Podcasts about clinical correlation

ONCE UPON A GENE - EPISODE 158 Medical Student - Urvi Gupta Joins the Global Genes Rare Compassion Program with Alexions Patient Advocacy Champion Wendy Erler Wendy Erler is passionate about the caregiver and patient voice being at the forefront of her work at Alexion Pharmaceuticals. Urvi Gupta is a second year medical student, working with the rare disease community to shape her professional path forward in the medical field. In this episode, I talk with Wendy Erler and Urvi Gupta about the Global Genes Rare Compassion Program.  EPISODE HIGHLIGHTS Wendy, can you tell us about yourself? I lead the patient advocacy team at Alexion, a pharmaceutical company focused on rare diseases. We work with physicians, patients, families and caregivers and my job is focused on elevating that partnership and bringing the patient and caregiver voice into everything we do.  Urvi, can you share how you became involved with the rare disease community? In a class called Clinical Correlation, we had a patient visit and they mentioned the Global Genes Rare Compassion Program, which matches up medical students with patients who have rare diseases to allow them to learn from each other. I've had three patient partners through that program and it's been amazing and inspiring to network with everyone in the rare disease community.  Urvi, how essential do you think it is to experience a true doctor-patient relationship already? So many patients say their course of treatment varies greatly based on how well their doctor listens to them. I think that's so important when it comes to rare diseases because it's not something you see often and when a patient presents a unique set of symptoms, they can't be brushed off. It's been helpful to experience and come to understand that the patient's perspective is the one that matters and what will help get a diagnosis.  Urvi, in what ways are you interested in raising awareness of the rare disease community? I would advise all medical students interested in rare disease to join the Global Genes Rare Compassion Program. There are a lot of other rare disease organizations always looking for help and there's likely a perspective you can offer.  LINKS & RESOURCES MENTIONED Global Genes Rare Compassion Program https://globalgenes.org/compassion/ Alexion Pharmaceuticals https://alexion.com/ Connor B. Judge Foundation https://www.connorbjudgefoundation.org/ CONNECT WITH WENDY & URVI Wendy Erler https://www.linkedin.com/in/wendyerler/ Urvi Gupta https://www.linkedin.com/in/urvigupta1/ TUNE INTO THE ONCE UPON A GENE PODCAST Spotify https://open.spotify.com/show/5Htr9lt5vXGG3ac6enxLQ7 Apple Podcasts https://podcasts.apple.com/us/podcast/once-upon-a-gene/id1485249347 Stitcher https://www.stitcher.com/podcast/once-upon-a-gene Overcast https://overcast.fm/itunes1485249347/once-upon-a-gene CONNECT WITH EFFIE PARKS Website https://effieparks.com/ Twitter https://twitter.com/OnceUponAGene Instagram https://www.instagram.com/onceuponagene.podcast/?hl=en Built Ford Tough Facebook Group https://www.facebook.com/groups/1877643259173346/

In this segment of Clinical Correlation, Dr. Renee Kohanski completes part 2 of her review of the most effective treatments for patients with severe anxiety. She also announces that, after almost 200 episodes, the Psychcast is taking an indefinite pause. To reach Dr. Kohanski, email her at DocReneePodcast@gmail.com. To reach Dr. Lorenzo Norris, host of the Psychcast, email him at lnorris@mfa.gwu.edu. Clinical Correlation was published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In the first part of a two-part series on anxiety disorder, Dr. Kohanski shares what may be some surprising facts information about prescribing of the tried-and-true agents of anxiety, along with some clinical pearls. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment of Clinical Correlation, Renee Kohanski, MD, unpacks the new Open Notes mandate. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

One wouldn't think autism spectrum disorder belonged in the same universe as narcissistic personality disorder. Yet sometimes emotional disconnection and seeming lack of empathy leads to miscommunication. There is one key difference, however. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment of Clinical Correlation, Renee Kohanski, MD, offers some of her treasured nonpharmacologic pearls and discusses the power in practicing what we preach while forgiving our own human foibles. Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

We are still experiencing the direct hit in addition to the aftermath of the SARS-2 Corona Virus, especially it's devastating psychiatric impact.  It's always darkest before dawn, isn't it?  Let's lighten the path, shall we in episode 12 of Clinical Correlation.

In episode 11 of Clinical Correlation, Dr. Kohanski offers more pearls to approaching that seemingly innocent chief complaint of insomnia.  She welcomes listener commentary as always.   Clinical Correlation is published every other Monday on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

The Beatles aren't the first group to write about sleep and surely won't be the last. In these next two programs, Dr. Kohanski shares some of her pearls, pharmacologic and nonpharmacologic, on those gymnastic, jumping sheep. Clinical Correlation is a bimonthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment, Dr. Renee Kohanski explores the identity crisis facing many physicians today. Clinical Correlation is a bimonthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

As we begin 2021, Renee Kohanski, MD, muses about the roller coaster journey she and her listeners have been on during the challenging times of 2020. Clinical Correlation is a bimonthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment of Clinical Correlation, Dr. Renee Kohanski reminds listeners of our inherent desire to help one another and problem solve while cautioning against those who would place our most vulnerable populations at risk. Clinical Correlation is a bimonthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment of Clinical Correlation, Dr. Renee Kohanski tackles the very difficult and painful realities of a postelection country. Clinical Correlation is a bimonthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

In this week's installment of Clinical Correlation, Renée Kohanski, MD, ponders the loss of professional courtesy and the larger implications of medicine-shifting paradigms. Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.

Renee Kohanski, MD, discusses managing difficult referrals from trusted colleagues. Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com, and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast.  

Dr. Renee Kohanski discusses how important personal and professional development is among physicians in the workplace. Is your current job worth it? Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast  

Dr. Renee Kohanski, MD, uses a proverb to discuss how she talks to patients about facemasks, and how she talks to patients with face masks on. What's hiding behind the mask? *  *  * Clinical Correlation is a bi-monthly drop on the Psychcast feed. You can email the show at podcasts@mdedge.com and you can learn more about MDedge Psychiatry here: https://www.mdedge.com/podcasts/psychcast  

Introducing Clinical Correlation, a new podcast drop from the Psychcast. Renee Kohanski, MD, began producing observational segments for the Psychcast since its inception in April 2018. Clinical Correlation episodes will be published on Mondays twice per month. In this first edition, Dr. Kohanski recalls a poignant moment during her training when her mentor and then director, Donald Morgan, MD (https://bit.ly/35PAqY6), reconsidered his opinion prior to testifying in a court of law based on a simple question from a trainee. For Dr. Kohanski, this moment emphasized the importance of honest and open conversations.  You can email the show at podcasts@mdedge.com and you can learn more about the show at https://www.mdedge.com/podcasts/psychcast   

Psychcast host Lorenzo Norris, MD, meets Renee Kohanski, MD, to announce the launch of Clinical Correlation. In Clinical Correlation, which will be released every other Monday, starting Sept. 14, Dr. Kohanski will expand on her “Dr. RK” segment and explore issues of interest to the practicing psychiatrist. And later, we will revisit four of Dr. Kohanski’s “Best of” segments. Next week, Dr. Norris will return with an interview with Peter Yellowlees, MD, about clinicians’ embrace of telepsychiatry during the pandemic. They also discuss whether many of the COVID-19–related changes – including those tied to reimbursement – are here to stay. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com

Ilana Yurkiewicz, MD, recorded dozens of Clinical Correlation segments for Blood & Cancer for more than a year. She also hosted a three-part series on difficult conversations that trainees have with their patients. In this episode, we revisit the best of Dr. Yurkiewicz.   'How long do I have left?' 02:59 Anxiety 17:02 Optimism Bias 20:21 Social Support 23:51 Family Dynamics 26:07 For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

David Henry, MD, welcomes Bernard A. Mason, MD, to discuss Dr. Mason's favorite digital tools for working as a physician in part 1 of 2. Dr. Mason is an oncologist with the Pennsylvania Hospital and the University of Pennsylvania, both in Philadelphia.  Dr. Mason explains the actual benefits for doctors and health care providers for popular apps and services from storage to maps. He and Dr. Henry explore the following: One drive Google Drive Google Photos Google Maps Offline HERE WeGo This week's installment of Clinical Correlation, Ilana Yurkiewicz, MD, poses a complicated question about oncologist-patient relationships: Do they ever actually end? *  *  *   For more MDedge Podcasts, go to https://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD, on Twitter: @davidhenrymd Ilana Yurkiewicz, MD, on Twitter: @ilanayurkiewicz

Blood & Cancer takes you behind the podium at the American Society of Hematology annual meeting for an in-depth look at the latest developments in anemia and myelodysplastic syndrome, chimeric antigen receptor (CAR) T-cell therapy for mantle cell lymphoma, use of novel agents in follicular lymphoma, and a range of new advances being explored in chronic lymphocytic leukemia. Guests on the podcast include Brian T. Hill, MD, PhD, and Allison Winter, MD, both with the Cleveland Clinic, and Anthony Mato, MD, and Lindsey E. Roeker, MD, of Memorial Sloan Kettering Cancer Center in New York. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the gratitude that can come from surviving cancer. *  *  *  ASH19 abstracts discussed in this podcast: Abstract 843: Roxadustat in the treatment of anemia in patients with lower-risk myelodysplastic syndrome and low red blood cell transfusion burden. Abstract 754: (03:45) KTE:X19, an anti-CD19 CAR T-cell therapy in patients with relapsed/refractory mantle cell lymphoma: Results of the phase 2 ZUMA-2 trial. Abstract 3982: (08:28) Comparative outcomes of relapsed follicular lymphoma patients treated with novel agents: A multi-center analysis. Abstract 31: (13:45) ELEVATE TN: Phase 3 study of acalabrutinib combined with obinutuzumab or alone versus obinutuzumab plus chlorambucil in patients with treatment-naïve chronic lymphocytic leukemia. Abstract 33: (19:01) Ibrutinib and rituximab provides superior clinical outcome compared to FCR in younger patients with chronic lymphocytic leukemia: Extended follow-up from the E1912 trial. Abstract 36: Quantitative analysis of minimal residual disease shows high rates of undetectable MRD after fixed-duration chemotherapy-free treatment and serves as surrogate marker for progression-free survival: A prospective analysis of the randomized CLL14 trial. Abstract 355: Four-year analysis of Murano study confirms sustained benefit of time-limited venetoclax-rituximab in relapsed/refractory chronic lymphocytic leukemia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

When it comes to treating pain related to sickle cell disease, consider the underlying factors, from constipation to compression spine deformity. That’s just some of the advice from Ifeyinwa Osunkwo, MD, of Atrium Health and Levine Cancer Institute in Charlotte, N.C. She joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss her tips for treating pain and other complications of sickle cell disease. Dr. Osunkwo also provides an update on progress toward a cure in sickle cell disease that could be available to a large number of patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about why treating patients with cancer doesn’t make her sad. *  *  * Treating pain in sickle cell: In sickle cell disease, patients have acute episodes of vaso-occlusive crisis, as well as chronic pain. Consider whether the pain symptoms are an acute exacerbation of their chronic pain, an independent acute episode of pain, or chronic pain. In her practice, Dr. Osunkwo has moved to less chronic opioid use and more adjuvant use. She says treat the pain but look for the reason underlying it. The pain could be a result of bone damage, a compression spine deformity, constipation, or other factors related to their disease or the treatment. Consider the impact of opioid withdrawal after receiving a high dose in the hospital. Treating acute chest syndrome: Acute chest syndrome is usually not subtle in its presentation. It is acute and includes fever, pain, difficulty breathing or shortness of breath, hypoxia, and the patient looks sick. Consider their last chest x-ray and look for changes. Is this a new pulmonary infiltrate? This is a patient who should be transfused to get them out of distress. Most of acute chest syndrome cases happen 3 days into a hospital admission. Developments in sickle cell treatment: Two new drugs to treat sickle cell symptoms were approved in the United States in 2019: voxelotor (Oxbryta) to increase hemoglobin and crizanlizumab-tmca (Adakveo) to reduce the frequency of vaso-occlusive crisis. What is coming next? Researchers are working on potential cures for sickle cell that would be available to patients on a widespread basis. That includes haploidentical transplant and gene therapy. American Society of Hematology guidelines on the treatment of sickle cell complications. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Daniel G. Haller, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to review the top three GI cancer trials presented at the 2019 ESMO World Congress on Gastrointestinal Cancer, and how they are changing practice.  Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the difficulty in using age to guide cancer treatment.   *  *  * BEACON trial for colorectal cancer Patients with BRAF mutations have a poor prognosis and typically fail treatment prior to second line therapy. BEACON is a phase 3 trial that was designed to test BRAF/MEK combination targeted therapies in patients with BRAF-mutated metastatic colorectal cancer. The study found that the three-drug combination of encorafenib, binimetinib, and cetuximab significantly improved overall survival in patients with BRAF-mutated metastatic colorectal cancer. The response rate for targeted triple therapy was 26%, compared with 2% for controls. It may be important for all patients with colorectal cancer to be tested for BRAF. IDEA trial in colon cancer Use of oxaliplatin in chemotherapy treatment regimens results in improvement in outcomes for patents with stage III colon cancer. However, treatment with oxaliplatin can cause disabling neuropathy, which is directly proportional to the cumulative dose administered. The IDEA (International Duration Evaluation of Adjuvant Therapy) trial combines data from six trials, in which patients with stage III colon cancer were randomized to receive 3 months or 6 months of adjuvant chemotherapy with a fluoropyrimidine plus oxaliplatin. The incidence of peripheral neuropathy was significantly reduced with the 3-month regimen, as compared with 6- month treatment. Survival data for 3 months of treatment with oxaliplatin are still pending. In patients with positive circulating tumor DNA (ctDNA) prior to adjuvant therapy, 6 months of treatment was preferable. Pembrolizumab, plus or minus chemotherapy, in gastric cancer This was a well-balanced three-arm study which included groups of patients treated upfront with pembrolizumab alone, chemotherapy alone, or a combination of pembrolizumab with chemotherapy. The primary endpoint was overall survival. Pembrolizumab was noninferior to chemotherapy if the combined positive score (CPS) was greater than 1. Pembrolizumab plus chemotherapy was not superior, even for CPS greater than 0.85. When pembrolizumab is started alone, patients drop off quickly. However, the responders to pembrolizumab have a long duration of response. It may be beneficial to start with chemotherapy and switch to targeted therapy when the side effects of chemotherapy become too great. Show notes by Debika Biswal Shinohara, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Thomas LeBlanc, MD, of Duke Cancer Institute in Durham, N.C., joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss the evolution of the palliative care field and some of the underrecognized ways that it can improve care for hematology-oncology patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a patient who put aside her own desire for hospice because of family pressure to pursue curative treatment. *  *  * Palliative medicine has evolved tremendously over the past decade; it used to be synonymous with hospice and dying. It is now a sophisticated medical subspecialty with growing and large evidence base.  Palliative treatments are aimed at maximizing patient's quality of life and can be provided alongside other curative treatments.  Physicians, physician assistants, and nurse practitioners form an interdisciplinary team along with patients and their families.  Palliative care specialists can work alongside oncologists to optimize symptom management in patients with multiple or refractory/severe symptoms, including chemotherapy-induced nausea and pain neuropathy.  Palliative care specialists also can help provide a safe space and an extra layer of support to patients having difficulty coping with illness.  The American Society of Clinical Oncology (ASCO) has developed a guideline that all patients with advanced cancer should be receiving dedicated palliative care services concurrent with active treatment.  Workforce shortages in palliative care are limiting access for patients with cancer. Resource: Integration of palliative care into standard oncology care: ASCO Practice Guideline update (2017) Show notes by Debika Biswal Shinohara, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

In this special edition podcast, we bring you the best of Clinical Correlation, a segment on the human side of hematology-oncology care. Clinical Correlation is written, recorded, and produced by Ilana Yurkiewicz, MD, of Stanford (Calif.) University. This episode includes five of our favorite Clinical Correlation segments.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

In this special edition podcast, Blood & Cancer revisits an interview with Ilana Yurkiewicz, MD, of Stanford (Calif.) University. Dr. Yurkewicz is the writer and producer of the podcast’s Clinical Correlation segment, which puts a human face on hematology-oncology care. She sits down with MDedge producer Nick Andrews for a wide-ranging interview that covers everything from the best advice she’s ever gotten to her favorite science fiction writer. The interview first aired on our sister podcast, Postcall.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Howard “Skip” Burris, MD, chief medical officer of Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast to talk about what it’s like to be the 2019-2020 president of the American Society of Clinical Oncology. Dr. Burris joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to share his priorities as president and how he finds the time for advocacy, research, and clinical practice. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a couple who had cancer at the same time.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

David Mintzer, MD, of the University of Pennsylvania, Philadelphia, joins the podcast to discuss noteworthy drug approvals in hematology-oncology in 2019. Dr. Mintzer and Blood & Cancer host, David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, discuss what these new treatment options mean for clinicians and patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, is at the annual meeting of the American Society of Hematology with a reminder that the way we talk about patients matters. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * *  Dr. Mintzer’s review of new drug approvals in 2019: https://www.mdedge.com/hematology-oncology/article/211340/mixed-topics/2019-glance-hem-onc-us-drug-approvals?channel=27979 More articles on FDA approvals in hematology-oncology: https://www.mdedge.com/hematology-oncology/news-fda/cdc * * *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Matt Kalaycio, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to preview the potentially practice changing research that will be reported at the 2019 annual meeting of the American Society of Hematology. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, addresses the isolation that comes from dealing with a serious chronic illness, especially around the holidays. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *  FDA approves atezolizumab combo as first line for advanced NSCLC Atezolizumab is a monoclonal antibody and is already approved for adults with metastatic NSCLC with disease progression. By Laura Nicolaides The Food and Drug administration as approved atezolizumab in combination with paclitaxel and carboplatin chemotherapy for first-line treatment of adults with metastatic, nonsquamous non-small cell lung cancer with no EGFR or ALK genomic tumor aberrations.  *  *  *  ASH abstracts discussed in the podcast: Abstract 1: Post-transplantation cyclophosphamide after allogeneic hematopoietic stem cell transplantation: Results of the prospective randomized HOVON-96 trial in recipients of matched related and unrelated donors. Abstract 261: Superior survival with post-remission pediatric-inspired chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: Comparison of CALGB 10403 to patients reported to the CIBMTR. Abstract 322: Nonmyeloablative allogeneic transplantation confers an overall survival benefit with similar nonrelapse mortality when compared with autologous stem transplantation for patients with relapsed follicular lymphoma. Abstract 6: Mosunetuzumab induces complete remissions in poor prognosis non-Hodgkin lymphoma patients, including those who are resistant to or relapsing after chimeric antigen receptor T-cell therapies, and is active in treatment through multiple lines. Abstract LBA-5: Validation of BCL11A as therapeutic target in sickle cell disease: Results from the adult cohort of a pilot/feasibility gene therapy trial inducing sustained expression of fetal hemoglobin using posttranscriptional gene silencing. Abstract LBA-6: Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma: Primary analysis results from the randomized, open-label, phase 3 study Candor. Abstract 1588: A randomized trial of EPOCH-based chemotherapy with vorinostat for highly aggressive HIV-associated lymphomas: Updated results evaluating the impact of diagnosis-to-treatment interval and pre-protocol systemic therapy on outcomes. Abstract 940: Elucidating the role of IL6 in stress erythropoiesis and in the development of anemia under inflammatory conditions. Abstract 57: Patient harm from repetitive blood draws and blood waste in the ICU: A retrospective cohort study. Abstract 59: Impact of iron supplementation on patient outcomes in women undergoing gynecologic procedures: Systematic review and meta-analysis of randomized trials. Abstract 126: Polatuzumab vedotin plus obinutuzumab and lenalidomide in patients with relapsed/refractory follicular lymphoma: Primary analysis of the full efficacy population in a phase Ib/II trial. Abstract 168: Risk of hemorrhage in patient with polycythemia vera exposed to aspirin in combination with anticoagulants: Results of a prospective, multicenter, observational cohort study (REVEAL). Abstract 326: Safety and effectiveness of apixaban, LMWH, and warfarin among venous thromboembolism patients with active cancer: A retrospective analysis using four U.S. claims databases. Abstract 327: Safety and effectiveness of apixaban, LMWH and warfarin among venous thromboembolism patients with active cancer: A subgroup analysis of VTE risk scale. Abstract 566: Phase II study of oral rigosertib combined with azacytidine as first line therapy in patients with higher-risk myelodysplastic syndromes.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Jame Abraham, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia to review two cases of breast cancer, focusing on when to use the 21-gene Oncotype DX breast recurrence score and how to apply the results.   Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, explores what happens when the patient minimizes their symptoms in order to keep getting treatment. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *  This Week in Oncology Not all lung cancer patients receive treatment By Richard Franki In the United States, just over 15% of patients with lung cancer receive no treatment, according to the American Lung Association. *  *  *  Breast cancer cases Case 1: A 46-year-old, premenopausal woman who has had a right breast lumpectomy with a 7-mm tumor that is invasive ductal, ER/PR positive, and HER2 negative. Since her tumor is small and low grade, would you do Oncotype DX recurrence score testing? Dr. Abraham recommends: Explain to the patient that her benefit from chemotherapy will be limited, but that she meets the tumor size requirement for the Oncotype DX assay and offer her the test. Case 2: A 57-year-old women who is postmenopausal with a grade 1 tumor that is 10mm, ER/PR positive, HER2 negative, with 4 of 17 positive lymph nodes. Is there an advantage to adding the Oncotype DX testing for this patient? Dr. Abraham recommends: Offer the patient chemotherapy; recommend against Oncotype DX testing. Show notes by Mary Ellen Schneider   References Sparano JA et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018 Jul 12;379(2):111-21. Sparano JA et al. Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med. 2019 Jun 20;380(25):2395-2405. *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Jack West, MD, joins the podcast to discuss the immunotherapy in the treatment of lung cancer. Dr. West is an associate clinical professor in medical oncology at City of Hope Comprehensive Cancer Center in Duarte, Calif., and a thought leader in thoracic oncology. Dr. West and Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, discuss assays, liquid biopsy, and review a recent case in part two of their interview. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, reminds us that even when just “covering” a patient for another physician, you could be in for some difficult discussions. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *  This Week in Oncology Atezolizumab bests chemo in NSCLC patients with high PD-L1 expression by Jennifer Smith Atezolizumab monotherapy can improve overall survival in treatment-naive patients with stage IV non-small cell lung cancer and high PD-L1 expression according to the results of a phase 3 trial presented at the 2019 annual meeting of the Society for Immunotherapy of Cancer. Assays Important to rapidly test for PDL1, EGFR and ALK status and have all results before committing to first-line therapy. PDL1 testing results often take 24 hours, while EGFR and ALK results can take several weeks; committing to immunotherapy without knowing the status of molecular drivers is not ideal. Liquid biopsy Measures DNA from tumor cells circulating in the blood. Testing takes about a week. A positive result can be trusted. A negative result cannot be trusted, given low sensitivity, especially in patients with low tumor burden. Adverse effects of immunotherapy Striking variability in toxicity profiles among patients. Although overall better tolerated than chemotherapy, the “unknown” aspect of immunotherapy toxicities may be anxiety provoking for patients. Fatigue, rash, and thyroid abnormalities are most commonly seen. However, there is a broad array of toxicities that oncologists may not be familiar with, necessitating a multidisciplinary approach. Case discussion An otherwise healthy, middle-aged woman presents with two lung nodules: a 1.4 cm lesion in the left upper lobe, and a 3.1 cm lesion in the left lower lobe. Both are biopsy proven to be non–small cell adenocarcinoma. Both lesions are excised with clear margins. There is no lymph node, vascular, or pleural invasion. In this case, it makes sense to view these as two independent cancers. Unclear if the chance of recurrence is increased based on the presence of two, less than 4 cm lesions with negative prognostic features and adequate excision with clear margins. The anticipated benefit of adjuvant chemotherapy must be weighed against toxicities, and the individual patient’s ability to tolerate chemotherapy must be considered. Resources Dr. West’s cancer education website for patients and caregivers: cancergrace.org Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

  H. Jack West, MD, joins the podcast to discuss the latest trials of immunotherapies in the treatment of lung cancer. Dr. West is an associate clinical professor in medical oncology at City of Hope Comprehensive Cancer Center in Duarte, Calif., and a thought leader in thoracic oncology. Dr. West and Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, review Keynote-042, Keynote-189, and IMpower150, and discuss how the findings influence practice. You can find Dr. West on Twitter at @JackWestMD. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses how to be nonjudgmental when talking to patients about how they got cancer. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * This Week in Oncology: FDA Approves Ziextenzo for neutropenia-related infection reduction The FDA has approved the biosimilar Ziextenzo to reduce the incidence of infection in patients with nonmyeloid cancer who are receiving suppressive anticancer drugs that are associated with febrile neutropenia. Treatment for metastatic nonsquamous non–small cell lung cancer (NSCLC) without EGFR mutation or ALK translocation: Keynote-042 Design: Pembrolizumab alone vs. chemotherapy alone (carboplatin plus paclitaxel or carboplatin plus pemetrexed) 902 patients 1:1 randomization All patients with at least 1% PDL1 positivity Stratified into three groups: greater than 1%, greater than 20%, and greater than 50% PDL1 score No crossover permitted between groups Results: Overall survival is 16.7 months with pembrolizumab vs. 12.1 months with chemotherapy. PDL1 score 1% or greater: 16.7 months for pembrolizumab vs. 12.1 months for chemotherapy alone. PDL1 score 20% or greater: 17.7 months for pembrolizumab vs. 13.0 months for chemotherapy alone. PDL1 score 50% or greater: 20.0 months for pembrolizumab vs. 12.2 months for chemotherapy alone. There was no statistically significant difference in progression-free survival. Conclusion: Pembrolizumab monotherapy can be extended as first-line therapy to patients with locally advanced or metastatic non–small cell lung cancer and a high PDL1 score. Pembrolizumab monotherapy alone may not be the best choice for patients with a low PLD1 score.   Keynote-189 Design: Pembrolizumab plus chemotherapy vs. placebo plus chemotherapy (pemetrexed plus platinum agent) 616 patients 2:1 randomization All patients with at least 1% PDL1 positivity Crossover to pembrolizumab monotherapy was permitted among the patients in the placebo-combination group who had verified disease progression Results: Overall survival to 12 months: 69.2% with pembrolizumab plus chemotherapy vs. 49.4% with chemotherapy alone. Progression-free survival: 8.8 months with pembrolizumab plus chemotherapy vs. 4.9 months with chemotherapy alone. Conclusion: Pembrolizumab should be added to standard chemotherapy of pemetrexed and a platinum-based drug for significantly longer overall survival and progression-free survival than chemotherapy alone, regardless of level of PDL1 positivity.   IMpower150 Design: Atezolizumab plus bevacizumab plus carboplatin plus paclitaxel (ABCP) vs. bevacizumab plus carboplatin plus paclitaxel (BCP) vs. atezolizumab plus carboplatin plus paclitaxel (ACP) 1,202 patients 1:1:1 randomization Patients with any PD-L1 immunohistochemistry status were eligible Stratified by level of Teff gene-signature expression Results: Overall survival was longer in the ABCP group than in the BCP group (19.2 months vs. 14.7 months). Progression-free survival was longer in the ABCP group than in the BCP group (8.3 months vs. 6.8 months). In the Teff-high population, progression-free survival was significantly longer in the ABCP group than in the BCP group (11.3 months vs. 6.8 months). Conclusion: Addition of atezolizumab to bevacizumab plus chemotherapy significantly improved progression-free survival and overall survival among patients with metastatic nonsquamous NSCLC, regardless of PD-L1 expression. Unclear if ABCP regimen is superior to pembrolizumab monotherapy (in greater than 50% PDL1 group) or pembrolizumab plus pemetrexed plus platinum agent (in all PDL1 groups) as a four-drug regimen may be less attractive than these options. Teff status has not yet been proven to be useful for clinical decision making.   References Mok TSK et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non–small cell lung cancer (KEYNOTE-042): A randomised, open-label, controlled, phase 3 trial. Lancet. 2019;393:1819-30.   Gandhi L et al. Pembrolizumab plus chemotherapy in metastatic non–small cell lung cancer. N Engl J Med. 2018;378:2078-92. Socinski MA et al. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378:2288-301.   Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

David L. Streiner, PhD, of McMaster University, Hamilton, Ont., and the University of Toronto, joins Blood & Cancer host David Henry, MD, of Pennsylvania Hospital, Philadelphia, to explain what a post hoc analysis is and why it should be interpreted with caution. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, explores what to tell patients when it comes to prognostic scoring system results. * * *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * *  This week in Oncology: In rectal cancer, fragmented care linked to lower survival by Jim Kling, reporting from Clinical Congress 2019. Post hoc analyses What is a post hoc analysis? Analyzing data after a study has already had conclusions made and looking for patterns that were not prespecified. Dr. Streiner’s advice for researchers: Pick a small number of primary outcomes and develop a narrow hypothesis. Then use post hoc analysis as a means of assessing future questions that can be investigated in a subsequent study. Dr. Streiner’s advice for clinicians: Treat a post hoc analysis as a hypothesis that requires further study. It should be viewed with some degree of suspicion because it may have been significant only by chance. Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   References Marcus R et al. Obinutuzumab for the first-line treatment of follicular lymphoma. N Engl J Med. 2017;377:1331-44. Crawford ED et al. Comorbidity and mortality results from a randomized prostate cancer screening trial. J Clin Oncol. 2011;29:355-61. Streiner DL et al. Size, follow-up, data analysis – good; post hoc analysis, interpretation – not so good. Commun Oncol. 2011;8:379-80.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

Strategies and guidelines for delivering bad news to patients from David Henry, MD, and Ilana Yurkiewicz, MD.  Timestamps: This week in Oncology (01:30) Conversation (04:22) This week, the host of Blood & Cancer and the writer, producer, and talent behind the Clinical Correlation segment sit down together for the first time ever.  Dr. Henry and Dr. Yurkiewicz share strategies and anecdotes about their experiences learning how to give patients terrible news and --perhaps more importantly -- how not to.  Links: SPIKES mnemonic Dr. Henry: Academic Biography Dr. Yurkiewicz Academic Biography Hard Questions column This week in Oncology.  Immunotherapy enables nephrectomy with good outcomes in advanced RCCby Susan London Some patients with advanced renal cell carcinoma treated with immune checkpoint inhibitors can safely undergo nephrectomy and experience favorable surgical outcomes and pathologic responses according to a cohort study from Urologic Oncology.  SOURCE: Singla N et al. Urol Oncol. 2019 Sep 12. doi: 10.1016/j.urolonc.2019.08.012 For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter @mdedgehemonc David Henry on Twitter @davidhenrymd Ilana Yurkiewicz on Twitter @ilanayurkiewicz  

Justine V. Cohen, DO, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss a recent melanoma case in the adjuvant setting and when to consider targeted therapies or immune checkpoint inhibitors for these patients.  Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when a patient’s anxiety threatens to get in the way of the clinician’s decision making. Time stamps: Meet the guest (00:51) This Week in Oncology (03:02) Interview with Dr. Justine Cohen (05:48) Clinical Correlation (26:25) This week in Oncology FDA approves rivaroxaban for VTE prevention in hospitalized, acutely ill patients by Lucas Franki FDA approval for the new indication is based on results from the phase 3 MAGELLAN and MARINER trials, which included more than 20,000 hospitalized, acutely ill patients. Therapies for melanoma Classes of therapies for adjuvant melanoma include immune checkpoint inhibitors and targeted therapies. Historically, high-dose interferon was the only available therapy for melanoma. This was associated with a lot of toxicities, without great benefits in terms of overall survival. About 50% of melanomas are BRAF mutated and amendable to adjuvant treatment with the combination of BRAF/MEK inhibitors. Immunotherapy can be used in BRAF mutated patients or BRAF wild type (no mutation). Ipilimumab (anti-CTLA4) demonstrated recurrence-free survival benefit and an overall survival benefit. Toxicity = grade 3 or grade 4 immune-related side effects. Nivolumab and pembrolizumab (anti-PD1) have taken the place of ipilimumab. They are associated with lower rates of toxicities (14%-15%). Side effects of immunotherapy: “itis” (fever, ocular toxicity, lung, colon, rash, many others). These side effects may persist despite cessation of immunotherapy unlike targeted therapies, in which side effects resolve after stopping. Treatment decisions following adverse events depend on how much therapy is delivered prior to the event and the severity of toxicity.   Drug Class Mechanism of action Interferon Antiviral ·   Inhibits protein synthesis ·   Inactivates viral RNA ·   Enhances phagocytic and  cytotoxic mechanisms   Ipilimumab Checkpoint inhibitor ·   IgG1 monoclonal antibody against cytotoxic T-lymphocyte antigen 4   Nivolumab Checkpoint inhibitor ·   Human IgG4 monoclonal antibody against programmed death 1 (PD-1)   Pembrolizumab Checkpoint inhibitor ·   Human IgG4 monoclonal antibody against programmed death 1 (PD-1) Dabrafenib Targeted therapy ·   BRAF inhibitor   Vemurafenib Targeted therapy ·   BRAF inhibitor Trametinib Targeted therapy ·   MEK inhibitor    Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. References Weber J et al. Adjuvant nivolumab versus ipilimumab in resected stage III or IV melanoma. N Engl J Med. 2017;377:1824-35. Eggermont AMM et al. Adjuvant pembrolizumab versus placebo in resected stage III melanoma. N Engl J Med. 2018;378:1789-1801. Long GV et al. Adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma. N Engl J Med. 2017;377:1813-23.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

In episode 51, Nick and Emi Okamoto, MD, discuss what makes a good doctor-patient relationship, how EMRs affect burnout, and when, if ever, it's okay to have had a drink before a clinical shift.  The interview portion of this episode comes from Ilana Yurkiewicz, MD, who hosts a discussion about difficult conversations that residents and fellows need to have with their patients. Dr. Yurkiewicz, along with Emily Bryer, DO, and Ronak Mistry, DO, address those times when a patient asks what you would do if the patient were your family member, and how much patients really want to know about their situation.  Dr. Yurkiewicz is a hematology/oncology fellow at Stanford (Calif.) University and the host and producer of the Clinical Correlation segment of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. Dr. Bryer and Dr. Mistry are both at the University of Pennsylvania, Philadelphia. You can contact Nick and Emi by emailing podcasts@mdedge.com, and you can follow Nick on Twitter at @nick_andrews__ or Instagram at @medicalmuggle.  Time stamps: Good doctor-patient relationships (01:40) Drinking before the clinic? (03:20) How EMRs affect ob.gyn. care (07:27) Hard conversations with Dr. Ilana Yurkiewicz (15:20) Links: What Makes a Good Doctor-Patient Relationship? (Medscape) The electronic medical record's role in ObGyn burnout and patient care (MDedge/ObGyn) Downloadable PDF Having a beer before a shift (Reddit: r/medicine) Ilana Yurkiewicz, MD Academic Profile Blood & Cancer Hard Questions Column Emily Bryer, DO  Ronak Mistry, DO For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com  

In this edition, we conclude our 3-part series about having hard conversations with patients as a trainee. This week's case poses the following question: "What would you do if this were your family member?" Ilana Yurkiewicz, MD, Blood & Cancer cohost and producer of the Clinical Correlation segment, is joined by the two residents who have been behind the Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, joins the podcast to talk about whether multiple myeloma patients with should receive maintenance therapy until progression.  Timestamps: TBD Dr. Henry's on difficult conversations (01:15) This week in Oncology (04:17) Difficult conversations for trainees part III (06:37) Links: This week in Oncology What is the optimal duration of maintenance in myeloma? Ilana Yurkiewicz, MD Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University.  Hard Questions Emily Bryer, DO Ronak Mistry, DO   For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Hematology/oncology requires clinicians to have some of the most difficult conversations in all of medicine. In part 2 of our 3-part series, we tackle how to talk about ending curative therapy even when the family wants to keep going.  These conversations are hosted by Ilana Yurkiewicz, MD, the host and producer of the Clinical Correlation segment and the author of Hard Questions, a monthly column at MDedge Hematology-Oncology. She is joined by the two residents who have been behind the Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, also joins the podcast to talk about treatment discontinuation in multiple myeloma. Timestamps: This week in Hematology/Oncology: 04:00 Conversation: 08:00 Links: This Week in Oncology: Study finds no standard for treatment discontinuation in myeloma Ilana Yurkiewicz, MD: Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University. Hard Questions Emily Bryer, DO Ronak Mistry, DO For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Hematology/oncology requires clinicians to have some of the most difficult conversations in all of medicine. In this edition, we begin a three-part series about having those conversations.  These conversations will be hosted by Ilana Yurkiewicz, MD, the host and producer of the Clinical Correlation segment and the author of Hard Questions, a monthly column at MDedge Hematology-Oncology. She is joined by the two residents who have been behind Blood & Cancer show notes from the beginning, Emily Bryer, DO, and Ronak Mistry, DO, both of the University of Pennsylvania, Philadelphia. David H. Henry, MD, editor in chief of MDedge Hematology-Oncology and the host of Blood & Cancer, joins the podcast to talk about this week's discussion and a new Food and Drug Administration approval from earlier in September.   Time stamps: Intro (00:05) This Week in Oncology (04:11) Conversation (07:30) Links: This Week in Oncology:  FDA approves pembrolizumab/lenvatinib combo for advanced endometrial carcinoma Ilana Yurkiewicz, MD: Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford (Calif.) University. Hard Questions Emily Bryer, DO Ronak Mistry, DO   For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

 Alok Khorana, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to break down the latest recommendations from the American Society of Clinical Oncology on venous thromboembolism (VTE) prophylaxis in cancer patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares her answer to a frequent question from cancer patients: What should I eat? This Week in Oncology What is the role of thromboprophylaxis in patients with cancer in the outpatient setting?  Key change in ASCO recommendations: Thromboprophylaxis with apixaban, rivaroxaban, or low-molecular-weight heparin (LMWH) may be offered to select high-risk outpatients with cancer. Prophylactic anticoagulation should not be given to every patient with malignancy. Khorana score predicts the venous thromboembolism in patients with malignancy. Influenced by type of malignancy, hemoglobin, platelet count, leukocyte count, and BMI. High risk = Khorana score of 2 or higher may be offered prophylaxis. Patients with pancreatic cancer and gastric cancer are particularly coagulopathic. Does the presence of a CNS lesion(s) preclude anticoagulation for a DVT/PE? All CNS lesions have a risk of hemorrhage. A CNS lesion hemorrhage is not significantly greater when anticoagulated Among high-risk cancer patients who undergo surgery, is there a role for postoperative prophylaxis with LMWH? Data show a persistent risk of VTE up to 4 weeks following abdominal/pelvic surgery.   Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   References: Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO Clinical Practice Guideline Update ascopubs.org/doi/pdf/10.1200/JCO.19.01461 Rivaroxaban for thromboprophylaxis in high-risk ambulatory patients with cancer nejm.org/doi/full/10.1056/NEJMoa1814630 Apixaban to prevent venous thromboembolism in patients with cancer nejm.org/doi/full/10.1056/NEJMoa1814468   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

David Fajgenbaum, MD, of the University of Pennsylvania, Philadelphia, is a pioneer in the research of Castleman disease and he’s a patient himself. He joins Blood & Cancer host David Henry, MD, of Pennsylvania Hospital, Philadelphia, to talk about the presentation of Castleman, available treatments, and his own patient journey. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about compassion fatigue among friends and family of cancer patients. This Week in Oncology Time Stamps: This week in Oncology (03:51) Interview (07:24) Clinical Correlation (34:15) Show notes Castleman disease is a group of disorders unified by certain histologic features, including: Atrophic (B-cell depleted) germinal centers with wide mantle zones. Increased number of plasma cells in the interfollicular space. Increased number of blood vessels in the interfollicular space. The disease can be subdivided into unicentric Castleman disease (UCD) or multicentric Castleman disease (MCD), based upon the extent of the lymph node involvement. Multicentric Castleman is further subdivided into HHV8-associated and non HHV8-associated (idiopathic) disease. Determination of HHV-8 status is very important for the selection of the appropriate therapeutic strategy. The presentation of Castleman Disease may be similar to the presentation of lymphomas, including fatigue, night sweats, peripheral edema, pancytopenia, and disseminated lymphadenopathy. The diagnosis depends on the unique histologic appearance after bone marrow biopsy is performed. Patients with Castleman disease often require hospitalization given rapid progression of symptoms due to massive cytokine release. MCD is a rare clinical entity, and to date, only one randomized controlled trial has been published to date (involving siltuximab). Therapeutic options: Unicentric Castleman disease Effectively treated with surgical excision of enlarged lymph node. Multicentric Castleman disease Rituximab (anti-CD20 monoclonal antibody) Has been used off-label as first-line treatment in HIV-positive/HHV-8-positive MCD, alone or in combination with conventional chemotherapeutics. Siltuximab (anti-IL-6 monoclonal antibody) Currently the only approved treatment of idiopathic MCD in the United States. Tocilizumab (humanized IL-6 receptor antagonist) Approved for treatment of idiopathic MCD in Japan. Sirolimus (mTOR pathway inhibition) Under investigation at the University of Pennsylvania for treatment of patients who have been refractory to IL-6 blockade. Bortezomib (selective proteasome inhibitor) and Anakinra (IL-1 receptor antagonist) A small number of case reports suggest these may be used in MCD.   Dr. Fajgenbaum can be reached at davidfa@pennmedicine.upenn.edu. More information about Castleman disease can be found at www.cdcn.org.  Dr. Fajgenbaum’s memoir is Chasing My Cure: A Doctor’s Race to Turn Hope into Action Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz    

  David L. Streiner, PhD, of McMaster University, Hamilton, Ont., and the University of Toronto, joins Blood & Cancer host David Henry, MD, of Pennsylvania Hospital, Philadelphia, to talk about meta-analyses and what they really tell us about the evidence for treatment. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about when a second or third opinion can be detrimental in aggressive cancer. This Week in Oncology Show notes Meta-analysis: A systematic, thorough review of the literature, extraction of the effect sizes, and mathematical combination of effect sizes to produce an overall estimate. Analyses (both negative and positive trials) with larger sample sizes get more weight than smaller studies do.  Example: Erythropoiesis-stimulating agents in oncology: A study-level meta-analysis of survival and other safety outcomes Br J Cancer. 2010; 102(2):301-15. Analyzed 60 studies, including unpublished works. Conclusion of the meta-analysis: Erythropoiesis-stimulating agents had no significant effect on the outcome of survival. Forest plots: Null hypothesis = odds ratio of 1 means no difference between the two groups. Squares on the right of the line favor control group. Squares on the left of the line favor treatment group. The size of the square corresponds with the sample size. Each meta-analysis is to be evaluated as an estimate of truth, but not truth itself. Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

Daniel G. Haller, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss two real-world gastrointestinal cancer cases and how the latest research should influence the approach to care. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about pressure from patients to overtreat indolent cancer. This week in Oncology: Perceived discrimination linked to delay in ovarian cancer diagnosis for black women Perceived everyday discrimination was associated with an extended duration between symptom onset and cancer diagnosis in black women with ovarian cancer. Time Stamps: This week in Oncology (04:47) Interview with Dr. Haller (07:27) Clinical Correlation (26:20) Show Notes Patient case #1: Patient presents with a T2 tumor with right-sided colon cancer with invasion of a large right vessel. What is the best management?  The IDEA collaboration: Large analysis to evaluate CAPOX vs. FOLFOX therapy for colorectal cancer and to determine 3 months vs. 6 months of therapy. Researchers at the 2019 American Society of Clinical Oncology annual meeting presented an evaluation of the treatments in stage II colon cancer with high-risk features (Abstract 3501). Definition of high risk: T4, inadequate nodal harvest, poorly differentiated, obstruction, perforation or vascular/perineural invasion. Difficult for pathologists to diagnose T4 disease. The definition of high-risk disease was slightly different in each individual trial. T stage makes the most difference of all. Overall data: Difference in survival is 3% between 3 months and 6 months of therapy. Results by regimen: CAPOX: 3 months vs. 6 months, the difference in survival is almost identical. FOLFOX: 3 months vs. 6 months, difference in survival was 7%, with 6 months being superior. Link: asco.org/239/AbstView_239_257383.html Refresher on grading colorectal cancers: net/cancer-types/colorectal-cancer/stages Patient case #2: A 38-year old woman with past medical history of diverticulitis presents with left lower quadrant pain and is treated with antibiotics but does not improve. She was referred for colonoscopy, which reveals sigmoid polyp; pathology shows moderately differentiated adenocarcinoma. A CT scan is performed, which reveals a lesion that is transmural, circumferential in the sigmoid, and requires surgery. Sigmoid is colectomy performed for a large tumor and serosal and pericolic and immediately adjacent retroperitoneal soft tissue is noted. Other notable features included lymphovascular invasion but no metastases. Genetic testing shows RAS/BRAF negative and MMR analysis notes PMS2 negative.  Concern for Lynch syndrome given right-sided disease, female, large tumor; therefore, genetic testing for Lynch syndrome is recommended. This is important because patient requires more frequent colonoscopies. Work with surgeons to recommend keeping clips in place to minimize area that gets radiation. Approach to treatment: Dr. Haller recommends the “sandwich approach,” in which the patient receives chemotherapy, then radiation, then more chemotherapy. FOLFOX or CAPOX are both chemotherapy options.   Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Ilana Yurkiewicz on Twitter: @ilanayurkiewicz      

  William J. Gradishar, MD, of Feinberg School of Medicine and Northwestern Medicine in Chicago, chats with David H. Henry, MD, host of Blood & Cancer, to review some of the top breast cancer research presented at the 2019 annual meeting of the American Society of Clinical Oncology. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about dealing with help-seeking and help-rejecting patients.   Show notes This episode discusses three randomized, controlled phase 3 trials that were presented at ASCO 2019:  KRISTINE trial (abstract 500) Design: Patients with HER2-positive breast cancer were randomized to receive either neoadjuvant trastuzumab, pertuzumab, and chemotherapy (docetaxel, carboplatin) vs. trastuzumab emtansine plus pertuzumab. Primary endpoint: Pathological complete response rate. Secondary endpoints: Toxicity, event-free survival, invasive disease-free survival. Conclusion: Docetaxel, carboplatin, and trastuzumab plus pertuzumab resulted in a higher rate of pathological complete response than did trastuzumab emtansine plus pertuzumab, but was associated with more serious adverse events. PREDIX trial (abstract 501) Design: Patients with HER2 positive and hormone receptor positive breast cancer were randomized to receive either neoadjuvant trastuzumab emtansine monotherapy vs. docetaxel, trastuzumab, and pertuzumab. Primary endpoint: Pathological complete response rate. Secondary endpoints: Toxicity and quality of life. Conclusions: Trastuzumab emtansine monotherapy was better tolerated while maintaining comparable PCR rate as the group which received docetaxel, trastuzumab, and pertuzumab.  TAILORx trial (abstract 503) Design: Patients with node-negative, estrogen receptor–positive breast cancer with an Oncotype DX recurrence score of 11-25 were randomized to receive either hormone therapy alone or hormone therapy together with combination chemotherapy. Primary endpoint: Rate of distant recurrence at 9 years.  Conclusions: There was no benefit from chemotherapy for younger women (aged 50 years or younger) with a recurrence score of 16-20 and at low risk clinically (small tumor size and favorable histologic grade). Those age younger than age 50 years with a score of 16-20, but high risk clinically, may benefit from chemotherapy. Much of the benefit derived from chemotherapy was because of ovarian suppression. Using the recurrence score in combination with clinical risk stratification allows clinicians to identify more young women who can be spared chemotherapy, and more young women who may benefit from antiestrogen therapy.   Show notes by Sugandha Landy, MD, a resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   References J Clin Oncol 37. 2019 May 20 (suppl; abstr 500). doi: 10.1200/JCO.2019.37.15_suppl.500. J Clin Oncol 37. 2019 May 20 (suppl; abstr 501). doi: 10.1200/JCO.2019.37.15_suppl.501. J Clin Oncol 37. 2019 May 20 (suppl; abstr 503). doi: 10.1200/JCO.2019.37.15_suppl.503. Lancet Oncol. 2018 Jan;19(1):115-26. N Engl J Med. 2019 Jun 20;380:2395-405.    For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

David L. Streiner, PhD, of McMaster University, Hamilton, Ont., and the University of Toronto, joins Blood & Cancer host David Henry, MD, of Pennsylvania Hospital, Philadelphia, to explain what P values actually measure and how they both help and hinder the interpretation of clinical research findings. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, explores how quickly cancer can turn into bankruptcy. Show notes In statistics, P value is null hypothesis significance testing. The P value assesses the following: If the null hypothesis (i.e., there is no difference) is true, what is the probability that we could get data that is extreme? What are researchers doing when they test this way? Given the null hypothesis (i.e., we are assuming data is from chance alone), what is the probability that the data are actually true? What do researchers actually want to be able to do? Given the data, what is the probability of the null hypothesis (i.e., random chance alone is responsible for the difference)? The P value is affected by sample size; a smaller sample is more easily influenced by variable data and can result in outcomes that are not statistically significant. Large sample sizes are affected less by variables. It is important to differentiate what is statistically significant from what is clinically significant. Remember, P less than .05 is an arbitrary number. Do not let a P value deter use of a therapy that may show clinical benefit. Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Edward S. Kim, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., chats with David H. Henry, MD, host of Blood & Cancer, about how to perform clinical trials in the community oncology setting. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses a byproduct of our fragmented health care system – patients having to hear the same bad news repeated over and over. Show notes  Only 3%-4% of adult oncology patients are enrolled in clinical trials. Most patients diagnosed with cancer are seen in community settings (as opposed to academic centers). Oncologists in the community setting face significant obstacles to enrolling their patients in clinical trials: Communication between academic and community centers often is lacking, especially in more rural areas of the country. Community-based oncologists usually are not compensated for time spent on research or academic work. Treatment pathways used by many oncologists may not offer any information regarding clinical trials. The traditional infrastructure of a community practice may not have the necessary experts to facilitate clinical trial participation. Community oncologists may not feel comfortable talking to their patients about a novel drug of which they have little knowledge. How can community oncologists facilitate participation in clinical trials? There must be a cultural change, starting with the organization’s leadership. A study coordinator is crucial. Data, finance, and regulatory individuals are likely required. Coordination with pharmacy and pathology usually is necessary. Electronically Accessible Pathways (EAPathways) is a tool developed by Dr. Kim’s team. It is available and allows any oncologist to input a patient’s information to determine if there is an appropriate clinical trial available. Show notes by Sugandha Landy, MD, a resident in the department of internal medicine, University of Pennsylvania, Philadelphia Dr. Kim can be reached at Edward.Kim@atriumhealth.org   Additional reading Patronik KE and ES Kim. A novel clinical pathways approach to delivering regional-based clinical trials and patient care in a hybrid academic- community-based system. J Clin Pathways. 2018 May;4(4):52-5. Ersek JL et al. Implementing precision medicine programs and clinical trials in the community-based oncology practice: Barriers and best practices. Am Soc Clin Oncol Educ Book. 2018 May 23:38:188-96.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

Ginah Nightingale, PharmD, of the Jefferson College of Pharmacy at Thomas Jefferson University in Philadelphia chats with David H. Henry, MD, host of Blood & Cancer, about the definition of polypharmacy and the challenges it poses in treating older cancer patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the waiting that cancer patients face. Show notes Older adults comprise about 15% of the total population but account for more than 33% of prescription drug use. Polypharmacy can be defined as taking five or more medications (prescription and nonprescription), as well as being on medications that have adverse effects in older adults. Older adults are at increased risk for adverse effects from polypharmacy for multiple reasons, including multiple comorbidities and altered drug metabolism. In a study by Nightingale et al., 61% of patients already had a major drug-drug interaction on their medication list prior to initiation of cancer therapy. In a study by Sharma et al., 22% of patients were taking proton pump inhibitors concurrently with tyrosine kinase inhibitors, an interaction that was associated with increased risk of death at 90 days and 1 year. Patients who receive medications from multiple pharmacies, such as a specialty pharmacy for oncologic drugs, are at increased risk of polypharmacy errors. Tools to screen for polypharmacy include: Beers criteria by American Geriatrics Society STOPP/START criteria (commonly used in Europe) Medication appropriateness index Considerations such as patient’s life expectancy and quality-of-life goals should be taken into account when deciding which medications are necessary and what may be deprescribed. Clinicians should encourage patients to bring in all medications to every doctor’s visit, and certainly at the time of initiation of cancer treatment. Show notes by Sugandha Landy, MD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.   Additional reading American Geriatrics Society 2019 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019 Apr;67(4):674-94. O'Mahony Denis et al. STOPP/START criteria for potentially inappropriate prescribing in older people: Version 2. Age Ageing. 2015 Mar;44(2):213-8. Nightingale G et al. Evaluation of a pharmacist-led medication assessment used to identify prevalence of and associations with polypharmacy and potentially inappropriate medication use among ambulatory senior adults with cancer. J Clin Oncol. 2015 May 1;33(13):1453-9. Sharma M et al. The concomitant use of tyrosine kinase inhibitors and proton pump inhibitors: Prevalence, predictors, and impact on survival and discontinuation of therapy in older adults with cancer. Cancer. 2019 Apr 1;125(7):1155-62.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz

Pancreatic cancer and clinical trials   David H. Henry, MD, host of Blood & Cancer, is on location at the 2019 annual meeting of the American Society of Clinical Oncology during this podcast, speaking with Davendra Sohal, MD, of the Cleveland Clinic. Dr. Sohal presented preliminary results from SWOG S1505, a phase 2 study on neoadjuvant chemotherapy for resectable pancreatic adenocarcinoma. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when a cancer patient wants to act against medical advice. Show Notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia SWOG S1505 trial: Neoadjuvant chemotherapy experience with mFOLFIRINOX vs. gemcitabine/nab-paclitaxel for resectable pancreatic adenocarcinoma.  Patients with resectable pancreatic adenocarcinoma typically have surgery prior to chemotherapy. Many patients with pancreatic adenocarcinoma recur after surgery. Randomized phase 2 trial of resectable pancreatic adenocarcinoma Patients were given chemotherapy for 3 months. If there was no progression, patients underwent surgery, followed by more chemotherapy. About one-third of these patients were found to have nonresectable disease. Additional data will be published in 2020. Neoadjuvant chemotherapy may be easier to tolerate since it is given prior to surgery. Venous thromboembolism is a common among patients with metastatic pancreatic cancer.   Resources  SWOG S1505 trial: NCT02562716 ASCO 2019, Abstract 4137   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz  

David H. Henry, MD, host of Blood & Cancer, is joined by two experts on the financial toxicity of cancer. Melissa Monak and Kimberly Bell, both of the Cleveland Clinic, presented research at the 2019 annual meeting of the American Society of Clinical Oncology on the implementation of a financial navigation program at the Cleveland Clinic’s Taussig Cancer Center. In this podcast, they discuss the findings of their research and how just educating patients about their insurance benefits can improve access and patient satisfaction. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, revisits the “illusion of options” and what happens when this false hope originates with the treatment team. Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia   Prior authorizations, high deductibles, and out-of-pocket expenses often delay cancer treatment. Financial navigators connect with patients diagnosed with a malignancy who have not yet started treatment. These navigators identify insurance benefits, estimate out-of-pocket costs, and find copayment assistance programs or other charitable options.   Resources Development of a financial navigation program to ease the burden of financial toxicity. J Clin Oncol 37. 2019 May 26. ASCO 2019, Abstract 6565. Patient financial burden: Considerations for oncology care and access – One organization’s approach to addressing financial toxicity (Cleveland Cancer Institute white paper).   For more MDedge podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @mdedgehemonc

Episode 24:   David H. Henry, MD, host of Blood & Cancer, is on location at the 2019 annual meeting of the American Society of Clinical Oncology in this podcast. Dr. Henry speaks with one of his own residents, Ronak Mistry, DO, about recent research among “bloodless medicine” patients, iron deficiency, and the ASCO experience. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what happens when patients do their own literature search for treatment options.   Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  “Bloodless medicine” patients demonstrated superior outcomes following cardiovascular surgery when their hemoglobin was optimized to a higher level. Iron deficiency is defined as transferrin saturation less than 20 with concurrent ferritin 100-300 or ferritin less than 100. Intravenous iron repletion is superior to oral iron repletion among patients with heart failure. Iron repletion in heart failure correlates with improved functional status. Iron deficiency anemia in heart failure goes underrecognized and undertreated.   Additional reading Iron supplementation, response in iron-deficiency anemia: Analysis of five trials. Am J Med. 2017 Aug;130(8):991.e1-991.e8. Risk-adjusted clinical outcomes in patients enrolled in a bloodless program. Transfusion. 2014 Oct;54(10 Pt 2):2668-77.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz            

Episode 22: David Scadden, MD, of Harvard University Medical School, Boston, joins Blood & Cancer host David H. Henry, MD, of the University of Pennsylvania, Philadelphia, for a conversation about his book, “Cancerland: A Medical Memoir,” as well as immunotherapy and the challenge of patient care in the EHR age. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about enrolling patients in clinical trials and the tension between their needs and the goals of research. Read more about Dr. Scadden’s research: http://www.scaddenlab.com/ Read more about Cancerland: https://us.macmillan.com/books/9781250092755 For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz   

James C. Reynolds, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to discuss the ins and outs of constipation among cancer patients: how to recognize it, how to treat it, and why you need to ask about it. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University talks about those tough phone calls. You can interact with the show on Twitter: @DavidHenryMd @IlanaYurkiewicz @MDedgeHemOnc Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia  Stool dysmotility is defined by a both objective imaging and the Bristol stool scale. Narcotics, mechanical issues (anastomoses), nausea, lack of exercise, and low-liquid or low-fiber diet contribute to constipation. There is a placebo effect of up to 40% for drugs given for constipation. Reglan (metoclopramide) in low doses, used sporadically, is relatively safe. However, it has been associated with Parkinsonian-type movement disorders and depression. Gastric emptying tests (and stomach function) are influenced by stress, mood, nausea, side effects, and hormones. They are not efficacious to evaluate gastric motility in the inpatient setting. Anal pain and fecal incontinence can occur during acute therapy (including radiation proctitis). It is important for clinicians to ask patients about constipation as it may be paradoxical and manifest as diarrhea. Fecal incontinence and sphincter dysfunction following therapy is multifactorial. Flat plate, proctosigmoidoscopy, and anal manometry can give a detailed description of anal function and compliance. It is important for clinicians to ask patients about constipation and fecal incontinence. Further reading: Managing constipation in adults with cancer (J Adv Pract Oncol. 2017 Mar;8[2]:149-61). Bristol Stool Chart   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc

In this bonus edition, MDedge Postcasts voice Nick Andrews brings an interview from our sister show, the Postcall Podcast with Ilana Yurkiewicz, MD.  You can learn more about the Postcall Podcast by clicking here. Ilana Yurkiewicz, MD, is a hem/onc fellow at Stanford. She writes the Hard Questions Column for MDedge Hematology/Oncology and writes/records/produces the Clinical Correlation segment of Blood & Cancer, the official podcast of MDedge Hematology/Oncology.   Dr. Yurkiewicz's 's articles: Doctor will you please lie to me? Should doctors disclose primary results?   A complete list of Dr. Yurkiewicz's column, Hard Questions is available here, and you can check out Blood & Cancer here. Links from the interview: Ted Chiang Story of Your Life Exhalation Arrival  

Nick and Emi Okamoto, MD, take the weekly quiz, Dr. Emi gives advice for talking to your friends and family about your crazy schedule, and can you tell if it's advice for residents or advice for newlyweds?   Time stamps: MDedge Quiz (02:09) Advice Game: Newlyweds or Residents? (06:45) This week in MedTwitter (09:46) How to participate in holidays when you're working/can't make it (10:58) "I feel, I think, I want," educating your family (11:55) Health equity (13:33) Interview Intro (15:27) Interview with Ilana Yurkiewicz, MD. 18:15) Meet Dr. Yurkiewicz: family, hobbies, etc. (31:06) What Dr. Yurkiewicz reads, Ted Cheng - Story of Your Life, Arrival (33:35) Best advice for residency/internship: (36:53) Worst advice for residency/internship (39:28) Dr. Yurkiewicz on the future of Hem/Onc. Credits (46:16) Blood & Cancer Clinical Correlation (47:07)   Show Notes: MDedge Weekly quiz source articles: The Effects persist for children who witnessed 9/11 Study Finds CBD effective in treating heroin addiction Thousands of cancer diagnoses tied to a poor diet, study finds A cadet died in a tragedy. Now is parents can use his sperm to create his child, a judge rules FDA clears first diagnostic tests for extragenital testing for chlamydia and gonorrhea   You can take this or more MDedge Quizzes by clicking this link.   Tweet of the week: "The most frustrating thing about being a nurse (or in the medical field period) is the complete lack of understanding or empathy for our schedules by some." -- Ari BSN, RN @ArianaMasGrande   Dr. Okamoto's strategy is "I think, I feel, I want"  More on this strategy here.   Health Equity Emi's passion for healthcare for all humans. Read more about health equity here.   Interview Intro: This week's guest is Ilana Yurkiewicz, MD, a hem/onc fellow at Stanford. She writes the Hard Qeustions Columng for MDedge Hematology/Oncology and writes/records/produces the Clinical Correlation segment of Blood & Cancer, the official podcast of MDedge Hematology/Oncology.   Dr. Yurkiewicz's 's articles: Doctor will you please lie to me? Should doctors disclose primary results?   A complete list of Dr. Yurkiewicz's column, Hard Questions is available here, and you can check out Blood & Cancer here.   Links from the interview: Ted Chiang Story of Your Life Exhalation Arrival

Howard “Skip” Burris, MD, the chief medical officer of Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast as the guest host for a discussion of PD1 and PDL1 in the treatment of lung cancer. Dr. Burris interviews Melissa Johnson, MD, the associate director of lung cancer research at Sarah Cannon. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University dives into the financial realities of cancer care.   Show notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia   Programmed death ligand (PDL1) is a protein that is expressed by the tumor to escape detection by the immune system. T-cells produce PD1; when PD1 binds to PDL1, cancer can remain undetected. By blocking the binding of PD1 to PDL1, the immune system is able to recognize a tumor as foreign. Tumors with a high mutational burden typically have the most robust response to PD1 and PDL1 therapy. Treatment of patients with lung cancer with high mutational burden or high PDL1 score greater than 50% could likely be treated with monotherapy PDL1. Treatment of patients with lung cancer with low mutational burden or low PDL1 score consists of chemotherapy plus immunotherapy. In the field of lung cancer, tumor mutation burden is lower because lung cancer is typically driven by a single oncogene (EGFR, ALK, etc.). About 20% of lung cancer patients have a long and durable toxicity-free durable course when treated with PD1 and PDL1 inhibitors. Immunotherapy takes longer than chemotherapy to manifest a positive or beneficial change in patients. Monotherapy with PD1 and PDL1 inhibitors can cause autoimmune toxicity which may be recurrent. Upfront testing of PD1 and PDL1 in patients in clinics could lead to the early identification of patients who may benefit from immunotherapy.   Additional reading: ESMO biomarker fact sheet for immunotherapy. J Immunother Cancer. 2018 Jan 23;6(1):8. doi: 10.1186/s40425-018-0316-z. You can contact the show at podcasts@mdedge.com and you can interact with us on Twitter at @MDedgeHemOnc To subscribe to this and other MDedge podcasts, go to www.mdedge.com/podcasts.    

Daniel G. Haller, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to review the top research presented at ASCO GI 2019. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University shares the story of a patient who had no questions about the details of his treatment but needed answers about the “big picture.”   Show Notes By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia   Phase 2 trial of pembrolizumab (Keytruda), chemotherapy, and trastuzumab (Herceptin) in gastric cancer: Patients had previously untreated HER2 IHC+ or FISH+ tumors. Patients received pembrolizumab, trastuzumab/CAPOX (capecitabine and oxaliplatin) or FOLFOX (folinic acid, fluorouracil, and oxaliplatin). Patients all had a 100% response rate, prompting an ongoing phase 3 trial (KEYNOTE-811).   Third-line therapy for gastric cancer – TAGS, a phase 3 trial: supportive care vs. trifluridine plus tipiracil (Lonsurf): Gastrectomy did not affect outcome, safety, or pharmacokinetics. Neutropenia, a major toxicity, is manageable. Trifluridine and tipiracil are now a National Comprehensive Cancer Network Level 1 guideline for third-line therapy in patients with gastric cancer.   Neoadjuvant chemotherapy in pancreatic cancer: Compared neoadjuvant gemcitabine and S1 (NAC-GS) with upfront surgery for patients with pancreatic ductal adenocarcinoma and planned resection. Saw a significant survival benefit (37 months) of NAC-GS over upfront surgery (26 months).   Circulating tumor cells (CTC) in colorectal cancer: Studied patients with planned colonoscopies for colorectal screening. Took blood at the time of the procedure. Identified an absolute correlation with CTC and an increased disease burden in patients with colon cancer.   Additional reading:   Lancet Oncol. 2018 Nov;19(11):1437-48.  Oncotarget. 2018 May 11;9(36):24561-71.

  You can contact Blood & Cancer at podcasts@mdedge.com and you can follow MDedge Hematology Oncology on Twitter @MDedgeHemOnc. Episode 11: Blood & Cancer host David Henry, MD, welcomes John Glaspy, MD, to talk about anemia in cancer. And in today's Clinical Correlation, Ilana Yurkiewicz, MD, talks apathy. Dr. Yurkiewicz has a column at MDedge, which you can find by clicking here. Show notes   By Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania Hemoglobin is associated with quality of life and functional status, and quality of life improves continuously as hemoglobin rises from low (8 g/dL) to normal (12 g/dL) levels. The complete workup of anemia involves reticulocyte count, iron studies, folate, B12, peripheral smear, and creatinine. Anemia is a consequence of 1) cancer and 2) chemotherapy In patients with malignancy, the inflammatory state results in iron-restricted erythropoiesis, so patients may be functionally iron deficient even if their iron stores are replete. How do we treat anemia in cancer? Blood transfusion to rapidly improve hemoglobin Intravenous iron, if iron deficient Erythrocyte stimulating agents (ESA), if iron stores are replete. (Although IV iron augments ESA response in all cancer studies reported so far.) Risks associated with blood transfusion: Infection, transfusion-related-lung-injury, reactions to mismatched or well-matched blood, and iron overload (specifically in myelodysplastic syndrome). Recent FDA-mandated studies in anemic metastatic breast and non-small-cell lung cancer patients have demonstrated that there is no difference in survival among patients who receive ESA or placebo to treat their cancer/chemotherapy-associated anemia. HIF-1-alpha (hypoxia-inducible-factor) is a transcription factor produced in response to hypoxia. New class of drugs stabilizing HIF can result in both an increase in erythropoiesis and a decrease in hepcidin. References   2010 Dec 2;116(23):4754-61. Cancer Metastasis Rev.2007 Jun;26(2):341-52. Support Care Cancer.2006 Dec;14(12):1184-94. Cochrane Database Syst Rev.2016 Feb 4;2:CD009624. International Journal of Clinical Transfusion Medicine. 2018;6:21-31.    

We'd love to hear from you with ideas, suggestions, feedback, and questions for Dr. Henry or Dr. Yurkeiwicz at podcasts@mdedge.com and you can follow MDedge Hematology/Oncology at @MDedgeHemOnc.   Blood & Cancer episode 10:CDK4/6 inhibitors in breast cancer Richard Finn, MD, of the Geffen School of Medicine at UCLA joins guest host Jame Abraham, MD, of the Cleveland Clinic to discuss CDK4/6 inhibitors in the treatment of breast cancer, from the first pivotal studies to efficacy and patient selection. Later, Ilana Yurkiewicz, MD, talks about why it’s problematic to tell patients there is no more treatment in this week’s Clinical Correlation. Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford University and is also a columnist for Hematology News.   Show notes By Emily Bryer, DO, Resident in the department of internal medicine, University of Pennsylvania. Cyclin dependent kinase 4 and 6 (CDK4/6) control phosphorylation of the retinoblastoma gene product in the G1 to S transition of the cell cycle. Luminal ER-positive HER2-negative breast cancers are most sensitive to inhibition with a CDK4/6 inhibitor and act synergistically with tamoxifen. PALOMA 1 trial studied CDK4/6 Inhibitors in ER-positive breast cancer. Letrozole alone (10-month PFS) versus letrozole plus palbociclib (greater than 20-month PFS) Toxicity = grade 3 (ANC 500-1000) and grade 4 neutropenia (ANC less than 500) Low incidence of neutropenic fever Palbociclib and chemotherapy have distinct effects on the bone marrow. Palbociclib is cytostatic (also, toxicity is predictable and not cumulative) Chemotherapy is cytocidal Although efficacy is similar between CDK4/6 inhibitors (PFS hazard ratio +/-0.5), side effects vary. Ribociclib and palbociclib have a higher incidence of neutropenia Ribociclib affects QTC interval and liver enzymes Abemaciclib is associated with diarrhea and venous thromboembolism Ongoing studies are exploring 1) CDK4/6 inhibitor plus endocrine therapy versus endocrine therapy alone and 2) CDK4/6 inhibitors in the adjuvant setting. The population to most benefit from CDK4/6 inhibitors may include the patients who are high-risk for relapse following endocrine therapy alone (previously those who would also receive chemotherapy). Additional reading N Engl J Med 2018; 379:1926-36. Breast Cancer. 2018 Jul;25(4):402-6.

Stefan K. Barta, MD, of the University of Pennsylvania, joins David Henry, MD, to discuss the treatment and diagnosis of lymphoma in patients with HIV.    In this week's Clinical Correlation, Ilana Yurkiewicz, MD, has Part 2 of her discussion on informed consent in cancer. Dr. Yurkiewicz is a fellow in hematology and oncology at Stanford University and is also a columnist for Hematology News. More from Dr. Yurkiewicz here. Notes, Transcripts, Links  Show notes By Emily Bryer, DO Resident in the department of internal medicine, University of Pennsylvania.  Immunosuppression in patients with HIV, especially with low CD4 counts, is associated with the development of lymphomas.  Diffuse large B-cell lymphoma is the most common lymphoma in patients with HIV followed by Burkitt lymphoma and Hodgkin lymphoma.  Extra-nodal manifestations of lymphoma are more common in patients with HIV, especially with lower CD4 counts. Following pathologic diagnosis, staging of lymphoma should include: CT scan PET scan Evaluation of CNS (MRI brain and LP) Bone marrow biopsy Evaluation for hepatitis B and C co-infection. Fluorescence in situ hybridization (FISH) is a molecular technique that identifies portions of DNA and helps to identify translocations and rearrangements. cMYC, BCL2, and BCL6 are all pro-proliferative genes and commonly implicated in lymphoma. cMYC rearrangement pose higher risk of CNS involvement and CNS relapse.  cMYC rearrangement (as opposed to cMYC translocation) requires therapy that is more aggressive therapy than R-CHOP.  Treatment of high grade diffuse large B-cell lymphoma: R-EPOCH Ibrutinib plus R-EPOCH Resources/Links: AIDS Malignancy Consortium Blood. 2004;103:275-82. Blood. 2010 Apr 15; 115(15): 3008-16. Clinical Trial: NCT03220022  Ibrutinib, Rituximab, Etoposide, Prednisone, Vincristine Sulfate, Cyclophosphamide, and Doxorubicin Hydrochloride in Treating Patients With HIV-Positive Stage II-IV Diffuse Large B-Cell Lymphomas  

David Henry, MD, welcomes Daniel G. Haller, MD, to rehash research from ESMO 2018 as well as the way the meeting itself was run.  And Ilana Yurkiewicz, MD, stops by for this week’s Clinical Correlation. Dr. Yurkiewicz is a Hematology Fellow at Stanford and is also a columnist at MDedge Hematology/Oncology. More from Dr. Yurkiewicz here. Contact us: podcasts@mdedge.com MDedge on Twitter: @mdedgehemonc Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz SHOW NOTES By Emily Bryer, DO Resident in the department of internal medicine, University of Pennsylvania Health System CheckMate 142: Durable clinical benefit with nivolumab plus low-dose ipilimumab as first-line therapy in microsatellite high (MSI-H) and non-MSI-H colon cancer Phase 2 study included 45 patients with metastatic colorectal cancer Overall response rate (primary end point) was 60% and disease control rate was 84% Almost every patient had some response and the therapy was well-tolerated https://bit.ly/2TljlQE    Tribe 2: FOLFOXIRI plus bevacizumab followed by reintroduction of FOLFOXIRI plus bevacizumab versus FOLFOX plus bevacizumab followed by FOLFIRI plus bevacizumab Phase 3 study of 654 patients with unresectable metastatic colorectal cancer Progression free survival (primary end point) of FOLFOXIRI regimen was 18.9 months, compared with 16.2 months of the FOLFOX then FOLFIRI regimen Side effects of FOLFOXIRI: febrile neutropenia, neutropenia, GI toxicities https://bit.ly/2EMKBOa    Trifluridine/tipiracil versus placebo in patients with heavily pretreated metastatic gastric cancer (TAGS): a randomized, double-blind, placebo-controlled, phase 3 trial Phase 3 study included 506 patients with metastatic gastric cancer Trifluridine/tipiracil (oral drug) provided a 2-month overall survival advantage (primary end point), compared with placebo Major side effect: neutropenia https://bit.ly/2tW7PMI    Safety and clinical activity of 1L atezolizumab plus bevacizumab in a phase 1b study in hepatocellular carcinoma (HCC) Phase 1B study included 100 patients with HCC who had not received prior therapy Disease control rate was high as was duration of response Primary outcomes included safety and efficacy The overall response rate was 34% and the most common side effect was hypertension https://bit.ly/2EEPKaO   

Topics: Clinical correlation Helpful analogies Building a workshop network and becoming a volunteer speaker in your community Balancing production with outflowing Heart palpitations Epstein-Barr virus Visit Metabolicchaos.com

Faaantastic!  FDN Support Talk Radio is here for you to get information that matters most!  Get together with Reed Davis, FDN Mentors and Special Guests.  Submit questions ahead of time, or better yet, call in live and join in the discussion.  This is your chance to pick what's left of Reed's brain to improve your understanding of lab interpretations, case management challenges, and business issues you may be facing. This week's graduates: Gus Grima --London Sabrina Webb--CA Sarah Phillipe--Oregon Justin Mulligan—San Diego Jill Baillio—FL Topics: New Technology Platforms and Membership program coming soon.. FDN, Inc in process of working on 5-year plan, purpose, and goals Learning to form client impressions FDN Philosophy and Overcoming client objections through education New 101 and Clinical Correlation

Audio podcast from the 1st Annual SDPA Summer Dermatology Conference in Chicago, IL. This was “Dermatopathology and Clinical Correlation” with Marylee Braniecki, MD. This session is also available as a download on iTunes through the dermcast podcast page*. Click here to visit the page on iTunes. *Please note that it [...]