMA Network Open study found that overweight older adults had lower 30-day mortality after elective surgery compared to those of normal weight, highlighting the “obesity paradox” in surgical risk assessment. Finally, a new rapid, culture-free diagnostic method for sepsis can identify pathogens within two hours using microfluidics and deep learning, offering significant potential to improve survival in critically ill patients.

The FDA has granted accelerated approval to semaglutide (Wegovy) as the first drug for metabolic dysfunction–associated steatohepatitis (MASH), showing significant improvements in liver health and weight loss in the phase 3 ESSENCE trial. A systematic review of acetaminophen use in pregnancy found potential risks with long-term or frequent use but confirmed short-term, low-dose use remains appropriate when needed. Finally, an AI model integrating MRI, biomarkers, and clinical data improved prediction of knee osteoarthritis progression, enhancing physician accuracy and suggesting future support for earlier, personalized interventions.

A new JAMA study found that 84% of abortion prescriptions from Aid Access went to patients in states with bans, enabled by “shield laws” protecting telehealth providers across state lines. Provision rates were highest in underserved Southern and Midwestern counties, highlighting telemedicine's role in maintaining access. A Scientific Reports study showed that large language models for clinical use can be manipulated into giving unsafe answers through subtle “adversarial hallucination attacks,” with success rates over 95%. Finally, JAMA Ophthalmology reported GLP-1 agonists may slightly increase risk of sudden vision loss, though benefits still outweigh risks.

A multi-site randomized trial found that the suicide-prevention app OTX202 reduced repeat suicide attempts by 58% and sustained lower suicidal ideation through 24 weeks, especially in high-risk patients with prior attempts. A phase 3 trial showed canagliflozin significantly improved glycemic control in children and adolescents with type 2 diabetes, with safety comparable to adults. Finally, the SWIFT-SEG liquid biopsy detected multiple myeloma tumor cells in over 90% of cases, offering a less invasive alternative to bone marrow biopsies for diagnosis, monitoring, and precision treatment.

New guidelines from the 2025 Alzheimer's Association International Conference support using high-performing blood tests to help diagnose Alzheimer's in memory care patients, offering a less invasive option than spinal taps or PET scans. A NEJM trial found the smaller NTCU380mini IUD nearly as effective as the standard TCU380A, with fewer side effects and better tolerability. Lastly, a large study showed that adults with diabetes who exercised—even only on weekends—had significantly lower mortality, supporting flexible activity patterns.

A large observational study found small but potentially meaningful differences in cardiovascular safety among sulfonylureas compared to DPP-4 inhibitors in type 2 diabetes, with glipizide showing a statistically higher risk of MACE. A separate study revealed that over half of advanced-stage lung and colorectal cancer cases involved missed diagnostic opportunities, highlighting systemic delays in workups and follow-up. Finally, the EchoNext deep learning model accurately predicted structural heart disease from ECG data alone, outperforming cardiologists and showing potential for scalable, cost-effective screening. These findings underscore the importance of individualized treatment, earlier cancer detection, and AI-enabled cardiac diagnostics.

A new NEJM trial found methotrexate offers similar lung function improvements as prednisone in pulmonary sarcoidosis, but with fewer side effects—suggesting it could be a safer first-line option for some patients. A JAMA study revealed that patients trust physicians less when AI is mentioned in care ads, highlighting the importance of framing AI as a tool that supports—not replaces—clinical judgment. Another NEJM trial showed that giving take-home ondansetron to children after ED visits for gastroenteritis significantly reduced vomiting and return visits, with no added risks. Together, these studies support a shift toward individualized care, better patient communication, and practical interventions to improve outcomes.

Drs. Patel and Armstrong discuss how they are integrating FDA-approved therapies into geographic atrophy care. They share their perspectives on emerging treatments, including the potential for combination or staged approaches.

Drs. Armstrong and Patel discuss current and emerging therapies for diabetes-related macular edema and wet age-related macular degeneration including anti-VEGF agents, the need for durability and reduced treatment burden, alternative delivery strategies, novel molecules, and gene-therapy.

Dr. Richard S. Ostfeld discusses how human disruption of natural ecosystems, such as forest fragmentation and predator loss, has increased the risk of tick-borne diseases like Lyme and Powassan virus. He explains how climate change extends tick seasons and how common hosts like mice thrive in altered environments, boosting tick populations. Despite promising tick-control interventions, personal prevention remains key, as broad environmental strategies have yet to show consistent reductions in human disease.

Drs. Patel and Armstrong discuss the implementation and evaluation of AI-powered diabetic retinopathy and diabetes-related macular edema screening and telemedicine, including ways to handle an influx of referrals, questions about reimbursement, staffing, and liability.

Drs. Modi and Dedania discuss GLP-1 receptor agonists and the retinal patient, including how GLP-1 receptor agonists work, benefits and risks in patients with retinal disease, and data from retrospective studies.

Drs. Dedania and Modi discuss vitreous opacities, or floaters, including imaging, evaluating, and when and whether to pursue surgery. They discuss conditional circumstances that may influence whether to pursue surgery or not, as well as patient counseling.

Drs. Modi and Dedania discuss imaging, biomarkers, and diagnosis in geographic atrophy, as well as current therapies and those in late stage clinical trials.

This podcast highlights three updates: Moderna's Spikevax COVID-19 vaccine is now fully FDA-approved for high-risk children 6 months to 11 years, though rare myocarditis remains a concern. A large study found first-trimester TMP-SMX antibiotics increase congenital malformation risks compared to β-lactams, reinforcing β-lactams as safer. Finally, a trial showed no cardiovascular benefit from taking blood pressure medication at bedtime versus morning dosing.

Drs. Sabari and Socinski discuss maintenance therapy strategies in small cell lung cancer, including immunotherapy, chemotherapy, targeted agents, and radiation.

Drs. Socinski and Sabari discuss a couple of abstracts from ASCO 2025 about emerging therapeutics in small cell lung cancer.

Mark A. Socinski, MD and Joshua Sabari, MD review new data from ASCO 2025 that have a substantial impact on how oncologists treat patients with extensive-stage small cell lung cancer.

A Lancet analysis warns that USAID cuts could cause over 14 million preventable deaths by 2030, reversing decades of progress against infectious diseases. The TARGET Protein Trial found high-protein nutrition in ICU patients did not improve outcomes and may raise risks in kidney injury. A study in npj Vaccines showed older adults getting AS01-adjuvanted shingles or RSV vaccines had lower dementia risk, possibly due to immune effects. These findings stress the importance of global health funding, cautious ICU nutrition, and more research on vaccines and neurodegeneration.

The measles outbreak stands at 1,227 confirmed cases in 2025 so far—nearly five times the total for all of 2024—mostly among unvaccinated individuals. New data from the INTERACT trials show that rapidly lowering blood pressure after intracerebral hemorrhage improves survival and function, especially when treatment starts within three hours. The CDC's Vaccine Advisory Panel, controversially reconstituted with vaccine skeptics, voted to recommend only thimerosal-free single-dose flu vaccines despite decades of evidence showing no harm from thimerosal. This decision followed an unvetted presentation citing questionable data, raising concerns about scientific integrity and vaccine access.

Drs. Yuan and Callahan discuss data presented at ASCO 2025 about DESTINY-Breast06, SHR-A1811, and TQB2101, along with real-world data on rechallenging patients with T-DXd post grade 1 ILD.

Drs. Callahan and Yuan discuss data presented at ASCO 2025 on DESTINY-Breast09, PATINA, and MINI Trial, the utility of PFS-2 as an endpoint, and sequencing of treatments after first-line therapy.

Drs. Zaman and Podolanczuk discuss data for new and emerging therapies for ILD presented at ATS 2025, including nerandomilast, inhaled therapies for IPF and ILD, TNIK inhibitors, as well as new biomarkers and imaging for diagnosing ILDs.

Tanzira Zaman, MD and Elizabeth Volkmann, MD, MS discuss the new official American Thoracic Society Clinical Statement on the diagnosis and management of interstitial lung abnormalities which Dr. Podolanczuk presented at ATS 2025.

The FDA approved lenacapavir, a twice-yearly injectable PrEP shown to be 99% effective in preventing HIV, though high cost may limit global access. A phase 3 trial found that adding pembrolizumab to standard care improved event-free survival in head and neck cancer, especially in patients with high PD-L1 expression. MASLD-related deaths in the U.S. have quadrupled since 2006, rising most sharply in older adults and rural areas, and are expected to continue increasing.

Drs. Sood and Liu discuss emerging and investigational biomarkers for interstitial lung disease and their potential utility as predictors of progression or as tools for tailoring therapy.

Gabrielle Liu, MD, MS and Namita Sood, MD, FCCP discuss advances and future treatment targets for interstitial lung disease including some that are still under investigation.

A Chinese trial found dapagliflozin improved MASH outcomes, with higher resolution and fibrosis improvement rates than placebo. A JAMA Network Open survey showed 42% of abortion providers in ban states relocated, mostly to states with protections, highlighting growing care gaps. An oncology study found AI analysis of body composition better predicted chemo dose reductions than body surface area, especially in women.

Drs. Brander and Cohen discuss the growing role of measurable residual disease (MRD) testing in CLL and its clinical implications.

Drs. Cohen and Brander review toxicity and treatment management in CLL, specifically addressing the considerations that go into subsequent lines of treatment for patients who relapse following doublet, or even triplet, therapy.

Drs. Brander and Cohen discuss an ongoing debate in the management of CLL about BTK and BCL2 inhibitor combinations in the frontline treatment of CLL. Is it better to combine BTK and BCL2 inhibitors, or to start with one or the other as monotherapy?

Drs. Lipsky and Allan discuss the emerging role of immunotherapy in the management of patients with CLL, including CAR T-cell therapy and bispecific antibodies.

The CHALLENGE trial at ASCO 2025 showed that increased physical activity improves survival rates in colon cancer patients, with the exercise group demonstrating better health outcomes and survival rates compared to those receiving only health education. A phase 3 trial in The New England Journal of Medicine found that semaglutide significantly improves liver conditions in MASH patients, showing better resolution of steatohepatitis and fibrosis improvement compared to placebo. Additionally, a study in the NEJM revealed that combining finerenone and empagliflozin offers enhanced kidney protection in patients with chronic kidney disease and type 2 diabetes, significantly reducing urinary albumin levels.

John N. Allan, MD and Andrew H. Lipsky, MD discuss the evolution of CLL therapy and the power of doublet and triplet regimens, exploring combinations including BTK inhibitors with BCL-2 inhibitors and anti-CD20 monoclonal antibodies.

Drs. Scott and Liu discuss the safety of treatments for HER2-mutant lung cancer, including key toxicities, management strategies, and how prior therapies might affect treatment decisions.

Stephen V. Liu, MD and Susan C. Scott, MD discuss advances in treating HER2-mutant lung cancer. Until recently, treatments for HER2-mutant lung cancer primarily involved chemotherapy, immunotherapy, and HER2-targeted therapies, with mixed results. Now, the treatment landscape of HER2-mutant lung cancer is changing.

Measles cases in North America have exceeded 3,200, mainly due to low vaccination rates, with children most affected. Clinicians are urged to verify immunization status and close gaps. The EU is restricting azithromycin use amid rising antimicrobial resistance, dropping certain indications and adding new warnings. A trial shows methotrexate is a viable first-line alternative to prednisone for pulmonary sarcoidosis with differing side effects.

This week's episode covers the effectiveness of a fixed-dose albuterol-budesonide combination for asthma, new findings on Nerodomelast for progressive pulmonary fibrosis, the FDA's endorsement of a new COVID-19 vaccine targeting the JN.1 lineage, and insights into extended-phase anticoagulation for pediatric venous thromboembolism.

A Lancet study warns of consequences for HIV prevention if PEPFAR loses funding, potentially millions of new pediatric HIV cases and increased AIDS-related deaths. Medicare Part D is highlighted, with research linking subsidy loss to higher mortality rates. A report from BMJ notes a 3.1% decline in U.S. drug overdose deaths, signaling a possible peak in the fentanyl crisis.

Drs. Pemmaraju and Bose discuss the revised International Working Group criteria for anemia response in patients with myelofibrosis, outlining new definitions for transfusion status, gender-specific hemoglobin thresholds, and benchmarks for major and minor responses.

Drs. Bose and Pemmaraju discuss leukemic transformation in patients with myelofibrosis, reviewing its incidence, as well as risk factors, treatment, and prognosis.