PVRoundup Podcast

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.

Drs. Bose and Pemmaraju review secondary myelofibrosis arising from polycythemia vera or essential thrombocythemia and how it differs from primary myelofibrosis that develops de novo.

Maternal RSV vaccines and infant nirsevimab led to major drops in hospitalizations among infants ≤7 months, especially those ≤2 months old. The CDC's 2025 nPEP guidelines stress starting HIV prevention within 72 hours of exposure, with rapid testing and follow-up care. Treatment should begin without delay, and patients at ongoing risk should transition to PrEP. Surgical site infections after colorectal surgery have increased 21% since 2019, highlighting the need to strengthen infection control.

Drs. Starling and VanderPluym discuss common diagnostic pitfalls in migraine medicine and how the misinterpretation of symptoms can lead to unnecessary testing or incorrect treatments.

Drs. VanderPluym and Starling review the updated position statement from the American Headache Society indicating that CGRP-targeting migraine therapies should be considered as a first-line option.

This episode features the Beamion LUNG-1 trial, where zongertinib showed a 71% response rate in previously treated HER2-mutant NSCLC patients. The EAGLE-1 trial found gepotidacin non-inferior to standard treatment for urogenital gonorrhoea, with a 92.6% success rate. The U.S. Department of Health and Human Services and NIH launched the Generation Gold Standard initiative, a universal vaccine platform targeting pandemic-prone viruses, with trials ongoing for H5N1 avian influenza and coronaviruses.

Elizabeth Kensinger, PhD and Andrew Budson, MD explain how healthy lifestyle habits, memory offloading strategies, and turning facts into stories can support cognitive aging. They stress that enriching and novel activities are more effective for brain health than most apps. Dr. Budson supports the theory that beta amyloid defends against brain infections, linking it to viral triggers of Alzheimer's. He also highlights new drugs like lecanemab and donanemab that may slow early Alzheimer's progression and potentially prevent its onset.

A JAMA model warns measles could become endemic in the U.S. within 21 years if MMR vaccination rates don't rise, with over 850,000 projected cases. A Phase 3 NEJM trial found brensocatib reduced exacerbations in non-CF bronchiectasis. An EPIC study correlated higher breast cancer risk to higher education levels, beyond lifestyle and reproductive factors.

Mexico's first fatal H5N1 case involved a healthy child and highlights localized risk despite low global concern. Long-term antidepressant use was linked to higher sudden cardiac death risk, especially in younger adults. A U.S. study found 25% of adults with very high LDL cholesterol lacked statin treatment. These stories reveal persistent gaps in infection control, cardiac monitoring, and preventive care.

A polygenic risk score significantly improved prostate cancer detection beyond PSA testing, identifying more treatable and aggressive cancers in high-risk men. New WHO guidelines aim to reduce global meningitis deaths by standardizing early diagnosis, treatment, and care across settings. GLP-1 receptor agonists and SGLT2 inhibitors were linked to reduced Alzheimer's risk, with GLP-1s showing the most consistent neuroprotective effects in recent studies. Lastly, breast cancer mortality was 47% higher among Black women living in disadvantaged neighborhoods, underscoring the impact of social determinants on survival.

Mary Beth Cicero, co-founder of Three Daughters, shares how her passion for women's health led to the development of a new frameless, self-assembling magnetic IUD designed to significantly reduce the pain of insertion and retrieval. The device, inspired by embryo transfer techniques and using copper as its active ingredient, aims to improve comfort, eliminate strings, and offer a more body-conforming contraceptive option—especially for younger women deterred by current IUDs. As the product moves through clinical trials, the team is focused on both efficacy and ease of use, with hopes to expand into treating other uterine conditions in the future.

A large study in Wales found that older adults who received the shingles vaccine had a 20% lower risk of developing dementia over seven years, with the strongest effect seen in women. U.S. measles cases have surged past 500, driven largely by outbreaks in West Texas and linked to international travel, underscoring critical gaps in vaccination coverage. Meanwhile, new research shows that even the wealthiest Americans have shorter life expectancies than their European peers, pointing to systemic health disadvantages in the U.S.

Drs. Yu and Sabari trace the evolution of HER2-mutant lung cancer treatment from chemotherapy to targeted therapies, highlighting key advancements, challenges, and patient responses. They also explore emerging treatment strategies, resistance mechanisms, and the future of personalized therapy based on biomarkers and co-mutations.

A study published in JAMA Internal Medicine found that statin use in patients with chronic liver disease was associated with a lower risk of liver cancer and hepatic decompensation, suggesting potential protective effects beyond lipid management. Surveys by the Annenberg Public Policy Center revealed widespread misinformation about the risks of consuming raw milk, highlighting the need for public education on the importance of pasteurization. New research links red meat allergy (alpha-gal syndrome) to bites from deer ticks and western black-legged ticks, expanding the geographic risk area and emphasizing the need for clinicians to consider this diagnosis in patients with unexplained allergic symptoms following tick bites.

Drs. Sabari and Yu discuss the molecular landscape of HER2-mutant lung cancer, including its genomic characteristics, common co-mutations, and differences between HER2 mutations and HER2 amplification. This discussion also explores the prevalence and clinical patterns of HER2 mutations, their oncogenic mechanisms, their impact on tumor behavior and metastases, and potential environmental or genetic contributors to their development.

Helena Yu, MD and Joshua Sabari, MD explore the importance of testing for HER2 alterations in lung cancer; how HER2 positivity influences clinical decision-making; and the key methods used for detection, including immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing. It also addresses challenges in standardizing HER2 testing, disparities in access to biomarker testing, and the evolving role of liquid biopsy compared to traditional tissue biopsy.

Carrie Dougherty, MD, FAHS and Jessica Ailani, MD review migraine abstracts from the 2024 European Headache Congress.