Podcasts about first line treatment

Featuring perspectives from Dr Virginia F Borges, Ms Jamie Carroll, Mr Ronald Stein and Dr Seth Wander, including the following topics: Introduction (0:00) Role of CDK4/6 Inhibitors in Localized and Metastatic Hormone Receptor (HR)-Positive Breast Cancer (12:49) PI3K Inhibition as First-Line Treatment for HR-Positive, HER2-Negative Metastatic Breast Cancer (mBC) (38:24) Clinical Utility of AKT and PI3K Inhibitors in Progressive HR-Positive mBC (1:01:44) Current and Future Role of Oral Selective Estrogen Receptor Degraders in HR-Positive mBC (1:24:38) NCPD information and select publications

Drs Kaniksha Desai and Iram Hussain discuss the use of radiofrequency ablation for the treatment of hyperthyroidism. This podcast is intended for healthcare professionals only.

CME credits: 0.75 Valid until: 31-03-2026 Claim your CME credit at https://reachmd.com/programs/cme/the-impact-of-first-line-treatment-on-subsequent-treatment-options-for-metastatic-escc/33031/ This online CME activity focuses on the first-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC) with the addition of an immune checkpoint inhibitor (ICI) to chemotherapy. Participants will learn about anti-PD-1 agents for ESCC that are either approved or are actively being investigated, along with their differentiating features; practice-changing data; and current guideline recommendations to inform first-line treatment selection decisions for patients with metastatic ESCC. Strategies to monitor and mitigate adverse effects associated with the use of combination ICI and chemotherapy regimens to optimize treatment adherence and patient outcomes will also be explored. Please stay tuned for additional content to this program available for credit. The maximum amount of credit available for the entire activity 0.75.

CME credits: 0.75 Valid until: 31-03-2026 Claim your CME credit at https://reachmd.com/programs/cme/strategies-for-navigating-first-line-treatment-selection-in-metastatic-escc/33029/ This online CME activity focuses on the first-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC) with the addition of an immune checkpoint inhibitor (ICI) to chemotherapy. Participants will learn about anti-PD-1 agents for ESCC that are either approved or are actively being investigated, along with their differentiating features; practice-changing data; and current guideline recommendations to inform first-line treatment selection decisions for patients with metastatic ESCC. Strategies to monitor and mitigate adverse effects associated with the use of combination ICI and chemotherapy regimens to optimize treatment adherence and patient outcomes will also be explored. Please stay tuned for additional content to this program available for credit. The maximum amount of credit available for the entire activity 0.75.

CME credits: 0.75 Valid until: 31-03-2026 Claim your CME credit at https://reachmd.com/programs/cme/ici-combination-regimens-for-first-line-treatment-of-metastatic-escc/33028/ This online CME activity focuses on the first-line treatment of advanced or metastatic esophageal squamous cell carcinoma (ESCC) with the addition of an immune checkpoint inhibitor (ICI) to chemotherapy. Participants will learn about anti-PD-1 agents for ESCC that are either approved or are actively being investigated, along with their differentiating features; practice-changing data; and current guideline recommendations to inform first-line treatment selection decisions for patients with metastatic ESCC. Strategies to monitor and mitigate adverse effects associated with the use of combination ICI and chemotherapy regimens to optimize treatment adherence and patient outcomes will also be explored. Please stay tuned for additional content to this program available for credit. The maximum amount of credit available for the entire activity 0.75.

CME credits: 1.00 Valid until: 21-11-2026 Claim your CME credit at https://reachmd.com/programs/cme/from-guidelines-to-practice-first-line-treatment-choices-in-mcrc/32943/ In this series, Dr. Fortunato Ciardiello and Dr. Jenny Seligmann review the management of metastatic colorectal cancer (mCRC), with a focus on timing and methodology of molecular testing, targeted treatment combinations for BRAF-mutant mCRC, the management of treatment-related adverse events.

Featuring perspectives from Prof John Bridgewater, including the following topics: Introduction: Biology and Epidemiology; Classification (0:00) Localized Biliary Tract Cancers (6:25) First-Line Treatment of Metastatic BTC (20:04) HER2-Positive Advanced BTC (24:22) Management of Mixed Hepatocellular Carcinoma/BTC Tumors (43:18) Advanced Cholangiocarcinoma with an FGFR2 Fusion (47:59) Other Important Issues in BTC (52:33) CME information and select publications  

Featuring perspectives from Dr Enriqueta Felip and Dr Helena Yu, including the following topics: Introduction (0:00) First-Line Treatment of Metastatic Disease (2:34) Adjuvant and Neoadjuvant Therapy (22:31) EGFR Exon 20 Insertion Mutations (34:21) Antibody-Drug Conjugates (42:45) CME information and select publications

CME credits: 1.25 Valid until: 30-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/first-line-treatment-of-msi-hdmmr-mcrc-the-role-of-immunotherapy/29850/ The NCCN Clinical Practice Guidelines are crucial tool in the treatment of cancer and provide detailed recommendations for treatment selection. The guidelines are regularly updated as new therapies are approved or as drugs received expanded indications. Moreover, data are constantly evolving regarding the role of biomarkers and treatment choice. This activity has been designed to provide an overview of the NCCN guidelines for gastric, colorectal, and hepatocellular cancers and the optimal application of these recommendations to clinical practice.

CME credits: 1.25 Valid until: 30-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/immunotherapy-based-approaches-for-first-line-treatment-of-advanced-hcc-the-evidence/29849/ The NCCN Clinical Practice Guidelines are crucial tool in the treatment of cancer and provide detailed recommendations for treatment selection. The guidelines are regularly updated as new therapies are approved or as drugs received expanded indications. Moreover, data are constantly evolving regarding the role of biomarkers and treatment choice. This activity has been designed to provide an overview of the NCCN guidelines for gastric, colorectal, and hepatocellular cancers and the optimal application of these recommendations to clinical practice.

CME credits: 1.25 Valid until: 30-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/applying-current-guidelines-in-the-first-line-treatment-of-msi-hdmmr-mcrca-case-discussion/29852/ The NCCN Clinical Practice Guidelines are crucial tool in the treatment of cancer and provide detailed recommendations for treatment selection. The guidelines are regularly updated as new therapies are approved or as drugs received expanded indications. Moreover, data are constantly evolving regarding the role of biomarkers and treatment choice. This activity has been designed to provide an overview of the NCCN guidelines for gastric, colorectal, and hepatocellular cancers and the optimal application of these recommendations to clinical practice.

CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/incorporation-of-guideline-concordant-care-for-first-line-treatment-of-a-patient-with-metastatic-urothelial-carcinoma/29195/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.

CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/guideline-recommendations-for-first-line-treatment-intensification-with-parp-inhibitor-combinations-in-patients-with-metastatic-castration-resistant-prostate-cancer/29196/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.

CME credits: 1.25 Valid until: 20-12-2025 Claim your CME credit at https://reachmd.com/programs/cme/guideline-recommended-first-line-treatment-with-immunotherapy-and-targeted-therapy-combinations-in-renal-cell-carcinoma/29198/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN®), focuses on translating oncology clinical practice guidelines into practical strategies for treating genitourinary malignancies. Participants will learn how to integrate clinical trial data into guideline-concordant first- and subsequent-line treatment plans for patients with metastatic urothelial cancer (UC), metastatic castration-resistant prostate cancer (mCRPC), and metastatic renal cell carcinoma (RCC). The program highlights the importance of evidence-based approaches and the use of immunotherapy and targeted therapies for advanced genitourinary malignancies. Attendees will also explore emerging data that could influence future treatment guidelines, patient case examples, and insights from international faculty to develop region-specific therapeutic strategies aligned with NCCN recommendations.

Srikala Sridhar, MD, MSc, FRCPC - Transforming Care With Immunotherapy Combinations in the First-Line Treatment of Advanced or Metastatic Urothelial Carcinoma

Srikala Sridhar, MD, MSc, FRCPC - Transforming Care With Immunotherapy Combinations in the First-Line Treatment of Advanced or Metastatic Urothelial Carcinoma

CME credits: 1.00 Valid until: 27-11-2025 Claim your CME credit at https://reachmd.com/programs/cme/guideline-recommendations-for-first-line-treatment-of-advanced-nsclc-with-targeted-therapies/29134/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN), focuses on translating oncology guidelines into practical strategies for treating non-small cell lung cancer (NSCLC). Participants will learn how to integrate clinical trial data into guideline-concordant testing and treatment plans for patients with resectable and metastatic NSCLC. The program highlights the importance of evidence-based approaches in the perioperative setting and the use of immunotherapy and targeted therapies for advanced disease. Attendees will also explore emerging data that could influence future treatment guidelines and develop region-specific therapeutic strategies aligned with NCCN recommendations. As of November 12, 2024, a new Biologics License Application (BLA) for datopotamab deruxtecan (Dato-DXd) has been submitted to the FDA for accelerated approval in the US for patients with previously treated advanced EGFR-mutated NSCLC. The previously submitted BLA for patients with advanced nonsquamous NSCLC has been voluntarily withdrawn.

CME credits: 1.00 Valid until: 27-11-2025 Claim your CME credit at https://reachmd.com/programs/cme/innovations-in-oncology-learning-center-from-guidelines-to-practice-lung-cancer/29133/ This online CME activity, presented in collaboration with the National Comprehensive Cancer Network (NCCN), focuses on translating oncology guidelines into practical strategies for treating non-small cell lung cancer (NSCLC). Participants will learn how to integrate clinical trial data into guideline-concordant testing and treatment plans for patients with resectable and metastatic NSCLC. The program highlights the importance of evidence-based approaches in the perioperative setting and the use of immunotherapy and targeted therapies for advanced disease. Attendees will also explore emerging data that could influence future treatment guidelines and develop region-specific therapeutic strategies aligned with NCCN recommendations. As of November 12, 2024, a new Biologics License Application (BLA) for datopotamab deruxtecan (Dato-DXd) has been submitted to the FDA for accelerated approval in the US for patients with previously treated advanced EGFR-mutated NSCLC. The previously submitted BLA for patients with advanced nonsquamous NSCLC has been voluntarily withdrawn.

Featuring slide presentations and related discussion from Dr Pasi A Jänne, Prof Tom John, Dr Zofia Piotrowska and Dr Alexander I Spira, including the following topics: Recent Advances in the Management of Localized and Locally Advanced Non-Small Cell Lung Cancer (NSCLC) with an EGFR Mutation — Prof John (0:00) First-Line Treatment for Advanced NSCLC with an EGFR Mutation — Dr Spira  (32:48) Later-Line Therapy for Advanced NSCLC with an EGFR Mutation — Dr Jänne (1:03:51) Management of NSCLC with an EGFR Exon 20 Mutation — Dr Piotrowska (1:33:33) CME information and select publications

Please visit answersincme.com/VWG860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in oncology discusses patient selection and treatment for myelodysplastic syndromes. Upon completion of this activity, participants should be better able to: Identify practical strategies for risk stratification and mutation analysis of patients with myelodysplastic syndromes (MDS) to enable risk-adapted therapy; Review the clinical profiles of conventional and newly approved therapies to treat anemia in patients with lower-risk MDS; and Describe the impact of recent data on treatment practices for the management of anemia in erythropoiesis-stimulating agent (ESA)-naive patients with transfusion-dependent, lower-risk MDS.

CME credits: 1.00 Valid until: 17-07-2025 Claim your CME credit at https://reachmd.com/programs/cme/selecting-the-optimal-ici-partner-for-first-line-treatment-of-unresectable-hcc-ctla-4-vs-vegf-inhibitors/26332/ This online MinuteCE program provides a comprehensive evaluation of the latest clinical data on first-line immune checkpoint inhibitor (ICI) combinations for the treatment of unresectable hepatocellular carcinoma (HCC). Participants will critically assess survival outcomes and other key efficacy metrics from recent studies. The program emphasizes the application of efficacy and safety data to tailor treatment regimens based on individual patient profiles and preferences. Additionally, it addresses the recognition and management of treatment-related adverse events associated with these regimens. The course also incorporates strategies for effective communication and shared decision-making within the multidisciplinary care team, ensuring optimal patient-centered care.

This episode of Lung Cancer Considered discusses first-line treatment options for EGFR mutant NSCLC, in Italian. Guest: Dr. Jessica Menis is a thoracic medical oncologist with expertise in early-phase trials and drug development from Azienda Ospedaliera Universitaria Integrata Verona. Jessica, welcome to the podcast. Guest: Professor Filippo de Marinis is from Istituto Europeo di Oncologia, where he is Direttore della Divisione di Oncologia Toracica, and the president of Associazione Italiana Oncologia Toracica.

Featuring perspectives from Prof Eric Van Cutsem, including the following topics: Immune Checkpoint Inhibitors in Localized Gastroesophageal (GE) Cancers  Introduction (0:00) Case: A man in his mid 50s with localized, poorly differentiated signet ring, mismatch repair-deficient advanced gastric adenocarcinoma — Sunnie Kim, MD (3:39) HER2-Positive GE Cancers Case: A man in his early 70s with HER2-positive gastroesophageal junction (GEJ) adenocarcinoma and disease progression on FOLFOX/trastuzumab (PD-L1 CPS 0) — Dr Kim (19:22) First-Line Treatment of Metastatic Gastric and GEJ Adenocarcinoma Case: A man in his early 40s who presents with metastatic GEJ adenocarcinoma (CLDN18.2-positive, PD-L1 CPS 2) in visceral crisis from lung metastases — Dr Kim (38:53) Case: A man in his mid 60s with metastatic GEJ adenocarcinoma (PD-L1 CPS 20) — Dr Kim (50:50) CME information and select publications

CME credits: 0.75 Valid until: 26-04-2025 Claim your CME credit at https://reachmd.com/programs/cme/patient-case-tailoring-first-line-treatment-for-a-patient-with-metastatic-melanoma-and-impaired-performance-status/24368/ This activity focuses on improving clinician awareness and knowledge of LAG-3-based immunotherapy in metastatic melanoma. We aim to identify patients with metastatic melanoma who can benefit from LAG-3/PD-1 combination therapy and enhance the competence of the multidisciplinary team in managing these patients.

CME credits: 0.75 Valid until: 26-04-2025 Claim your CME credit at https://reachmd.com/programs/cme/first-line-treatment-of-metastatic-melanoma-after-adjuvant-anti-pd-1/24366/ This activity focuses on improving clinician awareness and knowledge of LAG-3-based immunotherapy in metastatic melanoma. We aim to identify patients with metastatic melanoma who can benefit from LAG-3/PD-1 combination therapy and enhance the competence of the multidisciplinary team in managing these patients.

Featuring perspectives from Dr Petros Grivas, Dr Vadim S Koshkin, Dr Kriti Mittal, Dr Mamta Parikh and Dr Scott T Tagawa, including the following topics: First-Line Treatment of Metastatic Urothelial Bladder Cancer (mUBC) — Enfortumab Vedotin/Pembrolizumab Case: A man in his late 80s with recurrent unresectable locally advanced UBC receives first-line enfortumab vedotin and pembrolizumab — Dr Parikh (0:00) Case: A woman in her mid 60s with newly diagnosed mUBC attains an excellent response with first-line enfortumab vedotin and pembrolizumab — Dr Mittal (12:14) Other Approaches to First-Line Treatment of mUBC — Nivolumab/Chemotherapy Case: A man in his mid 70s with multiregimen-recurrent mUBC attains a complete response to enfortumab vedotin monotherapy — Dr Koshkin (25:22) Case: A man in his mid 70s with muscle-invasive bladder cancer with 50% squamous histology receives adjuvant nivolumab — Dr Mittal (35:07) Comparing new first-line treatments for previously untreated unresectable or metastatic UBC: Brentuximab vedotin/pembrolizumab and nivolumab/chemotherapy (43:18) Integrating Enfortumab Vedotin Monotherapy into the Treatment of mUBC Case: A man in his late 70s with recurrent mUBC and disease progression after treatment on 2 clinical trials experiences a complete response with enfortumab vedotin monotherapy — Dr Parikh (48:15) Monitoring and management of enfortumab vedotin-associated dermatologic and neurologic side effects (50:53) Case: A woman in her early 60s with multiregimen-refractory mUBC — Dr Mittal (59:26) Integrating Sacituzumab Govitecan into the Treatment of mUBC Case: A woman in her late 70s with multiregimen-refractory mUBC experiences an ongoing response with dose-reduced sacituzumab govitecan — Dr Koshkin (1:05:26) Case: A man in his late 60s with relapsed/refractory mUBC receives fifth-line sacituzumab govitecan — Dr Parikh (1:15:09) FGFR-Targeted Therapy for mUBC — Erdafitinib   Case: A man in his mid 70s with relapsed/refractory mUBC with an FGFR3 mutation receives erdafitinib — Dr Koshkin (1:29:36) HER2-Targeted Therapy for mUBC — Trastuzumab Deruxtecan, Disitamab Vedotin Case: A man in his early 60s with relapsed/refractory mUBC with HER2 amplification experiences intolerable toxicities with enfortumab vedotin — Dr Parikh (1:43:25) Case: A woman in her mid 70s with relapsed/refractory HER2-low mUBC — Dr Koshkin (1:56:36) CME information and select publications 

In 'Episode 3', the final of the series on "Metastatic renal cell carcinoma", Dr. Andrea Mari (IT) talks with Dr. Chiara Ciccarese (IT) from the Medical Oncology Unit at Fondazione Policlinico Universitario A. Gemelli IRCCS, in Rome. Together they have an in-depth discussion on "Beyond first-line treatment strategies for metastatic renal cell carcinoma".Dr. Mari and Dr. Ciccarese delve into recent advancements in managing mRCC, including therapeutic options, and their impact on patient care and outcomes. From targeted therapies to immunotherapies, they offer a comprehensive exploration of the evolving treatment landscape.Tune in to this engaging and informative conversation with two distinguished experts at the forefront of cancer research and treatment.

In 'Episode 2' of the series on "Metastatic renal cell carcinoma", Dr. Andrea Mari (IT) talks to Dr. Laura Marandino (GB) about "The first-line treatment strategies for metastatic renal cell carcinoma".Dr. Andrea Mari and Dr. Laura Marandino unravel the complexities of mRCC management, exploring the latest advancements, therapeutic options, and their implications for patient care. From targeted therapies to immunotherapies, they provide a comprehensive overview of the evolving treatment landscape.Tune in as we navigate through this insightful conversation with two distinguished guests at the forefront of cancer research and treatment.This podcast episode was recorded before ASCO GU 2024. Please note that information discussed may not reflect updates from the conference. We encourage listeners to verify the latest information independently.

A couple of terms have found their way into the MS lexicon and they have left some people living with MS feeling confused and even frightened. If you've been diagnosed with relapsing-remitting MS and you've always assumed that disease progression only occurs at the time of a relapse, you may be wondering what progression independent of relapse activity, or PIRA, means and how it may or may not impact your MS journey. And if you are someone whose MS seems relatively stable and well-managed, you may be wondering whether your central nervous system is under some sort of silent attack from smoldering MS.  Professor Alan Thompson joins me this week to shine a bright light on what, for many, are anxiety-inducing terms and help us understand what they are actually attempting to describe. Professor Thompson is the recipient of virtually every high honor and award that's given in the field of multiple sclerosis research, including the John Dystel Prize for MS Research in 2017, the Sobek Research Prize in 2020, and the 2021 Charcot Award, which recognizes a lifetime of achievement in outstanding research into understanding and treating MS. We're also sharing results of a study that suggests that kids and teens who are living with MS may experience better outcomes if they are started on a high-efficacy disease-modifying therapy. We'll tell you about a study that adds to the evidence that autologous hematopoietic stem cell transplantation may be a highly effective treatment that allows some people living with MS to live symptom-free and even return to the workforce. We're sharing the details of an AI tool that can predict an individual's disease course, while we're talking about survey results that show some strong push-back from the patient community when it comes to using artificial intelligence in the diagnostic process. And we'll tell you about a study that shows that caffeine may improve balance, mobility, and even quality of life for people living with MS. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: What is "Progression Independent of Relapse Activity"?  1:31 STUDY: High-efficacy disease-modifying therapies are shown to be effective in treating pediatric onset MS  3:02 STUDY: Compelling evidence for autologous hematopoietic stem cell transplantation (HSCT) as an effective treatment for MS  6:49 An AI tool has been developed that can predict an individual's MS disease course  9:17 SURVEY: Some people have mixed feelings about using AI in diagnosing illness  11:47 STUDY: Caffeine is shown to improve balance and mobility in people with MS  14:38 Professor Alan Thompson helps define a couple of terms that people with MS may find confusing and even worrisome   16:47 Share this episode  28:15 Have you downloaded the free RealTalk MS app?  28:35 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/339 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com STUDY: Highly Effective Therapies as First-Line Treatment for Pediatric-Onset Multiple Sclerosis https://jamanetwork.com/journals/jamaneurology/fullarticle/2814784 STUDY: Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis: Long-Term Follow-Up Data from Norway  https://journals.sagepub.com/doi/10.1177/13524585241231665 STUDY: Predicting Disease Severity in Multiple Sclerosis Using Multimodal Data and Machine Learning https://link.springer.com/article/10.1007/s00415-023-12132-z SURVEY: Consumer Perceptions of Second Opinions and Concierge Health Services https://clinicbyclevelandclinic.com/consumer-perceptions-report STUDY: Potential Efficacy of Caffeine Ingestion on Balance and Mobility in Patients with Multiple Sclerosis: Preliminary Evidence from a Single-Arm Pilot Clinical Trial https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297235 Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 339 Guest: Professor Alan Thompson Privacy Policy

Last week, we saw some FDA approvals for a new drug regimens, as well as some expert opinion about cancer vaccines. Additionally research touched upon the potential benefit of concurrent ctDNA and tumor testing, and physical activity for pain reduction in cancer survivors.  FDA Approves Onivyde as First-Line Treatment of Metastatic Pancreatic Cancer On Tuesday, the Food and Drug Administration approved Onivyde plus oxaliplatin, fluorouracil and leucovorin — a regimen referred to as NALIRIFOX — for the frontline treatment of patients with metastatic adenocarcinoma. The approval was based on findings from the NAPOLI 3 trial, which showed that the drug combination improved overall survival (which is the time after treatment patients live before death of any cause) and progression-free survival (time they live before their disease worsens) compared to a combination of gemcitabine plus nab-paclitaxel.  While this approval provides a new, promising treatment for this patient population, Dr. Anthony Shields of the Karmanos Cancer Center in Detroit mentioned that the Onivyde-containing regimen is not a cure.  “In our patients with advanced disease, this is not a curative therapy at this point,” Shields said in an interview with CURE®. “It clearly improves survival. It's still got its share of toxicities, though. … We need better drugs, despite the improvements. If patients get this regimen is the first line, inevitably if they're doing OK we will give gemcitabine/nab-paclitaxel (combination) as the second-line regimen. But we really don't have a third line regimen.” Cancer Vaccine Could Go ‘Above and Beyond Standard of Care' For Patients The oncology community is on the cusp of a sea change regarding cancer vaccines, as one expert told us. “Current vaccines have a dismal record, and minimal evidence of efficacy,” said Dr. Jeffrey S. Weber, deputy director of the NYU Langone Perlmutter Cancer Center and Laura and Isaac Perlmutter Professor of Oncology at NYU Grossman School of Medicine, via email. Weber was among the researchers on recent KEYNOTE-942 study investigating mRNA vaccine mRNA-4157 (V940) and Keytruda versus standalone Keytruda for the treatment of patients with advanced-stage melanoma.With a median follow-up of 23 and 24 months, the recurrence or death rates were 22% and 40% and the 18-month recurrence-free survival rates were 79% and 62%, respectively. The Food and Drug Administration (FDA) granted Breakthrough Therapy Designation to the combination for the post-surgical treatment of patients with high-risk melanoma in 2023 based on the results of KEYNOTE-942. “This mRNA vaccine would be the first approved cancer vaccine with clear cut evidence of efficacy in a well-done phase 3 trial [which was recently initiated],” Weber said of mRNA-4157. Pharmaceutical companies Moderna and Merck have initiated V940-001, a phase 3 study evaluating mRNA-4157 and Keytruda as postsurgical treatment for stage 2B to 4 melanoma, announcing in June of 2023 that global patient recruitment had begun following primary analysis of the findings of KEYNOTE-942. Tumor Testing, ctDNA Finds More Patients Eligible for Personalized Drugs Circulating tumor DNA and tumor tissue-based testing can both help identify cancer characteristics that may point a patient toward a more targeted treatment regimen. Oftentimes, patients undergo only one of these two tests, but recent research showed that undergoing both of these tests may improve patients' chance of identifying targetable mutations.  Now, some patient populations — such as those with non-small cell lung cancer — may already be undergoing both tests in accordance with NCCN guidelines. The findings support that other groups in particular, such as those with breast cancer, may benefit from the dual testing modality.  In an interview with CURE, one of the study authors noted that the two tests can be “highly complementary,” and patients should talk to their health care teams about which test to undergo.  Physical Activity May Help Reduce Pain in Cancer Survivors Increased physical activity may be able to lessen pain in cancer survivors, according to one study.  Specifically, the researchers wrote, “Meeting or exceeding physical activity guidelines was associated with less pain intensity compared to being physically inactive. People who remained active longer term, were previously physically active or became active also reported less pain than those who remained inactive.”  These benefits were also seen in patients who were previously active but then became inactive — highlighting the possibility that the when it comes to pain reduction, the benefits of being active can stretch long-term. But interestingly, the was no association between  physical activity and painkiller use.  For more news on cancer updates, research and education, don't forget to subscribe to CURE®'s newsletters here.

CME credits: 1.00 Valid until: 05-02-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-is-the-current-standard-for-first-line-treatment-of-metastatic-her2-positive-ggej-cancers/18026/ The therapeutic landscape for gastric and gastroesophageal junction (G/GEJ) cancer is rapidly evolving, with biomarkers directing treatment selection. Recent evidence suggests that the combination of HER2-targeted therapies and immune checkpoint inhibitors has synergistic effects, highlighting the importance of the most recent clinical data regarding first-line treatments for advanced or metastatic G/GEJ cancers and the differentiation between HER2-positive and -negative tumors. In addition to HER2, Claudin 18 splice variant 2 (CLDN18.2) has emerged as a new biomarker for targeted treatment. Multiple factors should be considered in first-line treatment selection, including biomarker positivity, performance status, and potential toxicity. In this program, topics presented by expert faculty will illustrate the biomarker-related clinicopathologic features of G/GEJ cancers as well as how to incorporate the latest evidence to individualize first-line treatment for patients with G/GEJ cancers. Please stay tuned for additional content to this program available for credit. MedEd On The Go will track the episodes you watch and provide you with the option to claim credit once you have reached the level of participation needed in order to claim. The maximum amount of credits available for the entire activity is 1.25.

CME credits: 1.00 Valid until: 05-02-2025 Claim your CME credit at https://reachmd.com/programs/cme/what-is-the-current-standard-for-first-line-treatment-of-metastatic-her2-negative-ggej-cancers/18025/ The therapeutic landscape for gastric and gastroesophageal junction (G/GEJ) cancer is rapidly evolving, with biomarkers directing treatment selection. Recent evidence suggests that the combination of HER2-targeted therapies and immune checkpoint inhibitors has synergistic effects, highlighting the importance of the most recent clinical data regarding first-line treatments for advanced or metastatic G/GEJ cancers and the differentiation between HER2-positive and -negative tumors. In addition to HER2, Claudin 18 splice variant 2 (CLDN18.2) has emerged as a new biomarker for targeted treatment. Multiple factors should be considered in first-line treatment selection, including biomarker positivity, performance status, and potential toxicity. In this program, topics presented by expert faculty will illustrate the biomarker-related clinicopathologic features of G/GEJ cancers as well as how to incorporate the latest evidence to individualize first-line treatment for patients with G/GEJ cancers. Please stay tuned for additional content to this program available for credit. MedEd On The Go will track the episodes you watch and provide you with the option to claim credit once you have reached the level of participation needed in order to claim. The maximum amount of credits available for the entire activity is 1.25.

What is Trauma-Focused CBT?? Discover the Transformative Power of Trauma-Focused Therapy for Children in this Latest Pediatric Meltdown episode! Learn how Dr. Judith Cohen and her groundbreaking approach are revolutionizing children's mental health and trauma treatment. Delve into the impactful narrative of Trauma-Focused Cognitive Behavioral Therapy (TFCBT) as Dr. Cohen shares her expertise and the critical components of this life-changing therapy. From identifying trauma reminders to transferring agency to the child and parents, this episode is a must-listen for anyone passionate about pediatric mental health and trauma care. Join us as we unravel the intricacies of trauma therapy, uncover the key components of TF-CBT, and uncover the invaluable insights shared by Dr. Cohen in this enlightening discussion. [00:33 - 32:48] Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) ExplainedTF-CBT is a specific treatment developed for children and their families to overcome the impact of trauma.It encompasses 9 components, encapsulated in the acronym 'PRACTICE'.Practice of resiliency skills by children and their caregivers is emphasized outside therapy.Resiliency skills are reinforced through consistent practice within therapy for children and families[32:49 - 42:24] Supporting Trauma Therapists: Coping with Client Traumas Therapists' personal trauma experiences can shape their treatment methods.The burden of processing many children's trauma narratives weekly is challenging.Therapists navigate their emotional health and children's varied trauma recovery stages.Self-care and a compassionate medical community culture are crucial for therapists' longevity.[42:25 - 50:43] Evidence-Based Psychotherapy as First-Line Treatment for Childhood TraumaTrauma experiences directly influence the choice of treatment, with TF-CBT being the frontline option.Prescribing medication is not recommended until a sufficient trial of psychotherapy has been conducted.A good clinician will reassess and adapt TF-CBT techniques to suit each child's individual circumstances.Psychotherapeutic intervention aims to resolve trauma-related difficulties stemming from the child's experiences.[50:44 - 59:40] Advancements in Trauma Therapy Accessibility for ChildrenThe national certification for TF-CBT practitioners enhances accessibility to qualified therapists.The availability of certification sites as an important development over time.Bridging the gap between pediatric care and specialized trauma therapy.The integration of therapy directories into care plans makes it easier for clinicians to make informed referrals.[59:41 - 1:05:03] Closing segment TakeawayLinks to resources mentioned on the showNational Child Traumatic Stress Network:https://www.nctsn.org/interventions/trauma-focused-cognitive-behavioral-therap The NCTSN Secondary Traumatic Stress are available here: https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/nctsn-resourcesLocate TF-CBT certified therapists here: https://tfcbt.org/therapistsLocate PCIT...

Drs. Neeraj Agarwal and Jeanny Aragon-Ching discuss several key abstracts to be presented at the 2024 ASCO GU Cancers Symposium, including sequencing versus upfront combination therapies for mCRPC in the BRCAAway study, updates on the CheckMate-9ER and CheckMate-214 trials in ccRCC, and a compelling real-world retrospective study in mUC of patients with FGFR2 and FGFR3 mutations. TRANSCRIPT Dr. Neeraj Agarwal: Hello, everyone, and welcome to the ASCO Daily News Podcast. I'm Dr. Neeraj Agarwal, your guest host of the podcast today. I am the director of the Genitourinary Oncology Program and a professor of medicine at the University of Utah's Huntsman Cancer Institute, and editor-in-chief of ASCO Daily News. I am delighted to welcome Dr. Jeanny Aragon-Ching, a genitourinary oncologist and the clinical program director of Genitourinary Cancers at the Inova Schar Cancer Institute in Virginia. Today, we will be discussing key posters and oral abstracts that will be featured at the 2024 ASCO Genitourinary Cancer Symposium, which is celebrating 20 years of evolution in GU oncology this year.  You will find our full disclosures in the transcript of this podcast, and disclosures of all guests on the podcast at asco.org/DNpod.  Jeanny, it's great to have you on the podcast today to highlight some key abstracts for our listeners ahead of the GU meeting. Dr. Jeanny Aragon-Ching: Thank you so much, Neeraj. It's an honor to be here. Dr. Neeraj Agarwal: Jeanny, as you know, this year we are celebrating the 20th anniversary of the ASCO GU Cancers Symposium, and judging from this year's abstracts, it's clear that this meeting continues to play a major role in advancing GU cancer research. Dr. Jeanny Aragon-Ching: Indeed, Neeraj. This year's abstracts reflect the important strides we have made in GU cancers. So, let's start with the prostate cancer abstracts. What is your takeaway from Abstract 19 on BRCAAway, which will be presented by Dr. Maha Hussein, and of which you are a co-author? As our listeners know, several PARP inhibitor combinations with second-generation androgen receptor pathway inhibitors, or ARPIs, have recently been approved as first-line treatment for patients with metastatic castrate-resistant prostate cancer, or metastatic CRPC, and the question of sequencing PARP inhibitors and ARPIs instead of combining them has emerged. From that perspective, the results of the BRCAAway trial are very important. Can you tell us a little bit more about this abstract, Neeraj?  Dr. Neeraj Agarwal: I totally agree with you, Jeanny. The BRCAAway study attempts to answer the crucial questions regarding sequencing versus upfront combination of therapies in the mCRPC setting. It is a phase 2 trial of abiraterone versus olaparib versus abiraterone with olaparib in patients with mCRPC harboring homologous recombination repair mutations. Enrolled patients had mCRPC disease and no prior exposure to PARP inhibitors or ARPIs or chemotherapy in the mCRPC setting and had BRCA1 or BRCA2 or ATM mutations. As previously mentioned, these patients were randomized to 3 arms: abiraterone monotherapy at 1000 milligrams once daily, or olaparib monotherapy at 300 milligrams twice daily, or the combination of abiraterone and olaparib. The primary endpoint was progression-free survival per RECIST 1.1 or Prostate Cancer Working Group 3-based criteria or clinical assessment or death, so, whichever occurred first was deemed to be progression.   Secondary endpoints included measurable disease response rates, PSA response rate, and toxicity. This was a relatively small trial with 21 patients in the combination arm, 19 patients in the abiraterone monotherapy arm, and 21 patients in the olaparib monotherapy arm. It should be noted that 26% of patients had received docetaxel chemotherapy in the hormone-sensitive setting, and only 3% of patients had any prior exposure to an ARPI, and these were darolutamide or enzalutamide or in the non-metastatic CRPC setting.  The results are very interesting. The median progression-free survival was 39 months in the combination arm, while it was 8.4 months in the abiraterone arm and 14 months in the olaparib arm. An important finding that I would like to highlight is that crossover was also allowed in the monotherapy arms. Of the 19 patients receiving abiraterone, 8 crossed over to receive olaparib, and of the 21 patients receiving olaparib, 8 crossed over to the abiraterone arm. The median PFS from randomization was 16 months in both groups of patients who received abiraterone followed by olaparib or those who received olaparib followed by abiraterone. This is striking when compared to 39 months in patients who started therapy with the combination therapy of abiraterone with olaparib. Dr. Jeanny Aragon-Ching: Thank you so much for that wonderful summary, Neeraj. So the key message from this abstract is that combining olaparib and abiraterone upfront seems to be associated with improvement in PFS compared to just sequencing those agents. Dr. Neeraj Agarwal: Exactly, Jeanny. I would like to add that these results are even more important given that in real-world practice, only half of the patients with mCRPC receive a second-line treatment. Based on these results, upfront intensification with a combination of an ARPI plus a PARP inhibitor in the first-line mCRPC setting seems to have superior efficacy compared to sequencing of these agents. Dr. Jeanny Aragon-Ching: Thank you so much. Now, moving on to a different setting in prostate cancer, there were a couple of abstracts assessing transperineal biopsy compared to the conventional transrectal biopsy for the detection of prostate cancer. So let's start with Abstract 261. Neeraj, can you tell us a little bit more about this abstract? Dr. Neeraj Agarwal: Sure, Jeanny. So, in Abstract 261 titled "Randomized Trial of Transperineal versus Transrectal Prostate Biopsy to Prevent Infection Complications," Dr. Jim Hugh and colleagues led a multicenter randomized trial comparing these 2 approaches, so, transperineal biopsy without antibiotic prophylaxis with transrectal biopsy with targeted prophylaxis in patients with suspected prostate cancer. The primary outcome was post-biopsy infection. Among the 567 participants included in the intention-to-treat analysis, no infection was reported with the transperineal approach, while 4 were detected with the transrectal approach, with a p-value of 0.059. The rates of other complications, such as urinary retention and significant bleeding, were very low and similar in both groups. The investigators also found that detection of clinically significant cancer was similar between the 2 techniques and concluded that the transperineal approach is more likely to reduce the risk of infection without antibiotic prophylaxis. Dr. Jeanny Aragon-Ching: So the key takeaway from this abstract sounds like office-based transperineal biopsy is well-tolerated and does not compromise cancer detection, along with better antibiotic stewardship and health care cost benefits.  Moving on to Abstract 273, also comparing these two approaches, what would be your key takeaway message, Neeraj?  Dr. Neeraj Agarwal: In this Abstract 273, titled "Difference in High-Risk Prostate Cancer Detection between Transrectal and Transperineal Approaches," Dr. Semko and colleagues found that the transperineal biopsy based on MRI fusion techniques was also characterized by a higher possibility of detecting high-risk prostate cancer and other risk factors as well, such as perineural and lymphovascular invasion or the presence of cribriform pattern, compared to the conventional transrectal method. Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So we can see that the transperineal approach is gaining more importance and could be associated with more benefits compared to the conventional methods.   Let's now switch gears to kidney cancer, Neeraj. Dr. Neeraj Agarwal: Sure, Jeanny. Let's start by highlighting Abstract 361, which discusses patient-reported outcomes of the LITESPARK-005 study. So what can you tell us about this abstract, Jeanny?  Dr. Jeanny Aragon-Ching: Thank you, Neeraj. So as a reminder to our listeners, based on the LITESPARK-005 trial, it was a Phase 3 trial looking at belzutifan, which is an inhibitor of hypoxia inducible factor 2 alpha or I'll just call HIF-2 alpha for short, was very recently approved by the FDA as a second-line treatment option for patients with advanced or metastatic clear cell renal cell carcinoma after prior progression on immune checkpoint and antiangiogenic therapies. The title of Abstract 361 is "Belzutifan versus Everolimus in Patients with Previously Treated Advanced RCC: Patient-Reported Outcomes in the Phase 3 LITESPARK-005 Study," and this will be presented by Dr. Tom Pells at the meeting. At a median follow-up of 25.7 months, the median duration of treatment with belzutifan was 7.6 months, while it was only 3.9 months with everolimus. At the time of data cutoff date for the second interim analysis, 22.6% of patients remained on belzutifan while only 5% remained on everolimus. In the quality of life questionnaires, the time of deterioration to various quality of life scores, as assessed by standardized scales, was significantly longer in patients randomized to the belzutifan arm compared to those in the everolimus arm. Also, patients in the everolimus arm had worse physical functioning scores. Dr. Neeraj Agarwal: Yes, Jeanny. In addition to the improved outcomes associated with belzutifan, patient-reported outcomes indicate better disease-specific symptoms and better quality of life among patients treated with belzutifan compared to everolimus. This is great news for patients with advanced renal cell carcinoma.  Now, Jeanny, can you please tell us about the two abstracts that reported longer follow-up of CheckMate 9ER and CheckMate 214 trials in untreated patients with advanced or metastatic renal cell carcinoma? Dr. Jeanny Aragon-Ching: Yes, Neeraj. So you are referring to Abstracts 362 and 363. Let's start with Abstract 362. This abstract reports the results after a median follow-up of 55 months in the CheckMate 9ER trial, comparing the combination of nivolumab and cabozantinib to sunitinib in patients with advanced RCC without any prior treatment, so first-line therapy. The primary endpoint was PFS per RECIST 1.1 as assessed by an independent central review. So there were key secondary outcomes including overall survival (OS), objective response rates, and safety. Consistent with prior analysis at a median follow-up time of 18.1 and 44 months, the combination of nivolumab and cabozantinib at a median follow up of 55.6 months continues to show a significant reduction in the risk of progression or death by 42% and in the risk of death by 23% compared to sunitinib.  Dr. Neeraj Agarwal: And Jeanny, what can you tell us about the efficacy results of this combination by IMDC risk categories? Dr. Jeanny Aragon-Ching: Similar to prior results in patients with intermediate to poor risk IMDC risk category, the combination treatment maintained significant efficacy and reduced the risk of progression or death by 44% and the risk of death by 27%. To put it simply, the update now shows a 15-month improvement in overall survival with the cabozantinib-nivolumab combination compared to sunitinib, which is amazing. Also, in patients with favorable IMDC risk group, which represented truly a small number of patients in the trial, there was a strong trend for improvement of outcomes as well. I would like to point out that no new safety concerns were identified. Dr. Neeraj Agarwal: So, it looks like the key message from this abstract is that with longer follow-up, the combination of nivolumab and cabozantinib maintains a meaningful long-term efficacy benefit over sunitinib, supporting its use for newly diagnosed patients with advanced or metastatic renal cell carcinoma.   Let's move on to Abstract 363, which compares nivolumab with ipilimumab to sunitinib in first-line advanced renal cell carcinoma. What would you like to tell us about this abstract, Jeanny? Dr. Jeanny Aragon-Ching: Yes, Neeraj. The title of this abstract is "Nivolumab plus Ipilimumab versus Sunitinib for the First-Line Treatment of Advanced RCC: Long-Term Follow-Up Data from the Phase 3 CheckMate 214 Trial." In this abstract, Dr. Tannir and colleagues report outcomes with the longest median follow-up in first-line advanced RCC setting for any clinical trial. So the median follow-up now is about 18 months. The primary endpoints were OS, PFS, and objective response rates, as assessed by an independent review according to RECIST 1.1 criteria in the intermediate to poor risk IMDC risk group, which is the intent-to-treat (ITT) analysis, while secondary outcomes included the same outcomes in the ITT population of patients. Although the progression-free survival was similar in both arms, the combination of nivolumab-ipilimumab reduced the risk of death by 28% compared to sunitinib in the ITT population of patients. When stratifying the results by IMDC risk groups, the combination arm of nivolumab-ipilimumab showed significant improvement in the intermediate to poor risk group, but there was no difference in the favorable risk group. But in the study, no new safety signals were identified. Dr. Neeraj Agarwal: Thank you, Jeanny, for such a comprehensive description of the results of these two studies. I'd like to add that the median overall survival of patients with metastatic renal cell carcinoma in the ITT population in the CheckMate 214 trial has now reached 53 months, which would have been unimaginable just a decade ago. This is wonderful news for our patients. So the key takeaway from these two abstracts would be that immune checkpoint inhibitor-based combinations remain the backbone of first-line advanced renal cell carcinoma treatment.  Dr. Jeanny Aragon-Ching: Absolutely, Neeraj. This is wonderful news for all of our patients, especially for those who are being treated for first-line therapy.  Now, let's move on to the bladder cancer abstracts. We have two exciting abstracts from the UNITE database. What are your insights on Abstract 537, titled "Outcomes in Patients with Advanced Urethral Carcinoma Treated with Enfortumab Vedotin After Switch-Maintenance of Avelumab in the UNITE Study"? Dr. Neeraj Agarwal: As our listeners know, enfortumab vedotin is an antibody-drug conjugate that binds to a protein called Nectin 4 expressed on bladder cancer cells. In this abstract, Dr. Amanda Nizam and colleagues describe outcomes in 49 patients receiving third-line enfortumab vedotin after prior progression on platinum-based therapy and maintenance avelumab. At a median follow-up of 8.5 months, the median progression-free survival was 7 months and the median overall survival was 13.3 months with enfortumab vedotin in this treatment-refractory setting, the objective response rates were 54%. The message of this study is that enfortumab vedotin is an effective salvage therapy regimen for those patients who have already progressed on earlier lines of therapies, including platinum-based and immunotherapy regimens. Dr. Jeanny Aragon-Ching: Thank you, Neeraj, for that comprehensive review.  I want to focus on another patient population in the UNITE database, which is the use of fibroblast growth factor receptor (FGFR) alterations. Can you tell us more about the sequencing now of erdafitinib and enfortumab vedotin in these patients with metastatic urothelial cancer, as discussed in Abstract 616? Dr. Neeraj Agarwal: Sure, Jeanny. As a reminder, erdafitinib is a fibroblast growth factor receptor kinase inhibitor approved for patients with locally advanced or metastatic urothelial carcinoma harboring FGFR2 or FGFR3 alterations after progression on platinum-based chemotherapy. However, the optimal sequencing of therapies in these patients is unclear, especially with enfortumab vedotin being approved in the salvage therapy setting and now in the frontline therapy setting.  So in this retrospective study, all patients with metastatic urothelial carcinoma had FGFR2 or FGFR3 alterations. Dr. Cindy Jiang and colleagues report outcomes in 24 patients receiving enfortumab vedotin after erdafitinib, 15 patients receiving erdafitinib after enfortumab vedotin, and 55 patients receiving enfortumab vedotin only. This is a multicenter national study. Interestingly, patients receiving both agents had a longer overall survival in a multivariate analysis, regardless of the treatment sequencing, than patients receiving enfortumab vedotin alone or only with a hazard ratio of 0.52. The objective response rate of enfortumab vedotin in the enfortumab vedotin monotherapy arm was 49%. When these agents were sequenced, the objective response with enfortumab vedotin was 32% after erdafitinib and 67% when used before erdafitinib. Dr. Jeanny Aragon-Ching: Thank you so much, Neeraj. I think these are important real-world data results, but I would like to point out that larger and prospective studies are still needed to confirm these findings, especially regarding the outcome of erdafitinib after enfortumab vedotin, particularly when the latter is used in the first-line setting. Dr. Neeraj Agarwal: I totally agree, Jeanny. Now, let's discuss some abstracts related to disparities in the management of patients with genitourinary cancers.  Dr. Jeanny Aragon-Ching: Sure, actually, I would like to discuss 2 abstracts related to disparities in patients with prostate cancer. So the first one, Abstract 265, titled "Patient-Provider Rurality and Outcomes in Older Men with Prostate Cancer." In this study, Dr. Stabellini, Dr. Guha and the team used a SEER Medicare-linked database that included more than 75,000 patients with prostate cancer. The primary outcome was all-cause mortality, with secondary outcomes included prostate cancer-specific mortality. The investigators showed that the all-cause mortality risk was 44% higher in patients with prostate cancer from rural areas who had a provider from a non-metropolitan area compared to those who were in a metropolitan area and had a provider also from a metropolitan area. Dr. Neeraj Agarwal: Those are very important data and highlight the healthcare disparities among the rural population with prostate cancer that still exist.  So what is your key takeaway from Abstract 267, titled "Rural-Urban Disparities in Prostate Cancer Survival," which is a population-based study? Dr. Jeanny Aragon-Ching: Of course. This abstract discusses, actually, a very similar issue regarding access to healthcare among rural versus urban patients. In this study, Dr. Hu and Hashibe and colleagues and team at the Huntsman Cancer Institute assessed all-cause death and prostate cancer-related death risk in a retrospective study in which patients with prostate cancer based on rural versus urban residencies looked at 18,000 patients diagnosed with prostate cancer between 2004 and 2017. 15% lived in rural counties. Similar to the prior abstract we talked about, patients living in rural areas had about a 19% higher risk of all-cause mortality and a 21% higher risk of prostate cancer-specific mortality in comparison to patients living in urban areas. Dr. Neeraj Agarwal: So Jeanny, we can say that both of these abstracts, led by different groups of investigators, highlight that patients with prostate cancer living in rural areas have inferior survival outcomes compared to those living in urban areas, and it is time to focus on the disparities experienced by the rural population with prostate cancer.  Dr. Jeanny Aragon-Ching: Yeah, absolutely Neeraj. I concur with your thoughts.  So, any final thoughts before we wrap up the podcast today? Dr. Neeraj Agarwal: Yes, before concluding, Jeanny, I want to express my gratitude for your participation and the valuable insights you have shared today. Your contributions are always appreciated, and I sincerely thank you for taking the time to join us today.   As we bring this podcast to a close, I would like to highlight the significant advances happening in the treatment of patients with genitourinary cancers during our upcoming 2024 ASCO GU meeting. Many studies featuring practice-impacting data will be presented by investigators from around the globe. I encourage our listeners to not only participate at this event to celebrate these achievements, but to also play a role in disseminating these cutting-edge findings to practitioners worldwide. By doing so, we can collectively maximize the benefit for patients around the world.  And thank you to our listeners for joining us today. You will find links to the abstracts discussed today in the transcript of this episode. Finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Thank you very much.  Disclaimer: The purpose of this podcast is to educate and inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guest speakers express their own opinions, experience, and conclusions. Guest statements on the podcast do not necessarily reflect the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.  Find out more about today's speakers:     Dr. Neeraj Agarwal  @neerajaiims  Dr. Jeanny Aragon-Ching    Follow ASCO on social media:     @ASCO on Twitter     ASCO on Facebook     ASCO on LinkedIn       Disclosures:      Dr. Neeraj Agarwal:       Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, AstraZeneca, Nektar, Lilly, Bayer, Pharmacyclics, Foundation Medicine, Astellas Pharma, Lilly, Exelixis, AstraZeneca, Pfizer, Merck, Novartis, Eisai, Seattle Genetics, EMD Serono, Janssen Oncology, AVEO, Calithera Biosciences, MEI Pharma, Genentech, Astellas Pharma, Foundation Medicine, and Gilead Sciences    Research Funding (Institution): Bayer, Bristol-Myers Squibb, Takeda, Pfizer, Exelixis, Amgen, AstraZeneca, Calithera Biosciences, Celldex, Eisai, Genentech, Immunomedics, Janssen, Merck, Lilly, Nektar, ORIC Pharmaceuticals, Crispr Therapeutics, Arvinas     Dr. Jeanny Aragon-Ching:    Honoraria: Bristol-Myers Squibb, EMD Serono, Astellas Scientific and Medical Affairs Inc., Pfizer/EMD Serono  Consulting or Advisory Role: Algeta/Bayer, Dendreon, AstraZeneca, Janssen Biotech, Sanofi, EMD Serono, MedImmune, Bayer, Merck, Seattle Genetics, Pfizer, Immunomedics, Amgen, AVEO, Pfizer/Myovant, Exelixis,   Speakers' Bureau: Astellas Pharma, Janssen-Ortho, Bristol-Myers Squibb, Astellas/Seattle Genetics. 

In this "Podcast Takeover," Dr. Lidia Schapira guest hosts to discuss with Dr. Shannon Westin her own JCO paper, which reports on the DUO-E Trial. Dr. Ramez Eskander also joins in this lively discussion. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we get in depth on manuscripts published in the Journal of Clinical Oncology. I am your host, Shannon Westin, Social Media Editor of the JCO and Gynecologic Oncologist by trade. And actually, I'm super excited today because we are going to have a podcast takeover because we are discussing my own work, which was simultaneously presented at the European Society of Medical Oncology 2023 Congress and published in the Journal of Clinical Oncology on October 21st, 2023. And this was the DUO-E trial, “Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer.” Because we're discussing this work and we wanted you to have an unbiased podcast discussion, Dr. Lidia Schapira, who is a Professor of Medical Oncology at Stanford University and an Associate Editor of JCO and the Art of Oncology podcast host, is going to take over this podcast and really just pepper me with questions about this exciting work.  Welcome, Dr. Schapira.  Dr. Lidia Schapira: Thank you so much. It's such a pleasure to be with you. Dr. Shannon Westin: And before I turn over the reins, I also want to introduce one of my colleagues, who's going to be providing quite a bit of insight on this topic, Dr. Ramez Eskander, who is Professor of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Diego. And you will know he's the principal investigator of the GY-018 study, which established pembrolizumab and chemotherapy as the new standard of care in endometrial cancer. Welcome, Ramez.  Dr. Ramez Eskander: Thank you. Thank you, Dr. Westin. It's a pleasure to be here. And congratulations again to you and your study team for this exceptional work.  Dr. Shannon Westin: Thank you. And congratulations to you.  Dr. Schapira, thank you for being here and please do take it away. Dr. Lidia Schapira: So let's start by having you tell us a little bit about the standard of care for women with endometrial cancer and advanced endometrial cancer prior to this study. Ramez, I'm going to direct this question to you first. Dr. Ramez Eskander: For many years, actually since about 2012, carboplatin and paclitaxel, which ironically is a chemotherapy backbone really across all of our gynecologic tumors, emerged as the preferred doublet chemotherapy regimen for the management of advanced-stage metastatic or recurrent endometrial cancer. It evolved through a series of different clinical trials, in fact taking us from whole abdominal radiation, systemic chemotherapy, comparing single agents to doublets and then triplet regimen of TAP to carboplatin and paclitaxel, which ultimately, then, following the presentation of GOG Protocol 209 and its publication, as the chemotherapy backbone, being carboplatin and paclitaxel. And it's been that way for many, many years. Dr. Lidia Schapira: And how effective is the regimen? Dr. Ramez Eskander: The response rates to carboplatin and paclitaxel are actually quite reasonable in the patients who have advanced-stage disease, particularly if they haven't had prior systemic chemotherapy. Response rates in the 50% to 60% range. The issue is that the responses tend to be limited and disease recurrence is an expectation in these patients who have advanced-stage disease. And so that really highlighted the importance of trying to continue to advance therapeutic opportunities in these patients to improve long-term outcomes.  Dr. Lidia Schapira: As we think about improved long-term outcomes, we're thinking about a better treatment and also a kinder treatment, perhaps one that is also less toxic. Can you talk a little bit about the population of women with endometrial cancer? Are these older women? Do they have comorbidities?  Dr. Ramez Eskander: What we're seeing is, interestingly, there has been an evolution a bit in this space. Historically, we used to think about endometrial cancer as—the phrases we used to use are type I and type II. These type I tumors, we would say, are estrogen-driven malignancies; they tend to be seen in overweight or obese patients. And we would identify them in a theoretically younger patient population. And then we had these type II, or what we termed estrogen-independent malignancies, that we would see in an older patient population. Of course, with obesity came metabolic syndrome and other cardiovascular comorbidities, etc. But really, that narrative has evolved dramatically, and that's really something that will be highlighted in, I think, our discussion of these studies today, where the nomenclature that we used to historically use has evolved because of our understanding of the molecular characterization of this disease. So we've really gone away from that, and now we understand that we're seeing all of these different heterogeneous endometrial cancer types amongst patients of different ages, different comorbidities, different races and ethnicities. And so it's created a more complex picture for us. But certainly, there are comorbidities that these patients face, and that's important as we look to identify treatments strategies that are both effective and tolerable. Dr. Lidia Schapira: My final question before we jump into this very exciting study is about the Cancer Genome Atlas work. Can you tell us how that's changed the thinking and the design of the studies? Dr. Ramez Eskander: It was a seminal publication, really, back in 2012/2013 looking at an assessment of endometrial cancers to try and determine whether or not all of these "endometrial cancers" that we used to enroll on a single study are similar or divergent. And it's important because the study I referenced that really established the standard of care, GOG Protocol 209, as carboplatin and paclitaxel, there was no real consideration of molecular characterization at all. We enrolled all patients onto this study without thinking about these variables, of course, because it was designed, conducted, and completed before the TCGA data emerged. But what we learned from the TCGA is there appeared to be four distinct molecular subgroups. There were the POLE-mutated patient population. There was the mismatch repair deficient or MSI-high endometrial cancer population. There was the copy number-high or what we say are the p53-mutated. And then the last cohort was called the NSMP (no specific molecular profile). But now, that's even evolved; some people term it TP53 wild type. That's a bit of even a heterogeneous cohort amongst itself. So we're going to take these subsets, independent of POLE and an MSI-high, and we're going to look at TP53 or copy number-high, and that will probably be divvied out further, and the NSMP, and that will probably be subdivided. But really, it gave us these four components, which has then evolved. Many of you may have heard of the ProMisE algorithm or ProMisE Plus, which looked to take the data from TCGA so that we can start to really look at it in clinical practice. So it's really revolutionized how we think about these patients, how we think about the disease, and how we design trials.    Dr. Shannon Westin: And I just want to add to that because I think that it's so important, what Ramez said about the way we were developing trials, the way we were designing trials. We knew that these classifiers—we were learning these classifiers are prognostic. Now what we're really trying to hone in on is how predictive they are. And certainly, one of the major classifiers that we're going to talking about today is mismatch repair status, and that is most definitely predictive of response to therapies. But we're still learning about the other classifiers and how we might adjust the way we treat people, even deescalating care for certain patients. That is still being proven in clinical trials, although we suspect that it's going to be borne out as other clinical trials report. Dr. Lidia Schapira: It's a perfect segue to this current trial. Tell us a little bit about the objectives and the design of DUO-E. Dr. Shannon Westin: As Ramez said, the standard of care was chemotherapy. And so we wanted to see if there was a way to improve outcomes for these women with advanced and recurrent endometrial cancer in a really clinically relevant, meaningful fashion for patients. And so we knew that this TCGA classifier, the mismatch repair, was so important, and we thought that the addition of immunotherapy to chemotherapy would most certainly work in that population but could even work in the entire population because, generally, endometrial cancer seems to be a little bit more responsive to immunotherapy and to activation of the immune system than, say, some of our other gynecologic malignancies. And so we set out to see what the addition of durvalumab, which is a PDL-1 inhibitor, would add to chemotherapy. And this was two chemo as well as followed by durvalumab maintenance.  But even further, we had some really kind of exciting science data from our lab that said that if we combined a PARP inhibitor with immunotherapy that we could accentuate on the response to therapy and we could get more benefit. And there's kind of a lot behind that, but essentially, what we thought was that the damage that's caused by the PARP inhibitors would create an activation of different immuno-pathways, like STING pathway and activating cytokine release, and that we would get this synergistic activity. So one of the other objectives was to see if the addition of the olaparib, the PARP inhibitor, to durvalumab in that maintenance setting could even further improve benefit. So we had a dual primary endpoint looking at progression-free survival, so the amount of time people live without their cancer coming back. And that endpoint was first, the durvalumab-alone arm to control, and then the second portion of that was the durvalumab/olaparib arm back to control. Dr. Lidia Schapira: So before you tell us about the results, tell us a little bit about the study itself. I mean, I was very impressed that you did it in so many different locations. Tell us about that effort.  Dr. Shannon Westin: This was a huge collaborative effort both with the GOG Foundation, the Gynecologic Oncology Group Foundation, as well as ENGOT, which is our European colleagues that do amazing clinical trials. But in addition to that, we really worked very closely with our industry partner to really make sure we spanned the globe. And so we had groups from all over the world that participated and really were exceptional. The care that was taken and the hard work that went into this type of study across the world really can't be overstated. We were very lucky to have a wonderful infrastructure group. We met weekly for a long time, just keeping an eye on the data and making sure that everything was as positive as possible and, of course, that we were watching the outcomes of the patients very closely and making sure that there was no evidence of harm or issue. And so it really did take a village, truly, to run this study and to ensure that at the end of it, we got really great data that we can trust. Dr. Lidia Schapira: So tell us the results. Dr. Shannon Westin: So DUO-E was positive for both of its primary endpoints, which was very thrilling. So for the first analysis, which is the durva-alone arm to control, we saw a reduction in the risk of progression of 29%, so a hazard ratio of 0.71. And then the addition of olaparib seemed to further enhance this benefit, so a 45% reduction in the risk of progression for a hazard ratio of 0.55. But what's really exciting is our follow-up time was pretty long; it was about 17 months, so we were able to look at a couple of different analyses, including an 18-month landmark analysis where we saw approximately 50% of the patients were still alive progression free at 18 months, as compared to only 21% of patients being alive progression free in the control arm. So there was a doubling in that progression-free survival time point at 18 months, which is thrilling. Dr. Lidia Schapira: So Ramez, as an expert in the field, what was your reaction when you read or heard these results?  Dr. Ramez Eskander: It's exciting, honestly. So we have gone a long time without seeing really significant successes in the endometrial cancer space, a testament to the fact that we hadn't yet developed our understanding of how we could move this needle forward. But Dr. Westin and the DUO-E team conducted an exceptional clinical trial, as you mentioned, international study, rational and important hypothesis to adjudicate. And what we saw here was both now we had other studies—the RUBY trial, the GY018 trial, the  AtTEnd—and now here DUO-E, which added this hypothesis of PARP maintenance in addition to checkpoint to try to augment response and consistent, really provocative data, exciting, in line with what we've seen and hopefully will continue to drive the science in this space, most importantly. Dr. Lidia Schapira: So let me ask you a follow-up question to that. What kind of scientific questions are in the air now as a result of this trial and what the trial found? Dr. Ramez Eskander: Oh, goodness. Shannon and I could both take this, I'm sure. But I think in the dMMR population, we recognize that there's a ton of data that is supportive of the fact that these tumors are immune responsive, particularly in dMMR endometrial cancer, whether it's an epigenetic promoter hypermethylation, or a mismatch repair gene mutation. I think the data has emerged that immunotherapy is here to stay for these patients in the newly diagnosed advanced stage, even chemo naïve, who need adjuvant therapy.   The pMMR population, this is where we're seeing more and more questions emerge because we realize that that may be a cohort of different cancers. And I'll let Shannon speak to this briefly, but even the incorporation of the PARP inhibitor, in addition to the checkpoint, there's a biologic rationale for combining those two together to augment response. And to see the benefit in that trial—arm three and arm two, we can look at descriptively and look at the differences, but who are those patients? Where is the PARP and the checkpoint most effective? How do we expand that to a larger population of patients potentially? These are questions that emerged because, as Dr. Weston will allude to, I know we also talk about HRR mutations, which are captured, but we even have a lot to understand about that in endometrial cancer, where we've had more research in the ovarian cancer space. Dr. Shannon Westin: Being mindful of time, because I have, like, 1,000 hypotheses that have been generated by this study, which, I think, shows it's a great study, right? Because you get some answers, and as our colleague Brad Monk says, “The only definitive study is the negative studies.” This most certainly was not that. But just kind of expanding on what Ramez said, the interesting thing about DUO-E is that really the biggest benefit for the combination of the durvalumab and olaparib was in that mismatch repair proficient group. And I personally thought that we were going to see accentuation of the impact in the mismatch repair deficient group based on the science, but that just wasn't borne out by the data. It doesn't seem that the combination has that much to add in that mismatch repair deficient group. And when we tease out the mismatch repair proficient group, I think that's where a lot of interesting information is going to come because, to Ramez's point, we're going to tease out: Is it driven by the P53-mutant population? Is it driven by the population that has homologous recombination deficiency? How do we even measure homologous recombination deficiency in endometrial cancer? So I'm super excited about what we found and how that may help us to make those decisions for the patient in front of us.  The other thing I think needs to be made mention of—and this was something we saw in DUO-E as well as AtTEnd—we had a large population of patients that were recruited in Asia, 30%. Interestingly, when we look at the forest plot, that group doesn't seem to benefit as much from the addition of the olaparib. So we really need to tease out what's different about that population because what Nicoletta Colombo presented around AtTEnd, it looked like they didn't benefit from the atezolizumab either in that study. So there's clearly something different about that population, and we have a really big opportunity to look at that since we had such a large proportion of patients that were enrolled there. So that's another, I think, really intriguing question. Dr. Lidia Schapira: So how does this fit in the context of endometrial cancer treatment, and what are we going to do with patients in the clinic? I'd love to hear both of your perspectives, starting with you, Ramez. Dr. Ramez Eskander: It's an evolving answer, to say the least. What we can say definitively is that we have a United States FDA approval for the regimen of dostarlimab plus carboplatin and paclitaxel in the mismatch repair deficient, advanced-stage/recurrent or metastatic patient cohort. And again, that's because the magnitude of benefit that we saw in the RUBY trial, which looked at that, was actually analogous to what we saw in 018, AtTEnd, and DUO-E, again, consistently highlighting the benefit of the IO and the dMMR. We have yet to see how this is going to evolve the landscape in the larger patient population, which is the pMMR patient population. And it may be that based on the data that we have, we will see immunotherapy plus carboplatin and paclitaxel as the new standard of care in the pMMR cohort, or it may not. That's yet to be defined. And I think Dr. Westin will add to this, but I think that's also going to depend on the perception of how we view the cohort. Is it one group of patients? Are we going to have to think about subsets within the pMMR population? That is an active conversation. Dr. Shannon Westin: I would just add, having treated patients on this combo regimen with the durvalumab and olaparib, I have multiple patients that still remain on study, and this—we're looking at three and four years out. I just never saw anything like that before with standard chemotherapy, so there's definitely something here. So I want to know who those patients are, who benefits really the best from the combination, and who could we just give the immunotherapy to and get that same benefit. So we obviously always want people to live as long as possible. That's the bottom line. But we don't want to overtreat. And so I think balancing that is really important. Dr. Ramez Eskander: The point that was made earlier: We have yet, aside from MMR response to checkpoint, within the pMMR population, we understand that there may be subsets, but we have yet to prospectively validate that these molecular cohorts within the pMMR population are truly defining response to a particular therapeutic strategy. So we have to be cautious not to limit the treatment opportunities for these patients without having the data that we need to do so because, as Dr. Westin mentioned, for us—whether it was the Gy018 trial, the RUBY, the DUO-E trial—what we saw is there are pMMR patients who have a dramatic response even though they are “biomarker negative.” They're pMMR, they're TMB low, they're not POLE mutated, but yet they still derive a dramatic benefit. And so that goes back to the hypothesis about why we're even combining checkpoint with chemotherapy in which, for example, in lung cancer, there's been established success and approval. So I think we're all eager to see these strategies emerge as treatment opportunities for the pMMR patients as we work to still develop additional effective opportunities. Dr. Lidia Schapira: So, based on all of this and sort of the new twists on the scientific hypotheses that are now generated, what are the next steps? Dr. Shannon Westin: Well, I think we have to see if these drugs are available for patients. So looking at things like compendium listing and regulatory approvals obviously is going to be very important. But from the things that I can control, we are looking at the different molecular subtypes and understanding the different mutation status and trying to tease out who may be driving the biggest benefits so that we can help advise and make sure that we're doing the right thing for the patients. Dr. Lidia Schapira: And wearing my supportive care hat, I have to ask you, Shannon, about the tolerability. We often find that the quality of life and studies come out after, sometimes months or years after, the original trials are published. So let me take this opportunity to ask you now: How did women tolerate these drugs? Dr. Shannon Westin: The bottom line, Lidia, is, as expected, when you add additional drugs, you see additional side-effects. I think the good thing is that we're very comfortable with immunotherapy and we're very comfortable with PARP inhibition in gynecology because we have had access to these agents and so we know how to manage the toxicities. And so, from a standpoint of incidence, there was a higher incidence of grade three and higher adverse events in the group that had durvalumab/olaparib. But this was primarily driven by anemia, which is as expected and is usually pretty time-limited at the start of olaparib. From a long-term standpoint, there was a slightly higher proportion of patients that discontinued therapy, but it actually wasn't as much as I was worried about. So we saw a 19% discontinuation rate in the group that was just the control arm, and that went up to 24% in the dual arm, so definitely higher, but not that much higher. And when we moved to maintenance, which is really where—that's where the arm becomes unique, it was much lower at about 12%. And so that's exciting to me, that patients were able to stay on a drug and were able to tolerate it.  And then, to your other point, we do have a very nice patient-reported outcomes plan, and that is actually being analyzed as we speak with the hope of presenting it at the next major meeting, our Society of GYN Oncology meeting in March. So not right away, but I think in a pretty timely fashion, we'll have those data. Dr. Lidia Schapira: Congratulations, Shannon, on leading and presenting this wonderful study. So it's been a real pleasure to chat with the two of you. Dr. Ramez Eskander: Thank you. Dr. Shannon Westin: Thanks so much, Lidia. I really appreciate it. Thanks, Ramez, for being here.  And I will just say thank you to all of our listeners. We really hope you enjoyed this episode of JCO After Hours, where we discussed the DUO-E trial, which is a phase III trial evaluating durvalumab plus carboplatin/paclitaxel followed by maintenance durvalumab with or without olaparib as first-line treatment for advanced endometrial cancer. And again, please do enjoy this publication that was online at the Journal of Clinical Oncology on October 21st, 2023. And do check out our other podcast offerings wherever you get your podcasts. Have a wonderful day. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.      

Today we chat about the crazy rise in people suffering from anxiety, who it affects the most, and what the Australia & New Zealand Psychiatric Association recommends as first-line treatment. Here is the link to order the Hardy's supplements if you're interested - use code MBB25 (or MBBP25 if that doesn't work).See omnystudio.com/listener for privacy information.

This recording features audio versions of September 2023 Journal of Vascular and Interventional Radiology (JVIR) abstracts:An Interim Analysis of the First 102 Patients Treated in the Prospective Vertebral Augmentation Sacroplasty Fracture Registry  ReadEffectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis–Related Interphalangeal Joint Pain  ReadMiddle Meningeal Artery Embolization with Liquid Embolic Agents for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis  ReadDouble-Barrel Nitinol Stent Placement for Iliocaval Reconstruction: The Effect of Deployment Sequence and Direction on Final Configuration  ReadRadioembolization with Yttrium-90 Glass Microspheres as a First-Line Treatment for Unresectable Intrahepatic Cholangiocarcinoma—A Prospective Feasibility Study  ReadRobot-Assisted Transarterial Chemoembolization of Hepatocellular Carcinoma Using a Coaxial Microcatheter Driving Controller-Responder Robot System: Clinical Pilot Study  ReadA 5-Year Update on the IR Residency Match: 2022 National Survey Results of Program Directors and Matched Applicants Compared with 2017   ReadJVIR and SIR thank all those who helped record this episode:Host:Rommell Noche, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutAudio editor:Manbir Sandhu, University of California Riverside School of MedicineAbstract readers:Emily Barr, MBA, Burrell College of Osteopathic Medicine at New Mexico State UniversityJoy Achuonjei, MS, MBA, Zucker School of Medicine at Hofstra/Northwell, New YorkJoan Hwang, A.T. Still University School of Osteopathic Medicine, ArizonaChristopher Loiselle, MS, Lincoln Memorial University-DeBusk College of Osteopathic Medicine, TennesseeBenjamin Ellison, Medical University of South CarolinaJack Ficke, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutAnne-Marie Nwajei, MS, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Illinois ©  Society of Interventional RadiologySupport the show

Featuring perspectives from Ms Brenda Martone and Dr Jonathan E Rosenberg, including the following topics: Introduction (0:00) Overview; Localized Urothelial Bladder Cancer (UBC) (3:56) First-Line Treatment of Metastatic Disease (34:16) Sequencing of Therapy for Metastatic UBC (59:44) NCPD information and select publications

Drs Sapna Patel and Yana Najjar analyze the data and share their approach to frontline therapy. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/989035). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Combination Dabrafenib and Trametinib Versus Combination Nivolumab and Ipilimumab for Patients With Advanced BRAF-Mutant Melanoma: The DREAMseq Trial-ECOG-ACRIN EA6134 https://pubmed.ncbi.nlm.nih.gov/36166727/ Sequencing of Ipilimumab Plus Nivolumab and Encorafenib Plus Binimetinib for Untreated BRAF-Mutated Metastatic Melanoma (SECOMBIT): A Randomized, Three-Arm, Open-Label Phase II Trial https://pubmed.ncbi.nlm.nih.gov/36049147/ Long-Term Outcomes of Patients With Active Melanoma Brain Metastases Treated With Combination Nivolumab Plus Ipilimumab (CheckMate 204): Final Results of an Open-Label, Multicentre, Phase 2 Study https://pubmed.ncbi.nlm.nih.gov/34774225/ Health-related Quality of Life With Nivolumab Plus Relatlimab Versus Nivolumab Monotherapy in Patients With Previously Untreated Unresectable or Metastatic Melanoma: RELATIVITY-047 Trial https://pubmed.ncbi.nlm.nih.gov/37167764/ Overall Survival With Combined Nivolumab and Ipilimumab in Advanced Melanoma https://pubmed.ncbi.nlm.nih.gov/28889792/ Evaluation of Two Dosing Regimens for Nivolumab in Combination With Ipilimumab in Patients With Advanced Melanoma: Results From the Phase IIIb/IV CheckMate 511 Trial https://pubmed.ncbi.nlm.nih.gov/30811280/ Adjuvant Therapy of Nivolumab Combined With Ipilimumab Versus Nivolumab Alone in Patients With Resected Stage IIIB-D or Stage IV Melanoma (CheckMate 915) https://pubmed.ncbi.nlm.nih.gov/36162037/ Single-Agent PD-1 Blockade Is "Treatment of Choice" for Desmoplastic Melanoma https://pubmed.ncbi.nlm.nih.gov/37071762/ Single-agent Pembrolizumab May Benefit Patients With Rare Type of Skin Cancer https://www.aacr.org/about-the-aacr/newsroom/news-releases/single-agent-pembrolizumab-may-benefit-patients-with-rare-type-of-skin-cancer/ Atezolizumab, Vemurafenib, and Cobimetinib as First-Line Treatment for Unresectable Advanced BRAFV600 Mutation-Positive Melanoma (Imspire150): Primary Analysis of the Randomised, Double-Blind, Placebo-Controlled, Phase 3 Trial https://pubmed.ncbi.nlm.nih.gov/32534646/ Overall Survival Benefit With Tebentafusp in Metastatic Uveal Melanoma https://pubmed.ncbi.nlm.nih.gov/34551229/ Efficacy and Safety of Nivolumab Alone or in Combination With Ipilimumab in Patients With Mucosal Melanoma: A Pooled Analysis https://pubmed.ncbi.nlm.nih.gov/28056206/ Single-Agent Anti-PD-1 or Combined With Ipilimumab in Patients With Mucosal Melanoma: An International, Retrospective, Cohort Study https://pubmed.ncbi.nlm.nih.gov/35716907/ CheckMate 067: Long-Term Outcomes in Patients With Mucosal Melanoma. https://ascopubs.org/doi/abs/10.1200/JCO.2020.38.15_suppl.10019 A Randomized Phase 2 Trial of Encorafenib + Binimetinib + Nivolumab Vs Ipilimumab + Nivolumab In BRAFV600-Mutant Melanoma Brain Metastases https://www.swog.org/clinical-trials/s2000

What factors should clinicians consider when choosing an SSRI for treating patients with OCD? In this episode, we dive into the first-line treatment for OCD: SSRIs. Discover the most effective SSRIs for treating OCD, recommended doses, and potential adverse effects. Faculty: David Osser, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1.25 CME: Algorithm for the Pharmacotherapy of Obsessive-Compulsive Disorder Node 2: First-Line Treatment: SSRIs

An interview with Dr. Carol Maher,  Professor of Population and Digital Health at University of South Australia. So it's really interesting that the leading U.S. clinical guidelines for managing depression and anxiety consider exercise as an alternative treatment. Because that really implies that there's not evidence behind it or that it sort of isn't congruent with mainstream medicine. And neither of those things is true.  Exercise is very well accepted by mainstream medicine as holding real physical and mental health benefits.Dr. Carol MaherStudy conclusions on effectiveness of exercise and physical activityExercise as a mainstay approachBridging the evidence gapEffectiveness of interventions by frequency, intensity, time, typeEffectiveness of shorter programs Exercise has a larger effect than medication and psychotherapyExercise as a legitimate form of treatment for depression and anxietyTakeaways for cliniciansTakeaways for policy makersTakeaways for patientshttps://www.movetolivemore.com/https://www.linkedin.com/company/move-to-live-more@MovetoLiveMore

Featuring perspectives from Dr Richard Finn, Dr Lipika Goyal and Prof Arndt Vogel, moderated by Dr Katie Kelley, including the following topics: •      First-Line Treatment for Advanced Hepatocellular Carcinoma (HCC) — Dr Finn  o   Introduction (0:00) o   Case: A man in his early 70s with newly diagnosed metastatic HCC receives atezolizumab/bevacizumab — Warren S Brenner, MD (2:27)) o   Case: A woman in her late 50s with a history of hepatitis C and chronic kidney disease on dialysis with localized HCC after surgical resection; patient developed metastatic disease 10 months later — Liudmila N Schafer, MD (6:48) o   Faculty presentation: Dr Finn (11:47) •      Selection and Sequencing of Therapies for Relapsed/Refractory HCC — Dr Kelley  o   Case: A man in his mid 60s with metastatic HCC and a medical history of hepatitis C develops interstitial lung disease on atezolizumab/bevacizumab — Priya Rudolph, MD (21:48) o   Cases: A man in his late 60s with post-transplant recurrence develops metastatic HCC and receives lenvatinib followed by cabozantinib followed by regorafenib and a man in his late 70s with metastatic HCC after treatment with atezolizumab/bevacizumab, lenvatinib and currently cabozantinib — Lionel A Kankeu Fonkoua, MD and Susmitha Apuri, MD (26:58) o   Faculty presentation: Dr Kelley (35:56) •      Current and Future Role of Immunotherapy in the Treatment of Advanced Biliary Tract Cancers (BTCs) — Prof Vogel  o   Case: A woman in her mid 70s with metastatic cholangiocarcinoma who received first-line gemcitabine/cisplatin with durvalumab — Dr Brenner (45:40) o   Case: A man in his early 70s with localized cholangiocarcinoma deemed potentially resectable with tumor response — Jeremy Lorber, MD (50:23) o   Faculty presentation: Dr Vogel (55:10) •      Integration of Targeted Therapy into the Management of Advanced BTCs — Dr Goyal  o   Cases: A woman in her late 70s with intrahepatic cholangiocarcinoma considered unresectable — an FGFR2-KIAA1598 fusion was detected on NGS and a man in his early 60s with metastatic cholangiocarcinoma with severe muscle pain on pemigatinib — Dr Fonkoua and Joseph Martins, MD (1:06:18) o   Cases: A man in his early 50s with recurrent metastatic cholangiocarcinoma with a BRAF V600E mutation treated with dabrafenib/trametinib and a woman in her mid 60s with cholangiocarcinoma with an IDH1 mutation receives ivosidenib — Farshid Dayyani, MD, PhD and Niyati A Nathwani, MD (1:12:26) o   Faculty presentation: Dr Goyal (1:19:08) CME information and select publications

Featuring perspectives from Dr D Ross Camidge, Dr Justin Gainor, Prof Benjamin Solomon and Prof Solange Peters, including the following topics: •      Evolving Understanding and Management of Non-Small Cell Lung Cancer (NSCLC) with Targeted Mutations (0:00) •      Adjuvant Therapy for Patients with NSCLC with Targetable Mutations (11:17) •      Family Planning for Patients with Cancer (23:50) •      Optimal Identification of ALK-Positive Metastatic NSCLC — Dr Camidge (30:33) •      Selection of First-Line Treatment for ALK-Positive NSCLC — Dr Gainor (49:22) •      Sequencing and Selection of Therapy for Relapsed/Refractory ALK-Positive NSCLC — Prof Peters (1:23:33) •      Managing Side Effects of ALK Tyrosine Kinase Inhibitors (TKIs) — Prof Solomon (1:39:14) •      Case: A woman in her early 40s with Stage IIIB ALK-positive NSCLC who received alectinib for more than 4 years — Dr Gainor (1:59:37) •      Case: A woman in her mid 50s who remains in complete response with lorlatinib after 4 years — Prof Solomon (2:03:52) •      Case: A woman in her early 60s with Stage IV NSCLC with ALK translocation who received lorlatinib followed by alectinib — Prof Peters (2:10:18) •      Case: A woman in her late 60s with ALK-positive NSCLC who continues to receive brigatinib after discontinuation of alectinib due to concerns of drug-induced pneumonitis — Dr Camidge (2:15:44) •      Case: A woman in her late 40s with NSCLC with an ALK fusion who received multiple ALK TKIs — Dr Gainor (2:21:11) •      Case: A man in his early 30s with ALK-positive NSCLC and brain metastases who continues to receive lorlatinib after 6 years — Prof Solomon (2:26:33) CME information and select publications

In this episode, we have two interviews: one general, but incredibly entertaining, about health equity and one on a clinical study in chronic lymphocytic leukemia (CLL). This last interview is with Ryan Jacobs, MD (Dept. Hematology, Atrium Health Levine Cancer Institute), who discusses his new real-world study using more than 2 years of EMRs that shows that patients with CLL treated with first-line Bruton's tyrosine kinase inhibitor (BTKi) acalabrutinib were 89% more likely to initiate a next-line treatment when compared with patients treated with another BTKi first-line ibrutinib. But first, Physician's Weekly Editorial Board member and frequent contributor Alex McDonald, MD, speaks with La Tanya Hines, MD, a board-certified obstetrician and gynecologist practicing in Los Angeles about health equity—what it is and where it goes wrong.Enjoy listening! Additional reading:https://www.diversityinmedicine.uci.edu/dr-la-tanya-hines/Jacobs R. et al, Real-World Comparison of Time to Next Treatment for Patients with CLL Initiated on First-Line Treatment with Ibrutinib Versus Acalabrutinib. Presented at the American Society of Hematology (ASH 2022) on Monday, December 12, 2022, Abstract 797.Lu X, et al. Real-World Adherence to First-Line Ibrutinib and Acalabrutinib Single-Agent Among Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. Clinical Lymphoma Myeloma and Leukemia, Volume 22, Supplement 2, 2022: S280-S281, abstract CLL-492Let us know what you thought of this week's episode on Twitter: @physicianswkly Want to share your medical expertise, research, or unique experience in medicine on the PW podcast? Email us at editorial@physweekly.com! Thanks for listening!

In this episode of our three-part series on endometrial cancer, our faculty continue their discussion by turning to some of the ongoing, and some may say groundbreaking, clinical trials for the use of immunotherapies in the first-line setting. Visit www.MorningCommutePodcast.com/Endometrial4 to view the activity and CME/CE information, download the transcript, and complete the post-test and evaluation to earn CME/CE credit.

Proceedings from a daylong symposium hosted in partnership with Florida Cancer Specialists, featuring key clinical presentations and papers in lung cancer. Featuring perspectives from Drs Corey Langer and Christine Lovly, including the following topics: First-Line Treatment of Metastatic Non-Small Cell Lung Cancer (NSCLC) in Patients without Targetable Mutations (0:00) Neoadjuvant and Adjuvant Treatment of Localized NSCLC (14:29) Targeted Treatment of Metastatic NSCLC (32:44) CME information and select publications

Featuring perspectives from Drs Yohann Loriot, Elizabeth Plimack and Jonathan Rosenberg, including the following topics: Introduction (0:00) Current and Future Management of Localized Urothelial Bladder Cancer (UBC) (2:59) First-Line Treatment for Patients with Metastatic UBC (mUBC) (28:29) Later-Line Therapeutic Options for Patients with mUBC: Novel Investigational Strategies (47:08) CME information and select publications

Featuring perspectives from Drs Thomas Hutson and Brian Rini, including the following topics: Introduction — Common Questions in the Management of Renal Cell Carcinoma (0:00) Adjuvant Immunotherapy (11:26) First-Line Treatment of Metastatic Disease (27:00) Management of Relapsed/Refractory Disease (38:25) Treatment with Belzutifan (47:35) CME information and select publications

We will discuss the current FDA-approved first-line NCCN Category 1 treatment options for relapsed or stage IV clear cell RCC, specifically evaluating the various immunotherapy (IO) combination therapies, their clinical application, and considerations for choosing between available combinations. We will also review the side effect/toxicity profile and management strategies for each therapy.   The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.