PVRoundup Podcast

This episode of the PeerDirect Medical News Podcast reviews three developments with potential implications across nephrology, oncology, and public health. Highlights include the FIND-CKD trial showing finerenone may slow disease progression in chronic kidney disease patients without diabetes, seven-year CROWN trial data demonstrating durable long-term disease control with lorlatinib in advanced ALK-positive lung cancer, and a JAMA Network Open study linking measles-related vitamin A misinformation to increased toxic exposures. Together, these findings underscore evolving treatment paradigms and the growing impact of health communication on patient outcomes.

Drs. Dasgupta and Sarswat review how ATTR cardiomyopathy remains under-recognized despite its prevalence in older patients with heart failure, emphasizing clinical red flags across cardiac and systemic manifestations. They outline a practical diagnostic pathway that prioritizes early identification using light-chain evaluation, bone scintigraphy, and genetic testing to distinguish transthyretin subtypes and initiate timely, disease-modifying therapy.

Drs. Saver and Sanossian discuss ISC 2026 data highlighting neurologists' frequent inaction on markedly uncontrolled hypertension in high‑risk stroke patients and the need for specialists to “own” blood pressure management at every visit. They also review refinements in patent foramen ovale (PFO) risk stratification, including Pascal algorithm-defined “possible” PFO cases, and explore how a “clinical trial effect” may lower stroke risk through greater patient engagement.

Drs. McMahon and Kalunian discuss how patients with lupus nephritis face a markedly higher risk of cardiovascular disease and how traditional risk calculators fail to capture the added danger from chronic inflammation, steroids, and disease-specific factors. They call for a paradigm shift toward aggressive, early, and continuous cardiovascular protection—including tighter blood pressure targets, earlier statin use, lifelong hydroxychloroquine when possible, and close multidisciplinary management from the time of diagnosis.

This episode of the PeerDirect Medical News Podcast examines the rapidly expanding Ebola outbreak in Congo and concerns over weakening global public health infrastructure, reviews new Phase III obesity data showing substantial weight loss with Lilly's triple-agonist retatrutide, and highlights promising ASCO 2026 lung cancer data for a TROP2-directed ADC combined with pembrolizumab in frontline NSCLC.

Drs. Humphries and Swigris describe how AI-driven CT analysis can detect subtle imaging features of ILD and UIP, outperforming visual reads for risk stratification and prognosis. They highlight how these tools may enable earlier identification of patients at high risk for fibrosis progression while also stressing current limitations, including opacity of algorithms, data dependence, and the need to adapt imaging hardware and clinical workflows.

Drs. McMahon and Kalunian discuss how the latest lupus nephritis guidelines from the American College of Rheumatology and European Alliance of Associations for Rheumatology are shifting care from short-term, reactive treatment to longer-term, continuous maintenance—often 3 to 5 years or more—to better prevent kidney flares and preserve renal function. They highlight emerging data on biologic-based triple therapy (including belimumab); the importance of biomarkers and repeat biopsies; and the growing push toward personalized, sometimes indefinite, therapy for high‑risk patients.

Drs. Chandwani and Kuruvilla explain that migraine and facial pain often share trigeminal system mechanisms, leading to frequent misdiagnosis as dental, musculoskeletal, or sinus problems, possibly resulting in unnecessary procedures. The speakers emphasize CGRP-targeted therapies, careful mechanism-based diagnosis, and multidisciplinary collaboration across neurology, orofacial pain, physical therapy, and behavioral health to improve outcomes for patients with complex facial pain and migraine presentations.

Drs. Wierda and O'Brien discuss new combination treatments for CLL that achieve exceptionally high rates of undetectable disease, especially with triplet regimens. They also show that venetoclax-based retreatment works very well, supporting a move away from chemoimmunotherapy.

Drs. Yiu and Emami continue their wrap-up of the highlights from the 49th Annual Macula Society Meeting, focusing on new developments in imaging technologies, AI, and drug delivery for retinal diseases. They also touch on emerging basic science topics like the gut microbiome and metabolomics, and how these may support more personalized, systems-level approaches to eye disease.

Drs. Mantia and Berg continue their discussion of ESMO 2025 data on HER2‑directed antibody–drug conjugates in urothelial cancer and the importance of routine HER2 testing. They highlight the promising efficacy and manageable toxicity of these agents across disease stages and raise future questions about how best to sequence them.

This episode of the PeerDirect Medical News Podcast explores promising new data on the oral pan-RAS inhibitor daraxonrasib in KRAS-mutated pancreatic cancer, a randomized stroke trial evaluating adjunctive tirofiban after tenecteplase, and AI-driven breast cancer risk prediction models that may outperform breast density alone. Together, these studies highlight emerging advances in targeted oncology, acute stroke management, and precision screening technologies that could influence future clinical practice.

Drs. Sarswat and Dasgupta discuss contemporary decision-making in treating transthyretin amyloidosis, comparing oral stabilizers with subcutaneous silencers and emphasizing earlier diagnosis, phenotype-driven therapy, and individual patient preferences. They highlight how neuropathy and autonomic dysfunction influence choice of mechanism, review practical considerations such as side-effect profiles, dosing logistics, and drug–drug interactions, and briefly touch on emerging approaches like amyloid-removing and gene-targeted therapies.

Drs. Wierda and O'Brien discuss how fixed-duration venetoclax-based therapy can match continuous BTK inhibitor treatment in CLL while offering deep remissions and time off therapy. They also explore promising real-world CAR T-cell (liso-cel) results and stress the growing importance of vaccination and cancer screening as CLL patients live longer.

Drs. Sanossian and Saver highlight emerging evidence that routine dental care and oral hygiene may function as actionable, modifiable contributors to stroke prevention beyond traditional vascular risk factors. They also review CREST-2 data showing that carotid revascularization in asymptomatic high-grade carotid stenosis reduces stroke risk, but does not appear to confer additional cognitive benefit over intensive medical therapy alone.

Drs. Swigris and Humphries discuss how data-driven texture analysis (DTA) on HRCT enables precise, objective quantification of fibrotic burden in ILD, overcoming the limitations of semi-quantitative visual scoring and blunt physiologic measures. They further describe a complementary AI-based classifier that predicts histologic usual interstitial pneumonia (UIP) patterns from CT, enhancing prognostication and potentially reducing the need for surgical lung biopsy.

Drs. Mantia and Berg discuss HER2 as a biomarker in genitourinary cancers, focusing on testing strategies, prevalence, and the clinical implications of HER2 expression and ERBB2 mutations for patient management. They also review new data from ESMO 2025, highlighting the DISTINCT-1 trial and a HER2-targeted approach for high-risk upper tract genitourinary carcinoma.

New cardiovascular data suggest pulsed field ablation may challenge antiarrhythmic drugs as first-line therapy for persistent atrial fibrillation, while real-world evidence positions apixaban as the preferred DOAC for younger patients with nonvalvular AF due to superior safety and effectiveness. Additional findings from the SENIOR-RITA trial indicate that routine invasive management may not benefit frail older adults with NSTEMI and could worsen outcomes in the most frail patients. Together, these studies highlight a growing shift toward more individualized cardiovascular treatment strategies.

Daraxonrasib, a first-in-class oral RAS inhibitor, nearly doubled overall survival versus chemotherapy in previously treated metastatic pancreatic cancer, representing a potentially landmark advance in a historically difficult-to-treat disease. The antibody-drug conjugate datopotamab deruxtecan significantly improved progression-free and overall survival over chemotherapy in first-line triple-negative breast cancer, particularly for patients ineligible for immunotherapy. A Cochrane review of nearly 20,000 patients found anti-amyloid Alzheimer's therapies offer minimal clinically meaningful cognitive benefit while carrying meaningful safety risks, complicating their real-world use.

Drs. Maron and Rowin review how treatment for symptomatic obstructive hypertrophic cardiomyopathy has evolved from mainly using beta blockers and invasive procedures to now including newer cardiac myosin inhibitor drugs. These newer medications more reliably reduce obstruction and improve patient symptoms and exercise capacity, but require careful safety monitoring with regular heart function checks.

Shingles vaccination in adults with established cardiovascular disease was associated with dramatic reductions in heart attack, stroke, and mortality in a large real-world analysis, supporting its role as a cardiovascular risk-reduction tool beyond infection prevention. The VESALIUS-CV trial found evolocumab significantly reduced major cardiovascular events in high-risk diabetic patients without known ASCVD, challenging the convention of reserving PCSK9 inhibitors for secondary prevention only. AI-analyzed smartwatch data predicted heart failure hospitalizations days to weeks in advance, signaling a shift toward continuous remote monitoring in heart failure management.

Drs. Yiu and Emami review key themes from the 49th Annual Macula Society Meeting, emphasizing a shift toward earlier diagnosis and intervention, longer-acting therapies, and increasing reliance on advanced imaging biomarkers and AI. They also look at new and existing data on a range of emerging treatment options for both neovascular and atrophic macular conditions.

Drs. Kuruvilla and Chandwani discuss migraine as a key women's health issue driven largely by estrogen fluctuations across a woman's lifespan, influencing CGRP, serotonin, sleep, and comorbid pain conditions from menstruation through perimenopause and menopause. These experts emphasize individualized, interdisciplinary care that combines CGRP-targeted preventives, hormonal strategies, integrative medicine (eg, acupuncture, supplements), and lifestyle and sleep optimization to improve quality of life.

A trial found that discontinuing beta-blockers in stable post-MI patients without heart failure was noninferior to continuing them, suggesting long-term use may be unnecessary. Second, the 2026 ACC/AHA lipid guideline promotes earlier, personalized intervention using the PREVENT risk calculator and expanded biomarkers to reduce lifetime cardiovascular risk. Finally, a JAMA study found thiazide diuretics carry meaningful hyponatremia risk, especially in older adults and women, urging careful patient selection

Drs. Swigris and Humphries discuss how AI-driven, quantitatively trained algorithms can standardize the interpretation of high-resolution computed tomography (HRCT) in ILD by reducing inter- and intra-reader variability and improving fibrosis extent assessment. They contrast traditional visually based radiology with supervised machine learning approaches, including models trained on biopsy-confirmed diagnoses and disease behavior, to potentially enhance prognostication and clinical decision-making.

A randomized trial in the New England Journal of Medicine found prehospital whole blood transfusion did not improve 30-day mortality over standard component therapy in traumatic hemorrhage, supporting current transfusion protocols. A large population-based study showed patients with positive fecal occult blood tests who did not complete follow-up colonoscopy had significantly higher colorectal cancer incidence and more advanced-stage disease. Finally, a study in Nature Medicine of nearly 15,000 individuals found antibiotic exposure reduced gut microbial diversity for up to 4–8 years, with clindamycin and fluoroquinolones causing the most persistent disruption.

Drs. Sanossian and Saver review new evidence supporting intensified antithrombotic strategies to reduce recurrent ischemic stroke in high-risk, noncardioembolic patients without increasing intracranial hemorrhage. They place this within a comprehensive, multimodal secondary prevention framework that integrates pharmacologic therapy with aggressive risk factor modification (lipids, blood pressure, diabetes, and lifestyle).

Drs. O'Brien and Wierda discuss how fixed-duration venetoclax-based therapy can match continuous BTK inhibitor treatment in CLL while offering deep remissions and time off therapy. They also explore promising real-world CAR T-cell (liso-cel) results and stress the growing importance of vaccination and cancer screening as CLL patients live longer.

Drs. Dougherty and Ailani discuss the 2025 International Headache Society guidelines indicating that neuromodulation is an effective, non-invasive option for both acute and preventive migraine treatment. They stress that it works best as part of a personalized, multimodal plan alongside medications, behavioral therapies, and lifestyle changes.

Drs. Maron and Rowin provide an overview of hypertrophic cardiomyopathy, explaining how it is diagnosed by heart imaging and classified into obstructive and non-obstructive forms. They highlight that obstruction is a major cause of symptoms and stress the importance of carefully assessing patients' day-to-day limitations to guide treatment decisions.

Drs. Petri and Woolfson discuss a simple risk score using autoantibodies, complement, and demographics to predict which SLE patients are most likely to develop proteinuria and lupus nephritis. They also highlight evidence showing that earlier kidney biopsies at lower proteinuria levels, especially in patients with low complement, can detect serious disease sooner and improve outcomes.

This week's podcast covers three NEJM trials. First, apixaban showed over 50% less clinically relevant bleeding than rivaroxaban in acute venous thromboembolism patients, with similar efficacy. Second, romiplostim helped 84% of patients on oxaliplatin-based chemotherapy avoid dose modifications due to thrombocytopenia, versus 36% with placebo. Third, inhaled treprostinil slowed lung function decline in idiopathic pulmonary fibrosis patients over 52 weeks, though cough and discontinuation rates were higher.

Drs. Isaacs and Traina discuss DESTINY-Breast09, where first‑line T‑DXd + pertuzumab clearly outperforms the CLEOPATRA regimen in progression-free survival for metastatic HER2+ breast cancer. They focus on the dilemma of when to use T‑DXd: earlier, for maximal efficacy, or later, to protect quality of life and manage ILD and cardiac risks.

The WISDOM trial found risk-based breast cancer screening — using genetic and polygenic risk scores — is non-inferior to annual mammography, enabling more intensive surveillance for high-risk women while reducing unnecessary imaging for low-risk individuals. Among hypertensive adults, prediabetes combined with elevated cardiac biomarkers significantly increases heart failure risk, suggesting combined metabolic and biomarker screening could guide earlier prevention. RSV vaccination in older adults appears to reduce not only respiratory illness but also associated cardiovascular complications including heart attack and stroke.

Drs. Cytryn, Foote, and Thummalapalli review evolving HER2-targeted treatment strategies for upper GI, biliary, and colorectal cancers, emphasizing challenges with disease heterogeneity and treatment sequencing. They also highlight the importance of HER2 reassessment after progression and advancing diagnostic approaches.

Three studies highlight new findings: A phase 3 trial showed obinutuzumab significantly improved lupus responses versus placebo in active SLE patients on standard therapy. A trial of finerenone in type 1 diabetes with chronic kidney disease demonstrated meaningful reductions in albuminuria compared to placebo, suggesting a new renal-protective option. Finally, paired pediatric trials found that adding acetaminophen or hydromorphone to ibuprofen provided no additional pain relief for children's acute limb injuries, with opioids causing four times more adverse events. Ibuprofen alone remains the recommended first-line approach.

Drs. Isaacs and Traina review how HER2CLIMB‑05 and PATINA challenge the old CLEOPATRA‑based approach by showing that adding tucatinib or palbociclib to maintenance therapy can extend progression‑free survival in metastatic HER2+ breast cancer. They stress tailoring maintenance regimens to each patient's hormone receptor status, CNS risk, and tolerance for side effects.

Drs. Petri and Woolfson review the American College of Rheumatology Convergence 2025 data that suggest belimumab might lower mortality in SLE compared with traditional oral immunosuppressants, supporting earlier biologic use. They also discuss an observational study in lupus nephritis that links GLP-1 agonists to better kidney, survival, and cardiovascular outcomes than SGLT2 inhibitors, particularly in overweight patients.

Drs. Vakharia and Danzig highlight new AAO 2025 data on high-dose aflibercept, sleep apnea as a potential AMD risk factor, and an AI-guided anti-VEGF regimen that cuts injections while maintaining vision. Together, these advances point toward more personalized, efficient care for patients with neovascular AMD and DME.

Drs. Isaacs and Traina discuss new data in HER2+ breast cancer from the 2025 San Antonio Breast Cancer Symposium, focusing on early-stage studies including DESTINY-Breast11 and DESTINY-Breast05 and how data from these studies could potentially impact patient care in the future.

Drs. Wierda and O'Brien discuss emerging data showing the non-covalent BTK inhibitor pirtobrutinib outperforming traditional chemoimmunotherapy and showing favorable efficacy and safety versus ibrutinib in CLL. They also highlight promising early results from a triplet regimen for Richter transformation, suggesting the best survival outcomes yet seen in this historically high‑risk, hard‑to-treat population.

New AHA/ACC guidelines overhaul pulmonary embolism management with a five-tier risk classification, endorsing ED discharge for low-risk patients and DOACs as first-line therapy. A JAMA trial confirms IV acetaminophen adds modest but real pain relief when combined with morphine. A large cohort study shows SGLT2 inhibitors dramatically reduce kidney, cardiovascular, and liver complications in diabetic cirrhosis patients.

Drs. Cytryn, Foote, and Thummalapalli discuss recent data on HER2 testing modalities and the prevalence of HER2 positivity across hepatobiliary, upper GI, and colorectal cancers, highlighting implications for precision medicine. The conversation reviews the latest clinical trial findings and the evolving landscape of HER2-targeted therapies, with insights into optimal treatment sequencing for various GI cancer subtypes.

Drs. Ailani and Dougherty discuss onabotulinumtoxinA, a cornerstone treatment for chronic migraine, which reduces headache days and disability when given regularly with the PREEMPT protocol. They emphasize its unique benefits and how it pairs with CGRP therapies, oral preventives, and lifestyle changes for individualized care.

Three major studies reshape preventive care. Long-term follow-up from diabetes prevention trials, published in The Lancet Diabetes & Endocrinology, shows that achieving remission of prediabetes—normalizing glucose levels—cuts cardiovascular death or heart failure risk by about 50%, with benefits lasting decades. In The Lancet, a multicohort analysis of 540,000 adults found obesity increases risk of severe infection by 70%, with nearly threefold higher infection-related hospitalization or death in severe obesity. Finally, a randomized trial in The Lancet Child & Adolescent Health found no increased risk of eczema or respiratory illness in infants receiving acetaminophen versus ibuprofen, providing reassurance about its safety.

Drs. Dizon and Campos discuss how new antibody drug conjugates like trastuzumab deruxtecan are transforming treatment options for HER2+ gynecological cancers, showing promising results even in patients with low HER2 expression. They shared impressive clinical trial successes while emphasizing the importance of ongoing research into treatment sequencing and patient safety.

Drs. Campos and Dizon explore how groundbreaking research is redefining HER2-targeted therapies in gynecological cancers, moving beyond the old one-size-fits-all approach. They spotlight the promise and ongoing challenges of customizing treatment using new biomarkers and clinical trial data.

A phase 3 trial in The New England Journal of Medicine found that the oral PCSK9 inhibitor enlicitide reduced LDL by 57% at 24 weeks in high-risk patients, with similar adverse events to placebo. An oral option may improve uptake and help more patients reach lipid targets. In The Lancet, SMART-CHOICE 3 showed clopidogrel monotherapy after DAPT post-PCI reduced death, MI, or stroke versus aspirin, without more bleeding. Finally, a large meta-analysis confirmed most reported statin side effects are not causally linked, reinforcing their strong benefit–risk profile.

A JAMA Network Open consensus guide standardizes adult UTI triage for telehealth and in-person care. Nonpregnant women with classic cystitis symptoms and no resistance risks may receive empiric antibiotics without testing; men and higher-risk women require urinalysis with culture before treatment. Urine color or odor alone does not justify testing, and urgent evaluation is advised for suspected complicated infection or sepsis. A Danish registry study in JAMA Internal Medicine found SGLT2 inhibitors offer greater kidney protection than GLP-1 receptor agonists in type 2 diabetes. Long-term ASPREE follow-up in JAMA Oncology showed low-dose aspirin did not lower cancer incidence and increased cancer-related mortality in older adults.

Drs. Coombs and Danilov explore how to optimally sequence covalent BTK inhibitors, non‑covalent BTK inhibitors (such as pirtobrutinib), and venetoclax-based regimens for relapsed CLL, emphasizing real-world data and emerging trial results. They highlight that treatment choices hinge on prior response depth and duration, tolerability, mutational profile, and the need to preserve future options and clinical trial eligibility.

A large Lancet meta-analysis found no clinically meaningful association between prenatal acetaminophen exposure and autism, ADHD, or intellectual disability after restricting analyses to adjusted and sibling-comparison studies, with odds ratios essentially null; acetaminophen remains first-line for pain and fever in pregnancy. A Nordic BMJ case-control study of more than 17,000 gastric cancer cases found no increased risk of non-cardia adenocarcinoma with long-term proton pump inhibitor use after comprehensive confounder adjustment. Finally, a U.S. cohort study of older adults linked shingles vaccination to lower inflammation and slower biological aging across multiple systems, though causality cannot be confirmed due to observational design.