Podcasts about ild

Please visit answersincme.com/860/IME_2025_00013162-replay to participate, download slides and supporting materials, complete the post test, and get a certificate. Presented by Toby Maher, MB, MSc, PhD, FRCP; and Justin Oldham, MD, MS. In this activity, experts explore advances in ILD care, including personalized, multidisciplinary approaches to integrate novel antifibrotic therapy and enhance patient engagement. Upon completion of this activity, participants should be better able to: Recognize the rationale for novel antifibrotic therapy in interstitial lung disease (ILD); Apply the latest clinical data on novel antifibrotic therapy to therapeutic decision-making in ILD; and Outline multidisciplinary strategies to enhance the care of patients with ILD who are receiving antifibrotic therapies.

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

Why is nutrition an important part of managing overall health for someone living with ILD or PF? Whether it be hydration, unexpected side effects from medication or even weight fluctuation, your nutritional choices can help make a big impact! Lori Flint, a Registered Nurse and Support Group Leader for the Ann Arbor Pulmonary Fibrosis Support Group joins the show to discuss the impact nutrition can have for someone living with ILD! It's the 'Pulmonary Fibrosis' podcast! Brought to you by the Wescoe Foundation for Pulmonary Fibrosis -- visit Wescoe.org for more!See omnystudio.com/listener for privacy information.

Send us Fan MailIn this episode, we discuss drug induced ILD, reviewing its diagnostic criteria and management. Written by: Dr. Reenika Aggarwal. Reviewed by: Dr. Joshua Wald (Respirology) and Dr. Andrew Cheung (General Internal Medicine). Support the show

In this episode, we explore the emerging role of biomarkers in rheumatoid arthritis–associated interstitial lung disease (RA-ILD) with Dr. Brent Luedders, discussing how prior ILD research laid the foundation for his latest multi-cohort study. He walks us through the study design, including the use of VA and non-VA cohorts, the biomarker panel that was tested, and the key findings related to prevalent and incident RA-ILD, ROC analyses, and disease risk over time. We also discuss the study's limitations, the future of biomarkers in RA-ILD care, and Dr. Luedders' personal journey into rheumatology, research, and medical education.  Performance of an Idiopathic Pulmonary Fibrosis-Derived Multibiomarker Panel for Rheumatoid Arthritis-Associated Interstitial Lung Disease 

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

The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects.  Features Dr. Jack Cush, Editor at RheumNow.com. Show Notes: Chinese target emulation trial of MDA-5+, dermatomyositis w/ ILD. 106 Rx w/ UPA & 328 w/ TOFA. 6-month lung transplantation-free survival 72% vs 67% (UPA v TOFA). UPA non-inferior to TOFA in MDA5+DM-ILD https://t.co/BBAfbM06AM In 2025 DTC TV ad spending by top 10 incr to $2.67 billion (up from $2.1 B). Rheum Drugs in top 3: 1. Skyrizi $440 million 2. Tremfya $431 M 3. Rinvoq $376 M https://t.co/EsWgUqUy9Z 2. Dermatology Salaries 2025 – Dermatology is top 10 at $448K according to Medscape; expected to go down -1% in 2026; derms made up 2% of survey group 37K MDs 3. Itch is common in Scleroderma (SSc) and not related to Dz duration. Study of 2173 Pts (~20K itch assessments), 87 F; mean age 55 yrs; 40% w/ diffuse SSc. Itch (moderate 4/10) seen in ~35% at all times https://t.co/QnT8d0xA5Z 4. Asia-Pacific Lupus study of Mucocutaneous activity (MC-A) in 4102 SLE pts. 36% had MC-A (rash 1055; alopecia 731; m ulcers 352); 15% persistently. MC-A assoc w/ W, smoking, +serologies, vasculitis, myositis, serositis, nephritis, NP-SLE https://buff.ly/D5fXJdY 5. Predictors of Calcinosis Cutis in Systemic Sclerosis   6. AFFINITY Study - Combination Biologic Therapy in PsA A pilot trial assessed the efficacy and safety of the guselkumab+golimumab (COMBO) combination versus GUS monotherapy in active PsA (failing a prior tumor necrosis factor inhibitor (TNFi-IR) and showed superiority in ACR 50 https://t.co/f2CB8FnZMB 7. AAD 2026 Annual Mtg presents new data on another TYK2 inhibitor. In 2 phase 3 RCTs (ONWARD1 ONWARD2) envudeucitinib was superior to placebo & apremilast in 1700 plaque psoriasis pts https://t.co/DPlzDw5m7N 8. Among 1074 #PsA tested annually, RF positivity was found in 16.1% overall (5.1% RF+ at baseline). RF+ rediced odds of MDA (OR 0.53) w/ incr risk of bDMARD discontinuation (OR 2.65) https://buff.ly/BsM7NKQ 9. The National Psoriasis Foundation Primer on GLP-1 Receptor Agonists in Psoriasis - Review 10. Ixekizumab With Tirzepatide Efficacy in Obese Psoriatic Arthritis 11. Brepocitinib in Dermatomyositis

In this episode our host Dr Raquel Faria discusses two challenging cases with Professors Maria Dall'Era andRonald van Vollenhoven of the Lupus Academy Steering Committee. The two cases include:1. Myositis, ILD, and the long-term lupus patient whose long-term management never truly stays in one box.2. The nuances of a "slow-burn" pediatric-to-adult SLE transition, focusing on the diagnostic challenges of the "pre-lupus" label and the management of high-interferon phenotypes.Disclaimer: During Lupus Academy podcast episodes, participants may refer to off label use of medicines for patients with lupus. Lupus Academy does not make any recommendations about using a medicine outside the terms of its approved licence for use.

Why is fatigue such a significant part of ILD? What practical strategies, medical or lifestyle, have you seen make the biggest difference in helping patients manage fatigue? Dr. Valeria Santibanez, who specializes in Pulmonology and Pulmonary Critical Care at Jefferson Health, joins the show to discuss the impact that fatigue plays for patients with ILD. It's the PULMONARY FIBROSIS podcast! Brought to you by the Wescoe Foundation for Pulmonary Fibrosis -- get more info at Wescoe.org!See omnystudio.com/listener for privacy information.

Love the podcast? Send us a text!Every breast cancer treatment plan is highly personalized, and understanding potential side effects can help patients feel more prepared, informed, and empowered throughout care.In this episode of Breast Cancer Conversations, Laura speaks with Debbie Ciak, a breast cancer survivor diagnosed with Stage 2B ER/PR-positive, HER2-negative breast cancer with lymph node involvement.Due to features associated with a higher risk of recurrence, Debbie's care team recommended treatment with Verzenio (abemaciclib), a CDK4/6 inhibitor commonly prescribed alongside endocrine therapy for certain HR+, HER2- breast cancers.During treatment, Debbie experienced significant gastrointestinal symptoms and later developed respiratory symptoms that were ultimately identified as drug-induced interstitial lung disease (ILD), also known as pneumonitis.Debbie also shares how integrative support resources and survivorship programming helped her continue moving forward after treatment.Her story underscores the importance of individualized care, ongoing monitoring, and open communication between patients and healthcare providers when incorporating newer therapies into treatment plans.While every patient responds differently to therapy, conversations like this help support more informed discussions between patients and their care teams.Topics Covered• Stage 2B ER/PR+ breast cancer diagnosis • understanding recurrence risk factors • treatment decision-making • why Verzenio was recommended • managing common CDK4/6 inhibitor side effects • Debbie's experience with ILD/pneumonitis • recognizing respiratory symptoms early • coordinating care across oncology and pulmonology • survivorship and ongoing monitoring • exercise and recovery • patient empowerment and advocacyThis episode is part of an ongoing series sharing real-world patient experiences on various therapies, highlighting the importance of education, communication, and personalized treatment decisions in breast cancer care.Support the showListener FeedbackIf this episode resonated with you, we invite you to leave a review on Apple Podcasts or Spotify.You can also click the link in the show notes that says "Love this episode? Send us a text" to share feedback.Messages are completely anonymous.If you would like us to follow up directly, please include your email address in your message so we can respond.Latest News: Become a Breast Cancer Conversations+ Member! Sign Up Now. Join our Mailing List - New content drops every Monday! Discover FREE programs, support groups, and resources from SurvivingBReastCancer.org! Enjoying our content? Please consider supporting our work. 

In this episode, Dr Matthew Gubens and Dr Helena Yu discuss the evolving role of TROP2-directed therapies in non-small-cell lung cancer, with a focus on how antibody–drug conjugates (ADCs) fit into current treatment strategies, including The mechanism of action and clinical trial outcomes of TROP2-directed ADCs like datopotamab deruxtecan and sacituzumab tirumotecan Use of these therapies in EGFR-mutant disease and how they fit into a changing treatment landscape Practical advice on associated adverse events and additional considerations, A look at future directions on the horizon, such as first-line studies and predictive biomarkers Get access to all of our new podcasts by subscribing to the Decera Clinical Education Oncology Podcast on Apple Podcasts, YouTube Music, or Spotify. Presenters: Matthew Gubens, MD, MS, FASCO​ Medical Director, Thoracic Medical Oncology​ University of California, San Francisco​ San Francisco, California Helena Yu, MD​ Professor of Medicine​ Thoracic Oncology Service​ Memorial Sloan Kettering Cancer Center​ New York, New York Link to full program:https://bit.ly/41vAnfH Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Så diskuterer vi igen, hvad det vil sige at være dansk. Kan man være mere eller mindre dansk eller er danskhed en absolut størrelse, som fortrænger alt andet? Er danskhed en særlig kærlighed? Til dannebrog? Til demokratiet? Til de bølgende marker, til fodboldlandsholdet eller Arne Jacobsen? Eller handler det slet ikke om bestemte nationale attributter, men om selve hengivenheden i vores hjerter? Diskussionen er langt fra ny. I 1848 skrev Grundtvig om den danske folkelighed: "Til et Folk de alle høre, Som sig regne selv dertil, Har for Modersmaalet Øre, Har for Fædrelandet Ild". Udsyn spørger Christian Albrekt Larsen, professor ved Institut for Politik og Samfund på Aalborg Universitet, hvad det er, vi forsøger at afklare med disse diskussioner og hvorfor vi nu har dem igen? Vært: Kaspar Colling Nielsen.

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

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

In this week's episode we interview Joseph Parambil, MD, staff member in the department of pulmonary, allergy and critical care medicine at Cleveland Clinic, about the current challenges of interstitial lung disease, or ILD. ·        Intro by Adam J. Brown, MD 0:12 ·        Welcome back Joseph Parambil, MD 0:32 ·        But first, some medical history on ILD 1:04 ·        ILD vs. IPF 2:26 ·        A quick aside into silicosis and bleomycin 4:27 ·        Trying to describe pulmonary fibrosis 5:23 ·        The different types of ILD 9:44 ·        Finding a slow progression of disease and autoimmune conditions 10:59 ·        Pulmonary fibrosis diagnoses in 1963 14:41 ·        The modern era of ILD 16:22 ·        Nonspecific interstitial pneumonia 20:12 ·        Handing things over to Dr. Parambil 23:01 ·        Helping rheumatologists understand ILD/The alphabet soup 24:34 ·        The shift from biopsies and using immunosuppression 33:07 ·        Is the workup similar for UIP and NSIP? 35:26 ·        Is there a standard protocol for workup in terms of serologies? 36:30 ·        The danger of choosing the wrong treatment 38:43 ·        Immunosuppression in patients with pulmonary hypertension and ILD 40:52 ·        UIP and ANCA vasculitis 42:12 ·        Compared to ten years ago, how are we doing with treatments? 43:10 ·        Where are we with lung transplants? 50:49 ·        Looking at hematopoietic stem cell transplants 53:24 ·        The importance of early diagnosis 54:14 ·        Antifibrotic medicines 56:15 ·        Chronic and acute interstitial lung diseases 58:41 ·        Thank you, Dr. Parambil 1:03:54 ·        A conclusion from Dr. Brown 1:04:20 ·        Thank you for listening 1:04:55 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. Joseph Parambil, MD, is a staff member in the Respiratory Institute and the director of the HHT Center of Excellence and the Vascular Anomalies Center at the Cleveland Clinic. He is associate professor of medicine at Cleveland Clinic's Lerner College of Medicine. He is certified by the American Board of Internal Medicine with additional specialty certification in pulmonary medicine and critical care medicine. References: Homolka J. CMAJ. 1987;PMID:3315158 Liebow A, et al.  : "Frontiers of Pulmonary Radiology." The interstitial pneumonias, pp. 102-141. 1969. Grune & Stratton. Liebow A, et al. Calif Med. 1969;PMID:PMC1501512 Noble PW, et al. Am J Respir Cell Mol Biol. 2005;doi:10.1165/rcmb.F301 Scadding JG, et al. Thorax. 1967;doi:10.1136/thx.22.4.291 Disclosures: Brown and Parambil report no relevant financial disclosures.

Full article: Quantitative CT Measurements of Interstitial Lung Disease: Same-Day Variability Between Two Vendors—A Prospective Study Longitudinal monitoring of interstitial lung disease (ILD) requires insight into the variability of quantitative ILD measurements. Dora Chen, MD, discusses the article by Ahn et al. reporting results of a prospective study in which patients with ILD underwent same-day chest CT examinations using scanners from different vendors.  

ILD in RA - Recent Advances. Dr. Jeffrey Sparks

The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects.  Features Dr. Jack Cush, Editor at RheumNow.com.  SHOW NOTES FDA sent a complete response letter to AstraZeneca on their application (BLA) for anifrolumabs (Saphnelo) subcutaneous use in SLE. Despite a positive TULIP-SC trial & EU approval of SC-anifrolumab, FDA & sponsor still have to work things out. CRL reasons are unknown https://t.co/3dNwEyolrj Review of Calcinosis Cutis - Surgical intervent. most effective (excision, curettage, laser ablation, etc). Medical measures inconsistently, partially effective, best if used early & localized (CCB, TCN, probenecid, immunomodulation, biologics, colchicine, NA thiosulfate, & JAKi https://t.co/rv0hQBv6nX Systematic Review of Targeted Rx for Systemic Sclerosis: from 32 RCTs & 2036 pts Rx w/ 23 targeted agents. Guselkumab had greatest effect on mRSS, followed by tofacitinib, inebilizumab, & baricitinib. For FVC, B-cell Rx (belimumab, RTX) had highest efficacy https://buff.ly/vHOSRws Dermatomyositis outcomes w/ 2475 pts (claims) & 1196 pts (EHR). Half had myositis panels & 35% had + MSAbs. Steroid use common in 69% & 74%. HCQ, MTX, MMF. Outocmes (per 1000PYs) wereL all-cause hospitalisation 92, malignancy 15.3, ILD 6.4, and myocarditis 2.1 https://t.co/DJqKGNGX76 Danish DERMBIO registry of psoriasis pts Rx w/ biologics. Among 3790 bionaive pts ustekinumab had best 1-5 yr survival vs (ADA & SEC). In 3403 bioexperienced pts, bimekizumab, guselkumab, & risankizumab had highest 2-year drug survival rate. https://t.co/TInyLPMYkb Real-world study of 1202 #PsA pts shows that secukinumab retention rates were lower w/ smoking (79%/73%/72% in never/former/current smokers) but not w/ obesity (72%/77%/77% in normal/overweight/obese), Adh HR signif. higher w/ former (1.32) & current smokers (1.27)   https://t.co/1REWmod73W Together PSO Trial - Combination Ixekizumab and Tirzepatide Today Lilly announced top line results of the TOGETHER-PsO open-label, Phase 3b trial demonstrating the significant benefits of concomitant ixekizumab (IXE: an IL-17A inhibitor) and tirzepatide (TIR: GLP-1agonist) over https://t.co/YWCjN2NyGM

How do support groups complement medical care for conditions like Pulmonary Fibrosis? How does connecting with others living with Pulmonary Fibrosis help reduce anxiety, depression, or fear? How can support groups help patients prepare for conversations with their healthcare team? Jen Wescoe joins Kevin Crockett to discuss the great work her team is doing behind the scenes to help improve the communication between support groups and individuals living with ILD -- and YOU can help!! Take the survey here! It's the 'Pulmonary Fibrosis' podcast! Brought to you by the Wescoe Foundation for Pulmonary Fibrosis -- get more info at Wescoe.org!See omnystudio.com/listener for privacy information.

In this episode of the Oncology Brothers podcast we navigated the rapidly evolving treatment landscape of Metastatic Hormone Receptor-Positive Breast Cancer. We were joined by Dr. Kevin Kalinsky, Director of the Breast Cancer Program at the Winship Cancer Institute, Emory University, to discuss the implications of new targeted therapies, optimal sequencing strategies, and practical toxicity management. Listen us on: Spotify: https://open.spotify.com/show/31BXhY9FM4gPWG10WgE11o Follow us on social media: •⁠  YouTube: https://www.youtube.com/@oncologybrothers •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ The discussion covered: • The critical role of NGS testing (tissue vs. liquid biopsy) in identifying PIK3CA, ESR1, AKT1 and PTEN alterations. • Frontline management of high-risk, endocrine-resistant disease with the inavolisib triplet (INAVO120) and its overall survival benefit. • Choosing between CDK4/6 inhibitors (abemaciclib vs. ribociclib) in de novo metastatic disease. • Post-CDK4/6 inhibitors on progression we covered, the use of oral SERDs (imlunestrant) and AKT inhibitors (capivasertib). • The "ADC explosion", sequencing T-DXd (DESTINY-Breast06), sacituzumab govitecan (TROPiCS-02), and datopotamab deruxtecan (TROPION-Breast01). • Clinical pearls for managing toxicities: stomatitis, hyperglycemia, rash, neutropenia, and ILD. Join us as we break down the latest data and provide actionable insights for the practicing oncologist. Don't forget to subscribe for more episodes in our breast cancer algorithm series! #MetastaticBreastCancer, #HRPositive, #ADCsequencing, #PIK3CA-AKT, #OncologyPodcast, #OncologyBrothers

İkili Görüş'te İlkan Dalkuç, konuğu yazar Çağlar Karakış ile Millî Dayanışma, Kardeşlik ve Demokrasi Komisyonu Raporu'nun raporunu ve sonuçlarını, Münih Güvenlik Konferansı'nı değerlendiriyor.00:00 Giriş00:30 Millî Dayanışma, Kardeşlik ve Demokrasi Komisyonu aslında 2004'te kurulmuştu diyebiliriz03:10 Süreç''in aktörleri bu kez daha kararlı ama halkta o kadar karşılığı yok08:40 Komisyonlar toplanır, İmralı'ya gidildi, silahlar yakıldı. Sahaya nasıl yansıdı?13:00 Süreç'in en temel noktası: Asgari değil azami müşterek14:10 Anayasal/değişikliklerin yapılması çok zaman almayacak18:10 Genel Kürt kamuoyunda, DEM Parti seçmeni Süreç için ne düşünüyor?23:40 Rapor'daki bazı kelimelerin kullanım sıklığından hareketle... (terör, kardeşlik, barış)27:20 Süreç al çözümü ver adaylığı ile mi çözülecek?31:10 İyimser olmak için, iktidarın yumuşayacağı iddiası için bir gerekçe göremiyorum40:05 Türkiye'de demokrat kesimler birbirini kırmamalı49:20 Pembe tablodaki kara leke: Emekli maaşı 20 bin, "dul" 17 bin 900, engelli 3 bin 500 lira56:00 Türkiye'de en milliyetçi aktör olarak Erdoğan algılanıyor58:00 Erdoğan'ın sonraki seçimde yetkiyi alıp da bozabileceği başka ne kaldı?01:00:00 "Barış' yarına kalmaz; hangi kombini giysem" diye düşünmüyorum ama sanıldığı kadar uzak değil01:02:50 Suriye'nin "mevcut" durumu uzun süre stabil kalabilir mi?01:07:30 Muharrem İnce benim çok sevdiğim bir siyasetçi değilDİ01:10:05 Ok, 90'lar çok kötüydü de 90 sonrasının 20 küsur yılı?01:11:55 "Cumhurbaşkanının Türkiye'yi iyi yönettiği tartışılır ama muhalefeti iyi yönettiği tartışılmaz"01:14:50 Birisi, bir güç gelip de kimseye demokrasi, hukuk vs. vermeyecek01:20:30 (CB övmüyorum ama) iktidarın söylemsel sertliğinin bir amacı var01:26:30 Bu yayının size ulaşmasındaki emekleri için Aybike Boyacıoğlu'na teşekkür faslı :)01:28:40 "Gelin tanış olalım..."Ayrıcalıklardan yararlanmak için bu kanala KATIL:https://www.youtube.com/channel/UCWyDy24AfZX8ZoHFjm6sJkg/joinBizi Patreon'dan Destekleyin

 Interstitial Lung Abnormality (ILA) and Interstitial Lung Disease (ILD) are often detected using CT scans and other imaging. But the definition of ILAs and how abnormalities are found throughout a patient's clinical journey continues to grow and improve. Host Eddie Qian, MD, Vanderbilt University Medical Center, discusses the importance of spotting ILAs and diagnosing ILDs earlier for better patient outcomes with experts Anna Podolanczuk, MD, Weill Cornell Medical Center, and Joe Mammarappallil, MD, Duke University. This episode is sponsored in part by Boehringer Ingelheim. Read "Approach to the Evaluation and Management of Interstitial Lung Abnormalities: An Official American Thoracic Society Clinical Statement": https://www.atsjournals.org/doi/10.1164/rccm.202505-1054ST 

Synopsis: From managing a theme park in Canada to leading the U.S. business of one of the world's largest privately held pharma companies, Brian Hilberdink's journey is anything but conventional. Live from JPM 2026 in San Francisco, Biotech 2050 host Alok Tayi sits down with the President, U.S. Human Pharma at Boehringer Ingelheim to explore how frontline sales experience shaped a career now steering launches across obesity, chronic kidney disease, oncology, and rare disease. The pair dive into Boehringer's long-term, privately held model—one that reinvests nearly 30% of revenue into R&D—and the strategic thinking behind its ambitious pipeline: first-in-class breakthroughs in interstitial lung disease, major obesity programs, and upcoming waves of launches through 2027 and beyond. They also unpack the future of commercial pharma—from direct-to-consumer models and digital patient engagement to AI-powered launches and trial recruitment—plus Brian's candid views on China's innovation engine and the growing importance of rare disease. A masterclass in modern pharma leadership, portfolio strategy, and building for generations. Biography: Brian Hilberdink is an accomplished global executive with over 25 years of leadership experience in the pharmaceutical industry, currently serving as President of U.S. Human Pharma at Boehringer Ingelheim. In his role at Boehringer, he oversees several business units across multiple therapeutic areas, including cardiometabolic and renal diseases, obesity, pulmonary fibrosis (ILD), and oncology. Renowned for driving impactful results and fostering cultures of accountability and engagement, Brian consistently enhances organizational performance. Previously, Hilberdink served as Executive Vice President at LEO Pharma, where he led the North American Region and served as President of the U.S. affiliate, which became the primary growth driver for the company globally.. Earlier in his career, Hilberdink held several senior-level positions at Novo Nordisk, where he worked across multiple geographies. He was recognized for developing and executing innovative go-to-market strategies, resulting in the successful launch of multiple blockbuster therapies in the areas of obesity and diabetes.

We discuss the diagnosis and management of SCAPE in the ED. Hosts: Naz Sarpoulaki, MD, MPH Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/SCAPEv2.mp3 Download Leave a Comment Tags: Acute Pulmonary Edema, Critical Care Show Notes Core EM Modular CME Course Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below.  Course Highlights: Credit: 12.5 AMA PRA Category 1 Credits™ Curriculum: Comprehensive coverage of Core Emergency Medicine,  with 12 modules spanning from Critical Care to Pediatrics. Cost: Free for NYU Learners $250 for Non-NYU Learners Click Here to Register and Begin Module 1 The Clinical Case Presentation: 60-year-old male with a history of HTN and asthma. EMS Findings: Severe respiratory distress, SpO₂ in the 60s on NRB, HR 120, BP 230/180. Exam: Diaphoretic, diffuse crackles, warm extremities, pitting edema, and significant fatigue/work of breathing. Pre-hospital meds: NRB, Duonebs, Dexamethasone, and IM Epinephrine (under the assumption of severe asthma/anaphylaxis). Differential Diagnosis for the Hypoxic/Tachypneic Patient Pulmonary: Asthma/COPD, Pneumonia, ARDS, PE, Pneumothorax, Pulmonary Edema, ILD, Anaphylaxis. Cardiac: CHF, ACS, Tamponade. Systemic: Anemia, Acidosis. Neuro: Neuromuscular weakness. What is SCAPE? Sympathetic Crashing Acute Pulmonary Edema (SCAPE) is characterized by a sudden, massive sympathetic surge leading to intense vasoconstriction and a precipitous rise in afterload. Pathophysiology: Unlike HFrEF, these patients are often euvolemic or even hypovolemic. The primary issue is fluid maldistribution (fluid shifting from the vasculature into the lungs) due to extreme afterload. Bedside Diagnosis: POCUS vs. CXR POCUS is the gold standard for rapid bedside diagnosis. Lung Ultrasound: Look for diffuse B-lines (≥3 in ≥2 bilateral zones). Cardiac: Assess LV function and check for pericardial effusion. Why not CXR? A meta-analysis shows LUS has a sensitivity of ~88% and specificity of ~90%, whereas CXR sensitivity is only ~73%. Importantly, up to 20% of patients with decompensated HF will have a normal CXR. Management Strategy 1. NIPPV (CPAP or BiPAP) Start NIPPV immediately to reduce preload/afterload and recruit alveoli. Settings: CPAP 5–8 cm H₂O or BiPAP 10/5 cm H₂O. Escalate EPAP quickly but keep pressures to avoid gastric insufflation. Evidence: NIPPV reduces mortality (NNT 17) and intubation rates (NNT 13). 2. High-Dose Nitroglycerin The goal is to drop SBP to < 140–160 mmHg within minutes. No IV Access: 3–5 SL tabs (0.4 mg each) simultaneously. IV Bolus: 500–1000 mcg over 2 minutes. IV Infusion: Start at 100–200 mcg/min; titrate up rapidly (doses > 800 mcg/min may be required). Safety: ACEP policy supports high-dose NTG as both safe and effective for hypertensive HF. Use a dedicated line/short tubing to prevent adsorption issues. 3. Refractory Hypertension If SBP remains > 160 mmHg despite NIPPV and aggressive NTG, add a second vasodilator: Clevidipine: Ultra-short-acting calcium channel blocker (titratable and rapid). Nicardipine: Effective alternative for rapid BP control. Enalaprilat: Consider if the above are unavailable. Troubleshooting & Pitfalls The “Mask Intolerant” Patient Hypoxia is the primary driver of agitation. NIPPV is the best sedative. * Pharmacology: If needed, use small doses of benzodiazepines (Midazolam 0.5–1 mg IV). AVOID Morphine: Data suggests higher rates of adverse events, invasive ventilation, and mortality. A 2022 RCT was halted early due to harm in the morphine arm (43% adverse events vs. 18% with midazolam). The Role of Diuretics In SCAPE, diuretics are not first-line. The problem is redistribution, not volume excess. Diuretics will not help in the first 15–30 minutes and may worsen kidney function in a (relatively) hypovolemic patient. Delay Diuretics until the patient is stabilized and clear systemic volume overload (edema, weight gain) is confirmed. Disposition Admission: Typically requires CCU/ICU for ongoing NIPPV and titration of vasoactive infusions. Weaning: As BP normalizes and work of breathing improves, infusions and NIPPV can be gradually tapered. Take-Home Points Recognize SCAPE: Hyperacute dyspnea + severe HTN. Trust your POCUS (B-lines) over a “clear” CXR. NIPPV Immediately: Don’t wait. It saves lives and prevents tubes. High-Dose NTG: Use boluses to “catch up” to the sympathetic surge. Don’t fear the dose. Avoid Morphine: Use small doses of benzos if the patient is struggling with the mask. Lasix Later: Prioritize afterload reduction over diuresis in the hyperacute phase. Read More

Dr. Monty Pal and Dr. Hope Rugo discuss advances in antibody-drug conjugates for various breast cancer types as well as treatment strategies in the new era of oral SERDs for HR-positive breast cancer. TRANSCRIPT Dr. Monty Pal: Hello, and welcome to the ASCO Daily News Podcast. I'm your host, Dr. Monty Pal. I'm a medical oncologist and vice chair of academic affairs here at the City of Hope Comprehensive Cancer Center, Los Angeles. Today, I'm thrilled to be joined by Dr. Hope Rugo, an internationally renowned breast medical oncologist and my colleague here at City of Hope, where she leads the Women's Cancers Program and serves as division chief of breast medical oncology. Dr. Rugo is going to share with us exciting advances in antibody-drug conjugates (ADCs) that are expanding treatment options in various breast cancer types. She'll also address some of the complex questions arising in the new era of oral SERDs (selective estrogen receptor degraders) that are revolutionizing treatment in the hormone receptor-positive breast cancer space. Our full disclosures are available in the transcript of this episode.  Dr. Rugo, welcome, and thanks so much for being on the podcast today. Dr. Hope Rugo: Thank you. Pleasure to be here. Dr. Monty Pal: So, I'm going to switch to first names if you don't mind.  The first topic is actually a really exciting one, Hope, and this is antibody-drug conjugates. I don't know if I've ever shared this with you, but I actually started my training at UCLA, I was a med student and resident there, and it was in Dennis Slamon's lab. I worked very closely with Mark Pegram and a handful of others. This is right around the time I think a lot of HER2-directed therapies were really evolving initially in the clinics. Now we've got antibody-drug conjugates. Our audience is well-familiar with the mechanism there but tell us about how ADCs have really started to reshape therapy for HER2-positive breast cancer. Dr. Hope Rugo: Yeah, I mean, this is a really great place to start. I mean, we have had such major advances in breast cancer just this year, I think really changing the paradigm of treating patients. But HER2-positive disease, we've been used to having sequenced success of new agents. And I think the two biggest areas where we've made advances in HER2-positive disease, which were remarkably advanced this year in 2025, have been in antibody-drug conjugates with trastuzumab deruxtecan and with new oral tyrosine kinase inhibitors (TKIs) that have less of a target on EGFR and more on HER2, so they have an overall more tolerable toxicity profile and therefore a potentially better efficacy in the clinic. At least that's what we're seeing with these new strategies that we couldn't really pursue in the past because of toxicities of the oral TKIs. So, although our topic is ADCs, I'm going to include the TKI because it's so important in our thinking about treating HER2-positive disease. In the metastatic setting, we've seen these remarkable improvements in progression-free and overall survival in the second-line setting with T-DXd, or trastuzumab deruxtecan, compared to T-DM1. And then sequencing ADCs with giving T-DXd after T-DM1 was better than an oral tyrosine kinase or a trastuzumab combination with standard chemotherapy. That was DESTINY-Breast03 and DESTINY-Breast02. So, then we've had other trials since then, and T-DXd has moved into the early-stage setting, which I'll talk about in just a moment. But the next big trial for T-DXd in HER2-positive disease was moving it to the first-line setting to supplant what has become an established treatment for now quite a long time: the so-called CLEOPATRA regimen, which used the combined antibodies trastuzumab, pertuzumab with a taxane as first-line therapy. And then we've proceeded on with maintenance with ongoing HP for patients with responding or stable disease. And we'd seen long-term data showing, you know, at 8 years there was a group of patients whose cancers had never progressed and continued improved overall survival. So, T-DXd was studied in DESTINY-Breast09, either alone or in combination with pertuzumab compared to THP. The patient population had received a little bit more prior treatment, but interestingly, not a lot compared to CLEOPATRA. And they designed the trial to be T-DXd continued until progression with or without pertuzumab versus THP, which would go for six cycles and then stop around six cycles, and then stop and continue HP. Patients who had hormone receptor-positive disease could use hormone therapy, and this is one of the issues with this dataset because, surprisingly in this dataset and one other I'll mention, very few patients took hormone therapy. And even in the maintenance trial, the HER2CLIMB-05, less than 50% took hormone therapy as maintenance. This is kind of shocking to me and highlights an area of really important education, that outcome is improved when you add endocrine therapy for hormone receptor-positive HER2-positive metastatic disease in the maintenance phase, and it's a really important part of treatment. But suffice it to say, you know, you're kind of studying continued chemo versus stopping chemo in maintenance. And T-DXd, as we all expected, in combination with pertuzumab was superior to THP in terms of progression-free survival, really remarkably improved. And you could stop the chemo with toxicity, but most people continued it with T-DXd. Again, not a lot of people got hormone therapy, which is an issue, and you stop the chemo in the control arm. So, this has brought up a lot of interest in trying to use T-DXd as an induction and then go to maintenance, much as we do with the CLEOPATRA regimen with hormone therapy. But it brings up another issue. So first, T-DXd is superior; it's a great treatment. Not everybody needs to have it because we don't know whether it's better to give T-DXd first or second with progression - that we need a little bit longer follow-up. But just earlier this week, interestingly, the third week of December, the U.S. FDA approved T-DXd in the DESTINY-Breast09 approach with pertuzumab. So as I mentioned earlier, there was a T-DXd-alone arm; that arm has not yet reported. So very interesting, we don't know if you need pertuzumab or not. So what about the maintenance? That's the other area where we've made a huge advance here. So, we all want to stop chemo and we want to stop T-DXd. You don't want somebody being nauseated for two years while they're on treatment, and also there's a small number of patients with mostly de novo metastatic HER2-positive disease who are cured of their disease. We'd like to expand that, and I think these new drugs give us the opportunity to improve the number of patients who might be cured from metastatic disease. So the first maintenance study we saw was adding palbociclib, the CDK4/6 inhibitor, to endocrine therapy and HP, essentially. There, we had a remarkable improvement in progression-free survival difference of 15.2 months: 29 to 44 months, really huge. At San Antonio this year, we saw data with this oral tyrosine kinase inhibitor tucatinib, already showed it was great in a triplet, but as maintenance in combination with HP, it showed also a remarkable improvement in progression-free survival. But the numbers were all shifted down. So in PATINA, the control arm was in the 24-month range; here it was the tucatinib-HP arm that was in the 25 months and 16 months for control. So there was a differential benefit in ER-negative and ER-positive disease. So I think we're all thinking that our ideal approach moving forward would be to give T-DXd to most patients, we see how they do, and treat to best response. And then, stop the T-DXd, start HP, trastuzumab, pertuzumab for ER-negative, with tucatinib for ER-positive with palbociclib. We also have early data that suggests that both approaches may reduce the development of brain metastases, an issue in HER2-positive disease, and delay time to progression of brain metastases as seen in HER2CLIMB-05 in very early data - small numbers, but still quite intriguing that you might delay progression of brain metastases with tucatinib that clearly has efficacy in the brain.  So, I think that this is a hugely exciting advance for our patients, and these approaches are quickly moving into the early stage setting. T-DXd compared to standard chemo, essentially followed by THP, so a sequenced approach resulted in more pathologic complete responses than a standard THP-AC-type neoadjuvant therapy. T-DXd alone for eight cycles wasn't better, and that's interesting. We still need the sequenced non-cross-resistant chemo. But I think even more importantly, the data from DESTINY-Breast05 looking at T-DXd versus T-DM1 in patients with residual disease after neoadjuvant HER2-targeted therapy showed a remarkable improvement in invasive disease-free survival with T-DXd versus T-DM1, and quite early. It was a high-risk population, higher risk than the T-DM1 trial with KATHERINE, but earlier readout with a remarkable improvement in outcome. We expect to be FDA approved sometime in the first half of 2026. So then we'll get patients who've already had T-DXd who get metastatic disease. But my hope is that with T-DXd, maybe with tucatinib in the right group of patients or even sequenced in very high-risk disease, that we could cure many more patients with early-stage HER2-positive breast cancer and cure a subset, a greater subset of patients with de novo metastatic disease. Dr. Monty Pal: That's brilliant. And you tackled so many questions that I was going to follow up with there: brain metastases, etc. That was sort of looming in my mind. I mean, general thoughts on an ADC versus a TKI in the context of brain mets? Dr. Hope Rugo: Yeah, it's an interesting question because T-DXd has shown quite good efficacy in this setting. And tucatinib, of course, had a trial where they took patients with new brain mets, so a larger population than we've seen yet for the T-DXd trials, and saw that not only did they delay progression of brain metastases and result in shrinkage of existing untreated brain mets, but that patients who develop a new brain met, they could stay on the same assigned treatment. They got stereotactic radiation, and then the patients who were on tucatinib with trastuzumab and capecitabine had a further delay in progression of brain mets compared to those on the placebo arm, even after treatment of a new one that developed on treatment. So, I think it's hard. I think most of us for a lot of brain mets might start with the tucatinib approach, but T-DXd is also a very important treatment. You know, you're kind of trading off a diarrhea, some liver enzyme elevations with tucatinib versus nausea, which you really have to work on managing because it can be long-delayed nausea, and this risk of ILD, interstitial lung disease, that's about 12%, with most but not all trials showing a mortality rate from interstitial lung disease of just under 1 percent. In the early-stage setting, it was really interesting to see that with T-DXd getting four cycles in the neoadjuvant setting, a lot less ILD noted than the patients who got up to 14 cycles, as I think they got a median of 10 cycles in the post-surgical setting, there was a little bit more ILD. But I think we're going to be better and better at finding this earlier and preventing mortality by just stopping drug and treating earlier with steroids. Dr. Monty Pal: And this ILD issue, it always seems to resurface. There are drugs that I use in my kidney cancer clinic, everolimus, common to perhaps the breast cancer clinic as well, pembrolizumab, where I think the pattern of pneumonitis is quite different, right? What is your strategy for recognizing pneumonitis early in this context? Dr. Hope Rugo: Well, it is, and you know, having done the very early studies in everolimus where we gave it in the neoadjuvant setting and we're like, "Hmm, the patient came in with a cough. What's going on?" You know, we didn't know. And you have mouth sores, you know, we were learning about the drug as we were giving it. What we don't do with everolimus and CDK4/6 inhibitors, for example, is grade 1 changes like radiation pneumonitis, we don't stop, we don't treat it. We only treat for symptoms. But because of the mortality associated with T-DXd, albeit small, we stop drug for grade 1 imaging-only asymptomatic pneumonitis, and some of us treat with a half dose of steroids just to try and hasten recovery. We've actually now published or presented a couple of datasets from trials, a pooled analysis and a real-world analysis, that have looked at patients who were retreated after grade 1 pneumonitis or ILD and tolerated drug very well and none of them died of interstitial lung disease, which was really great to see because you can retreat safely and some of these patients stayed on for almost a year benefiting from treatment. So, there's a differential toxicity profile with these drugs and there are risk factors which clearly have identified those at higher risk: prior ILD, for example. A French group said smoking; other people haven't found that, maybe because they smoked more in France, I don't know. And being of Japanese descent is quite interesting. The studies just captured that you were treated in Japan, but I think it's probably being of Japanese descent with many drugs that increases your risk of ILD. And, you know, older patients, people who have hypoxia, those are the patients. So, how do we do this? With everolimus, we don't have specific monitoring. But for T-DXd we do; we do every nine weeks to start with and then every 12 weeks CT scans because most of the events occur relatively early. Somebody who's older and at higher risk now get the first CT at six weeks. Dr. Monty Pal: This is super helpful. And I have to tell you, a lot of these drugs are permeating the bladder cancer space which, you know, is ultimately going to be a component of my practice, so thank you for all this. We could probably stay on this topic of HER2-positive disease forever. I'm super interested in that space still. But let me shift gears a little bit and talk about triple-negative breast cancer and this evolving space of HR-positive, HER2-low breast cancer. I mean, tell us about ADCs in that very sort of other broad area. Dr. Hope Rugo: So triple-negative disease is the absolute hardest subset of disease that we have to treat because if you don't have a great response in the early stage setting, the median survival is very short, you know, under two years for the majority of TNBCs, with the exception of the small percentage of low proliferative disease subsets. The co-question is what do we do for these patients and how do we improve outcome? And sacituzumab govitecan has been one strategy in the later line setting that was shown to improve progression-free and overall survival, the Trop-2 ADC. We had recently three trials presented with the two ADCs, sacituzumab govitecan and the other Trop-2 ADC that's approved for HR-positive disease, datopotamab deruxtecan. And they were studied in the first-line setting. Two trials with SG, sacituzumab govitecan, those trials, one was PD-L1 positive, ASCENT-04. That showed that SG with a checkpoint inhibitor was superior, so pembrolizumab was superior to the standard KEYNOTE-355 type of treatment with either a taxane or gemcitabine and carboplatin with pembrolizumab for patients who have a combined positive score for PD-L1, 10 or greater. So, these are patients who are eligible for a checkpoint inhibitor, and SG resulted in an improved progression-free survival.  The interesting thing about that dataset is that few patients had received adjuvant or neoadjuvant checkpoint inhibitor, which is fascinating because we give it to everybody now. But access is an issue and timing of the study enrollment was an issue. The other thing which I think we've all really applauded Gilead for is that there was automatic crossover. So, you could get from the company, to try and overcome some of the enormous disparities worldwide in access to these life-saving drugs, you could get SG through the company for free once you had blinded independent central review confirmation of disease progression. Now, a lot of the people who got the SG got it through their insurance, they didn't bill the company, but 80 percent of patients in the control arm received SG in the second-line setting. So that impacts your ability to look at overall survival, but it's an incredibly important component of these trials. So then at ESMO, we saw the data from SG and Dato-DXd in the first-line metastatic setting for patients who either had PD-L1-negative disease or weren't eligible for an immunotherapy. For the Dato study, TROPION-Breast02, that was 10 percent of the patients who had PD-L1-positive disease but didn't get a checkpoint inhibitor, and for the ASCENT-03 trial population it was only 1 percent. Importantly, the trials allowed patients who relapsed within a year of receiving their treatment with curative intent, and the Dato study, TB-02, allowed patients who relapsed while on treatment or within the first six months, and that was 15 percent of the 20 percent of early relapsers. The ASCENT trial, ASCENT-03, had 20 percent who relapsed between 6 and 12 months. The drugs were better than standard of care chemotherapy, the ADCs in both trials, which is very nice. Different toxicity profiles, different dosing intervals, but better than standard of care chemotherapy in the disease that's hardest for us to treat. And importantly, when you looked at the subset of early relapsers, those patients also did better with the ADC versus chemotherapy, which is incredibly important. And we were really interested in that 15 percent of patients who had early relapse. I actually think that six months thing was totally contrived, invented, you know, categorization and doesn't make any sense, and we should drop it. But the early relapsers were 15 percent of TB-02 and Dato was superior to standard of care chemo. We like survival, but the ASCENT trial again allowed the crossover to an approved ADC that improved survival and 80 percent of patients crossed over. In the Dato trial, they did not allow crossover, they didn't provide Dato, which isn't approved for TNBC but is for HR-positive disease, and they didn't allow, of course, pay for SG. So very few patients actually crossed over in their post-treatment data and in that study, they were able to show a survival benefit. So actually, I think in the U.S. where we can use approved drugs already before there's a fixed FDA approval, that people are already switching to use SG or Dato in the first-line setting for metastatic TNBC that's both PD-L1 positive for SG and PD-L1 negative for both drugs. And I think understanding the toxicity profiles of the two drugs is really important as well as the dosing interval to try and figure out which drug to use. Dr. Monty Pal: Brilliant. Brilliant. Well, I'm going to shift gears a little bit. ADCs are a topic, again, just like HER2-positive disease we could stay on forever. Dr. Hope Rugo: Huge. Yes. Dr. Monty Pal: But we're going to shift gears to another massive topic, which is oral SERDs. In broad strokes, right, this utilization of CDK4/6 inhibitors in the context of HR-positive breast cancer is obviously, you know, a paradigm that's been well established at this point. Where do we sequence in oral SERDs? Where do they fit into this paradigm? Dr. Hope Rugo: Ha! This is a rapidly changing area; we keep changing what we're saying every other minute. And I think that there are three areas of great interest. So one is patients who develop ESR1 mutations that allow constitutive signaling through the estrogen receptor, even when there's not estrogen around, and that is a really important mutation that is subclonal; it develops under the pressure of treatment in about 40 percent of patients. And it doesn't happen when you first walk in the door. And what we've seen is that oral SERDs as single agents are better than standard single-agent endocrine therapy in that setting. The problem that we've had with that approach is that we're now really interested in giving targeted agents with our endocrine therapies, not just in the first-line setting where CDK4/6 inhibitors are our standard of care with survival benefit for ribociclib and, you know, survival benefit in subsets with other CDK4/6 inhibitors, and abemaciclib with a numeric improvement. So we give it first line. The question is, what do you do in the second-line setting? Because of the recent data, we now believe that oral SERDs should be really given with a targeted agent. And some datasets which were recently presented, which I think have helped us with that, have been EMBER-3 and then the most recently evERA BC, or evERA Breast Cancer, that looked at the oral SERD giredestrant with everolimus compared to standard of care endocrine therapy with everolimus, where 100 percent of patients received prior CDK4/6 inhibitor and showed a marked improvement in progression-free survival, including in the subsets of patients with a short response, 6-12 months of prior response to CDK4/6 inhibitor and in those who had a PIK3CA pathway mutation. The thing is that the benefit looks like it's much bigger in the ESR1 mutant population, although response was better, PFS wasn't better in the wild type. So, we're still trying to figure that out. We also saw EMBER-3 with imlunestrant and abemaciclib as a second line. Not everybody had had a prior CDK4/6 inhibitor; they compared it to imlunestrant alone, but still the data was quite striking and seemed to cross the need for ESR1 mutations. And then lastly, we saw data from the single arms of the ELEVATE trial looking at elacestrant with everolimus and abemaciclib and showed these really marked progression-free survival data, even though single-arm, that crossed the mutation status. At least for the everolimus combination, abemaciclib analysis is still to come in the mutated subgroups. But really remarkable PFS, much longer.  Single-agent fulvestrant after CDK4/6 inhibitor AI has a PFS in like the three-month range and in some studies, maybe close to five months. These are all at 10-plus months and really looking very good. And so those questions are, is it ESR1 mutation alone? Is it all comers? We'd like all comers, right? We believe in the combination approach and we're learning more about combinations with drugs like capivasertib and other drugs as we move forward. Everybody now wants to combine their targeted agent with an oral SERD because they're clearly here to stay with quite remarkable data. The other issue, so the second issue in the metastatic setting is, does it make a difference if we change to an oral SERD before radiographic imaging evidence of progression? And that was the question asked in the SERENA-6 trial where patients had serial monitoring for the presence of ESR1 mutations in ctDNA. And those who had them without progression on imaging could be randomized to switch to camizestrant with the same CDK4/6 inhibitor or stay on their same AI CDK4/6 inhibitor. And they showed a difference in progression-free survival that markedly favored camizestrant. But interestingly, the people who were on the standard control arm had an ESR1 mutation, we think AIs don't work, they stayed on for nine more months. The patients who were on the camizestrant stayed on for more than 16 months. And they presented some additional subset data which showed the same thing: follow-up PFS data, PFS2, all beneficial in SERENA-6 at the San Antonio [Breast Cancer Symposium]. So, we're still a little bit unclear about that. They did quality of life, and pain was markedly improved. They had a marked delayed time to progression of pain in the camizestrant arm. So this is all a work in progress, trying to understand who should we switch without progression to an oral SERD based on this development of this mutation that correlates with resistance. And, you know, it's interesting because the median time to having a mutation was 18 months and the median time to switch was almost 24 months. And then there were like more than 3,000 patients who hadn't gotten a mutation, hadn't switched, and were still okay. So screening everybody is the big question, and when you would start and who you would change on and how this affects outcome. Patients didn't have access to camizestrant in the control arm, something we can't fix but we have experimental drugs. We're actually planning a trial, I hope in collaboration with the French group Unicancer, and looking at this exact question. You know, if you switch and you change the CDK4/6 inhibitor and then you also allow crossover, what will we see? Dr. Monty Pal: We're coming right to the tail end of our time here, and I could probably go on for another couple of hours with you here. But if you could just give us maybe one or two big highlights from San Antonio, any thoughts to leave our audience with here based on this recent meeting? Dr. Hope Rugo: Yeah, I mean, I talked about a lot of those new data already from San Antonio, and the one that I'd really like to mention which I think was, you know, there were a lot of great presentations including personalized screening presented from the WISDOM trial by my colleague Laura Esserman, fascinating and really a big advance. But lidERA was the big highlight, I think, outside of the HER2CLIMB-05 which I talked about earlier in HER2-positive disease. And this study looked at giredestrant, the oral SERD versus standard of care endocrine therapy as treatment for medium and high-risk early-stage breast cancer. And what they showed, which I think was really remarkable with just about a three-year median follow-up, was an improvement in invasive disease-free survival with a hazard ratio of 0.7. I mean, really quite remarkable and so early. It looked as though this was all driven by the high-risk group, which makes sense, not the medium risk, it's too early. And also that there was a bigger benefit in patients who were on tamoxifen compared to giredestrant versus AI, but for both groups, the confidence intervals didn't cross 1. There's even a trend towards overall survival, even though it's way too early. I think that, you know, really well-tolerated oral drug that could improve outcome in early-stage disease, this is the first advance we've seen in over two decades in the treatment of early-stage hormone receptor-positive disease with just endocrine therapy. I think we think that we don't want to give up CDK4/6 inhibitors because we saw a survival benefit with abemaciclib and a trend with giving ribociclib in the NATALEE trial. So we're thinking that maybe one approach would be to give CDK4/6 inhibitors and then switch to an oral SERD or to have enough data to be able to give oral SERDs with these CDK4/6 inhibitors for early-stage disease. And that's all in the works, you know, lots of studies going on. We're going to see a lot of data with both switching 8,000 patients with an imlunestrant switching trial, an elacestrant trial going on, and safety data with giredestrant with abemaciclib and soon to come ribociclib. So, this is going to change everything for the treatment of early-stage breast cancer, and I hope cure more patients of the most common subset of the most common cancer diagnosed in women worldwide. Dr. Monty Pal: Super exciting. It's just remarkable to hear how this has evolved since 25 years ago, which is really the last time I sort of dabbled in breast cancer.  Thank you so much, Hope, for joining us today. These were fantastic insights. Appreciate you being on the ASCO Daily News Podcast and really want to thank you personally for your remarkable contribution to the field of breast cancer. Dr. Hope Rugo: Thank you very much, and thanks for talking with me today. Dr. Monty Pal: You got it. And thanks a lot to our listeners today as well. You'll find links to all the studies we discussed today in the transcript of this episode. Finally, if you value the insights that you hear today on the ASCO Daily News Podcast, please rate, review, and subscribe wherever you get your podcasts. Disclaimer: 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 opinion of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:   Dr. Monty Pal @montypal Dr. Hope Rugo   @hoperugo Follow ASCO on social media:        ASCO on X  ASCO on Bluesky       ASCO on Facebook        ASCO on LinkedIn        Disclosures:     Dr. Monty Pal:    Speakers' Bureau: MJH Life Sciences, IntrisiQ, Peerview   Research Funding (Inst.): Exelixis, Merck, Osel, Genentech, Crispr Therapeutics, Adicet Bio, ArsenalBio, Xencor, Miyarsian Pharmaceutical   Travel, Accommodations, Expenses: Crispr Therapeutics, Ipsen, Exelixis   Dr. Hope Rugo:    Honoraria: Mylan/Viatris, Chugai Pharma   Consulting/Advisory Role: Napo Pharmaceuticals, Sanofi, Bristol Myer   Research Funding (Inst.): OBI Pharma, Pfizer, Novartis, Lilly, Merck, Daiichi Sankyo, AstraZeneca, Gilead Sciences, Hoffman La-Roche AG/Genentech, In., Stemline Therapeutics, Ambryx  

Join us as we dive into the latest advancements in HER2-positive breast cancer from SABCS 2025. In this episode, we discussed key studies including DESTINY Breast-11 and DESTINY Breast-05, highlighting their implications for neoadjuvant and adjuvant treatments. We also explored the HER2CLIMB-05 trial and the recent approval of TDXD with pertuzumab in frontline settings for metastatic HER2-positive disease. Special guest Dr. Harold Burstein from Dana-Farber Cancer Institute shared his insights on the evolving landscape of HER2-positive breast cancer treatment, including the importance of patient selection and the management of side effects like interstitial lung disease (ILD). Tune in for a comprehensive recap of the latest data, treatment algorithms, and how these advancements are changing the lives of patients with HER2-positive breast cancer. Don't forget to like, subscribe, and check out our other episodes for more updates on treatment options and conference highlights! Topics Covered: • DESTINY Breast-11 and its impact on neoadjuvant therapy • Insights from DESTINY Breast-05 on adjuvant treatment for high-risk residual disease • HER2CLIMB-05 trial findings and implications for metastatic disease • The role of T-DXd with pertuzumab in frontline settings • The PATINA trial and its significance for triple-positive metastatic breast cancer Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and check out our other episodes for more insights on treatment algorithms, recent approvals, and conference highlights! #SABCS2025 #HER2positive #DestinyTrials #OncologyBrothers #BreastCancer

In this episode of the Oncology Brothers podcast, we are joined by Dr. Komal Jhaveri, a breast medical oncologist at Memorial Sloan Kettering, to discuss the evolving landscape of metastatic hormone receptor positive breast cancer, particularly focusing on low and ultra-low HER2 expression. Key topics include: • The significance of the DESTINY Breast-04 and DESTINY Breast-06 studies and their impact on treatment options. • The definition and implications of low and ultra-low HER2 expression in clinical practice. • The importance of HER2 testing and the dynamic nature of HER2 expression in tumors. • Treatment sequencing strategies, including the use of antibody-drug conjugates (ADCs) like trastuzumab deruxtecan (TDXd) and sasituzumab govitecan. • Management of treatment-related toxicities, including ILD, nausea, and alopecia. Join us for an insightful discussion that aims to keep healthcare professionals updated on the latest advancements in cancer care. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to subscribe for more episodes and insights!

Welcome back to the Oncology Brothers podcast! In this episode, we continue the CME series on HER2-positive GEJ and gastric cancer, shifting focus to the essential topic of treatment toxicity management. We're joined by two leading experts: Dr. Geoffrey Ku from Memorial Sloan Kettering and Dr. Shruti Patel from Stanford University. Building on their previous discussion of upper GI treatment algorithm with Dr. Rutika Mehta, this episode delves into the practical realities of managing patients on complex regimens. Drs. Ku & Patel break down the side effect profiles across the treatment continuum—from frontline trastuzumab-based combinations to emerging therapies like zanidatamab—and provide actionable strategies for community oncologists. Episode Highlights: • Practical management of frontline side effects with FOLFOX/XELOX chemotherapy plus trastuzumab and pembrolizumab • Reality check on trastuzumab cardiotoxicity: incidence rates and monitoring protocols in gastric vs. breast cancer • Immune-related adverse events with checkpoint inhibitors: what's common vs. rare in GI cancers • Critical insights on zanidatamab's synergistic diarrhea toxicity and mandatory prophylaxis strategies • TDXd (Enhertu) in second-line: moving beyond ILD fears to address frequent cytopenias and marrow management • Expert consensus on infusion reaction management for novel biologics • The importance of managing baseline symptoms in patients with dysphagia and nausea This episode bridges the gap between trial data and clinical practice, offering real-world wisdom on keeping patients on effective therapies through proactive toxicity management. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to subscribe for our complete CME series covering treatment algorithms, FDA approvals, and practical management strategies! Accreditation/Credit Designation Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Physicians' Education Resource®, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Acknowledgment of Commercial Support This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc. Link to gain CME credits from this activity: https://www.gotoper.com/courses/navigating-the-adverse-event-landscape-in-her2-gea-therapy

There was some learning to be done this year, there was some traveling to be done this year -- and there was some celebrating to do this year as well! Jen Wescoe of the Wescoe Foundation for Pulmonary Fibrosis joins Crockett to discuss all the wonderful events of 2025, and some of the exciting and revolutionary things she learned about on the road of battling IPF and ILD! It's the 'Pulmonary Fibrosis' podcast! Brought to you by the Wescoe Foundation for Pulmonary Fibrosis -- visit Wescoe.org for more!See omnystudio.com/listener for privacy information.

In this episode of the Oncology Brothers podcast, we dived deep into the world of antibody drug conjugates (ADCs) in non-small cell lung cancer (NSCLC). We welcomed Dr. Jacob Sands from the Dana-Farber Cancer Institute to discuss the latest ADCs approved for NSCLC, including Trastuzumab deruxtecan (TDXd), Datopotamab deruxtecan (Dato-DXd), and Telisotuzumab Vedotin (Teliso-V). We explored the side effect profiles of these therapies, focusing on critical toxicities such as interstitial lung disease (ILD), mucositis, and peripheral neuropathy. Dr. Sands shared valuable clinical pearls on managing these adverse events, emphasized the importance of proactive monitoring and patient education. Key topics covered in this episode: • Overview of ADCs and their role in NSCLC treatment • TDXd: alopecia, ILD, fatigue, nausea/vomiting • Dato-DXd:  cytopenias, mucositis, dry eyes • Teliso-V: peripheral neuropathy, fatigue, peripheral edema • The evolving landscape of ADCs and future directions in lung cancer treatment Whether you're a healthcare professional or someone interested in oncology, this episode provides essential insights into the management of side effects associated with these innovative therapies. Tune in for practical advice and expert opinions that can enhance patient care in the community setting. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and hit the notification bell for more episodes on practice-changing discussions in oncology! #ADC #NSCLC #TDXd #DatoDXD #TelisoV #ToxicityManagement #OncologyBrothers

Drs. Jack Cush and Artie Kavanaugh preview the upcoming RNL 2026 meeting in Dallas, TX on February 7 & 8, 2026. Register at RheumNow.Live Below is the program: Saturday, February 7, 2026, 7:50 - 8:00 am Welcome & Introductions Drs. Cush and Kavanaugh 8:00 - 10:00 am POD I - Rheumatoid Arthritis: Achieving Better Outcomes 8:00 – 8:30 am Mortality in RA: A Story of Decline, Delay, or Plateau? Elena Myasoedova, MD 8:30 – 9:00 am The Mucosal Hypothesis of Rheumatoid Arthritis Kristen Demoruelle, MD 9:00 – 9:30 am ILD in RA – Recent Advances Jeffrey Sparks, MD 9:30 – 10:00 am Rheumatoid arthritis Faculty Q&A 10:00 - 10:15 am STEP 1: Placebos in Rheumatology Andreas Kerschbaumer, MD 10:15 -10:30 am STEP 2: Disease Modification in Osteoarthritis Tuhina Neogi, MD PhD 10:30 – 11:05 Break 11:05 - 12:10 pm POD II – Advancing Practice 11:05 – 11:30 am Obesity & Inflammation: Weight Management in Rheumatology Uzma Haque, MD 11:30 - 11:55 am Mitigating risk in Rheum Pts undergoing surgery Susan Goodman, MD 11:55 -12:10 pm Practice Panel Faculty Q&A 12:10 – 1:00pm Lunch 1:00 – 3:00 pm POD III – Decisions in Psoriatic Arthritis 1:00 - 1:30 pm Paradoxical Psoriasis and Strange Reactions Joseph Merola, MD 1:30 - 2:00 pm Why Do Plain X rays in Psoriatic Arthritis Arthur Kavanaugh, MD 2:00 - 2:30 pm IL-23 vs IL-17 inhibitors in PsA Andre Ribero, MD 2:30 - 3:00 pm Past, Present & Future of Gout Robert Terkeltaub, MD 3:00 - 3:30 pm Psoriatic Faculty Q&A 3:30 - 4:05 pm Break 4:05 - 4:20 pm STEP 3: Helicobacter Pylori update Byron Cryer, MD 4:20 - 4:35 pm STEP 4: History of Gout Robert Terkeltaub, MD 4:35 – 5:15 pm Keynote Address: 50 Years of Osteoporosis Michael McClung, MD 5:30 – 7:00 pm Reception Sunday, February 8, 2026 Day TOPIC Speaker 7:50-8:00 am Welcome & Introductions Drs. Cush and Kavanaugh 8:00 - 10:00 am POD IV – Staying Ahead of Spondyloarthritis 8:00 – 8:30 am Diagnosing Axial Spondyloarthritis in 2026 Denis Poddubnyy, MD 8:30 – 9:00 am Spondyloarthritis Complications Jessica Walsh, MD 9:00 – 9:30 am 2026 Advances in Spondyloarthritis Catherine Bakewell, MD 9:30 – 10:00 am Spondyloarthritis Faculty Q&A 10:00 – 10:15 am STEP 5: Asymptomatic Elevation of CK Rojit Agarwal, MD MS 10:15 – 10:30 am STEP 6: Update on Myositis Antibodies Rojit Agarwal, MD MS 10:30 – 11:05 am Break 11:05 – 12:10 am POD V – Highlights in Autoimmune Disease 11:05 - 11:35 am SMILE Study – Hydroxychloroquine in ANA+ Arthralgia Nancy Olsen, MD 11:35 – 12:05 am Sjogren's Treatment Landscape in 2026 Matthew Baker, MD 12:05 - 12:20 pm Autoimmune Faculty Q&A 12:20 – 1:25 pm POD VI - Large & Small Vessel Vasculitis 12:20 – 12:45 pm Embracing Relapses in PMR and GCA Michael Putman, MD 12:45 - 1:10 pm Small vessel vasculitis Clay Cockerell, MD 1:10 - 1:25 pm Vasculitis Faculty Q&A 1:30 pm Adjourn

Jennifer Keeley and Mary Whittenhall, experienced nurse practitioners in the field of pulmonary hypertension, discuss the management of cough in patients receiving inhaled therapies for pulmonary hypertension and interstitial lung disease. #GossamerBioPartner #sponsored This Special Edition episode is sponsored by Gossamer Bio. Jennifer Keeley, DPN: My name's Jennifer Keeley. I'm a nurse practitioner and I practice in a large academic institution in Pittsburgh, Pennsylvania, Allegheny Health Network, specifically Allegheny General Hospital. I am a nurse practitioner there and have been in the clinic over 10 years, and in the PH space as a nurse practitioner for over 15 years, as a registered nurse for almost 20 years. So, I have a lot of experience and I'm really excited to be here today to talk about inhaled therapies and cough. Mary Whittenhall, MSN: My name is Mary Whittenhall. I'm also a nurse practitioner. I am currently an advanced practice provider at Pulmonary and Sleep Associates in East Providence, Rhode Island. I've been in pulmonary hypertension for about 11 years now. In that time, I have worked in a variety of settings, both inpatient and outpatient, managing patients with pulmonary vascular disease, and have also touched upon patients with interstitial lung disease and pulmonary hypertension.  I get very excited when I hear about new opportunities for our PH patients. I think a lot about even when I started in pulmonary hypertension and the therapies that were available to our patients. Many of these therapies had been around for a little bit of time. But also something that I think is extremely exciting is that there's just been a rapid progression in development of therapies. And now, with the focus of looking at these therapies as potentially disease modifying, not necessarily slowing the progression of disease. With the advent of all of these new therapies, there become more options for our patients, as well. Often, patients can't tolerate some of the medications that we have due to side effects and despite lots of work to manage these side effects, the patients are not always successful. One of the great things being involved in an academic center is that we have the ability to help link patients to cutting edge research, particularly looking at a new drug that is an inhaled therapy that has shown significant promise in improving the lives of patients with pulmonary hypertension. As a part of the PH community, we all do quite a bit of networking with each other, as well as with our patients and other colleagues in the space. In that time, we did network regarding the study and have participated in some activities where we're looking at the data from the Phase 2 part of this trial and then also looking at some of the side effect management related to the medication, which seemingly is well tolerated. However, for some patients it may not come extremely easy. I think that's where the role of the nurse or the advanced practice provider really comes in this space is that we have a real strong dedication to helping educate patients about ways to manage these side effects. We want patients to be able to continue with therapies. We don't want them to say, "Well, this isn't working for me, it's time to move on." I think that we have a lot of strategies and a lot of experience with trying to help patients really figure out the best way to manage these things and to be confident that they can continue on with obviously the biggest benefit of improving their pulmonary vascular disease. Jennifer Keeley, DPN: We actually met at an advisory board last year. It was an advisory board consistent of registered nurses and nurse practitioners who, just like Mary and myself, have vast experience with patients and therapies, not just in the inhaled space, but more conventional pulmonary vasodilator medications that have been used in our patients for many, many years. As Mary had suggested before, when we start to think about newer agents, many, many of them are not the conventional pulmonary vasodilator medications, but disease modifying agents. Now, we've acquired an armamentarium of medications. So, inhaled delivery is just a really great option to avoid systemic side effects on top of each other. Our PH patients today, many of them are on more than three therapies, many of them are on four or even more therapies, so the delivery of the medication is just one aspect. When we talk about cough and side effects, I like to think about it and explain to my patient when we talk about side effects, particularly cough, to imagine a Venn diagram with cough being in the middle and what affects cough. You see this outward circle, how we deliver it, what kind of device we deliver it in. The drug, how small, large are the particle size? Is it easy enough to use for our patients? The formulation, is it dry powdered versus inhaled aerosolized? And then finally, just the patient themselves. What's their background? What type of PAH do they have? So, we can talk a little bit more about this, but just to get us started, this is how this developed and we had a lovely advisory board meeting with seralutinib and Gossamer Bio, and this was the outcome of it. We produced a lovely poster. This is a conversation if you will, that Mary and I are going to have based on what we talked about and the poster production, that came out of that wonderful advisory board. Mary Whittenhall, MSN: Inhaled therapies are unique in a way in that they actually have direct access to the lungs. So, when you think of an oral medication, an oral medication needs to be digested in the gut and sometimes that systemic digestion takes a while. Additionally, it's also often that we see patients that have more systemic side effects when we're using an oral formulation. Intravenous or subcutaneous formulations of these medications tend to cause pretty strong systemic side effects for patients, and there tends to be a lot of management that we need to do to help make these side effects more tolerable. For most of our patients, I say to them, "You're going to think I'm cruel because I don't really want these side effects to go away." In a way, we look at them almost as if you have a cup and your cup is full of water and after the top of the water hits the rim of the cup, then the water starts to spill over onto the sides of the cup. I think of other medications that we typically prescribe for patients in that way that when we get that spill over, so to speak, it's an indication that we've actually targeted all of those receptors that we want to help with vasodilation. Now that we're looking at other medications that don't really necessarily look at vasodilation, we're looking more at treating the blood vessels in a different way or affecting the process for which those blood vessels become diseased. I think that the side effects become different and I think they become less. In working with inhaled therapies, as you can imagine, the number one side effect that most patients will complain of is cough. Sometimes we have patients who have an underlying cough already, and that's usually not related to PAH, but in PH-ILD where we now have an FDA indication to use another inhaled therapy, we've seen in treating these patients that baseline cough is something that is extremely problematic for them before they even start therapies. So, trying to find ways to improve that baseline cough, treat any underlying symptoms, things like acid reflux as well, that may cause that, treating seasonal allergies, et cetera, and then, obviously, managing any additional overlapping side effects that may occur because of the new therapy that they're on. Jennifer Keeley, DPN: I think that's a really important part, is to talk with the patient, educate the patient on these inhaled therapies. First and foremost, that cough is almost an expected side effect. These are patients particularly with our interstitial lung disease patients that have PAH, cough is a part of their daily life. It's important to document and ascertain what these patients' baseline cough is. In many, many clinics, particularly pulmonary PAH clinics, and I'm sure much like Mary's, many of my colleagues have recommended using validated cough questionnaires so that we can get a really, really good baseline of what that patient's baseline cough is. Are you coughing at night? Do you have mucus? How long have you been coughing? Does it interfere with the quality of your life? Do you cough at night? Does it keep you up? Does it interrupt your sleep? Those kinds of things that help differentiate acute cough versus chronic cough. Many of these patients cough every day. They also have other inhaled therapies such as our ILD patients that are also on corticosteroids, many of them on inhaled corticosteroid therapy that can thin the oral pharynx, the posterior pharynx, and really affect the degree of nerve innervation in the posterior pharynx in the mouth. So, just really understanding what the patient's baseline cough is and educating them on the fact that cough is likely going to be a side effect with the use of this inhaled therapy. Certainly, as we continue to use the therapy, we would hope that the cough can be mitigated either through some lifestyle modifications, some natural remedies, and even some medical remedies such as bronchodilators. But really teaching the patient about the medication and inherently that this is likely going to induce a cough, but that we have mitigation strategies to help dissipate the cough. I always like to tell my patients also in the clinical trials, particularly the Phase 2 clinical trials that are out there that patients had a lot of cough. The patients on drug that were in most of the Phase 2 clinical trials for seralutinib and even for treprostinil inhaled, 30 to 40% of them experienced cough. But at the same token, the placebo-based patients that did not receive drug in these Phase 2 clinical trials also had a lot of cough. So, what that's telling you is yes, you're going to get probably some more cough, but it's likely not going to be that much or more far advanced than the cough that you're already experiencing. I also think it's important to tell these patients, many, many patients that experienced cough did not stop the medication. Actually, in these Phase 2 clinical trials, very few stop the medication. So, that gives you a really good big picture that we are pretty good at educating our patients how to mitigate cough, and if we aren't, then we should learn how to do so. Mary Whittenhall, MSN: I think it's important for us to set some expectations for patients when we're talking about cough. We've already discussed a bit that cough can happen for people from other things outside of their lung disease, but it's important to also look at what may be causing the cough when we are giving a patient an inhaled therapy. So, any type of inhaled therapy, whether that be a dry powder, a mist, whether that's nebulized or through in actuated inhaler, there are particles inside of that medication as it's going in and those little particles, when your lungs inhale that medication, those particles are penetrating your lungs and your lungs are not accustomed to them being there. It's almost as if your lungs are saying, "I don't recognize this. I don't know why this is here," and it may feel like it's an irritant, so you may start coughing as a result of that, but the cough is not necessarily a bad thing. Those particles are there, and the job is to essentially help deliver the medicine to penetrate that lung tissue and then for your body then to absorb the medicine. Your airways and your blood vessels inside of your lungs are extremely close to each other. So, when you inhale that medication, those little blood vessels are also right next to where those airways are, and then that is how those blood vessels then absorb that medication, because they're so close to the site at which those particles come into your lungs. Jennifer Keeley, DPN: I think this is an important concept to understand. They choose the form of delivery based on the goal of delivering the most medication efficiently to the distal bronchioles. That's where the disease is. It's in the distal arteries. So, trying to formulate how we get these very powerful, oftentimes disease modifying agents into the periphery of the lungs can be very challenging. Dry powdered inhaler is one form that the variability of delivery is not as dispersed as an aerosolized. So, it's more efficient delivery to the place where the medication needs to work the best, and that's in the distal periphery of the lungs. Unfortunately, one thing you have to deal with is that oftentimes these medications, dry powdered medications, not just in the PH space, but there's a lot of other dry powdered inhalers in the COPD space, as well. Oftentimes, what happens is these powdered particles get dispersed extra thoracically. So, they get dispersed in the oral mucosa, in the posterior pharynx, on the way down into the stomach. That's wherein we have to deal with mitigating side effects. The biggest side effect of these particles, even though they're very small, is cough. So, technique comes into play. Mitigating things to coat the posterior pharynx come into play. Re-education comes into play. Show me again how you're doing this inhalation, because I don't think that you're holding this okay. In one instance, I had a patient that was inhaling dry powdered inhaler with the medication right out of the refrigerator. So, the medication was cold. It was clumping at the back of her throat. All of these things really take into consideration how we most efficiently get the medicine to these pulmonary arterial hypertension patients where their disease is oftentimes very difficult to get to, and other forms of medications that are systemic, orals, parenterals that have first pass metabolism, and so you're going to get more side effects from those medications. So, I always teach my patients, "Hey, we're a couple steps ahead because we're bypassing the type of metabolism that you get with orals and even parenterals." Mary Whittenhall, MSN: There are so many challenges that these patients face. Oftentimes, patients have never been sick before they develop this, and now we're putting them on multiple therapies, multiple modalities, telling them that there's going to be side effects and they need to learn how to manage them. It's certainly a lot to handle. But I think one of the best things that we have in our PH community is that we really work so hard to partner with the patients and their loved ones and forming this relationship, fostering that relationship as time goes on, I believe that these patients really do trust us and that what we're telling them is things are going to be okay. We are going to be there by your side. We're not going to give you this medicine and then say, "See you in six months. Hope everything goes well." We're really going to be working with them. In some cases in my specialty clinic, we have nurses, we have a pharmacist, a pharmacy tech, and then our advanced practice providers that check in with these patients quite regularly. We are actually taking the initiative to reach out to them versus the patient who may be having trouble advocating for themselves or feeling like, "Really, I don't want to be a pain, but this is challenging for me." We are really in touch with them, and that connection also helps to keep patients on therapy. So, what are some of the specific techniques to manage or mitigate cough? This is something that was a real hot topic at our last advisory meeting. We put together a bunch of folks in the room who deal with other inhaled therapies and patients that have cough and said, "Well, what do you tell patients to do?" First and foremost is to look at any other potentially underlying conditions that may be causing cough and ensure that treatment of those underlying conditions is optimized. I think cough is actually the number one referral for any type of pulmonary practice, but it is a really, really broad differential when it comes down to it. We obviously look first at things like environmental factors. If this could be seasonal allergies, then we try treating patients with antihistamines. Perhaps some of those are intranasal, as well, that may help with some things like rhinorrhea or post nasal drip. Acid reflux is actually a huge, huge reason for cough. Many patients say, 'Well, I don't get acid reflux. I don't feel that burning in my chest after I eat," but come to find out that it can actually be a silent trigger. So, treating patients with medicines that help to reduce acid or suppress acid will oftentimes help with that cough. On top of that, when we're dealing with patients that are on inhalers and now we're adding another inhaled therapy. I find that for some patients that are on actual inhalers that sometimes they do better with nebulized treatments. The nebulized treatments are slower, and may have a bit of a better penetration into the lungs and the patients tend to like it. It is one of those things that you do need to be compliant with in order to really see the benefits to it. I will say that oftentimes, again, partnering with the patient, giving them specific instructions about how to do all of this, we can really see some improvement to those symptoms. Then, there's just basic over-the counter measures and precautions, things like making sure that when you're eating that you're not laying down at least for 60 minutes after you've been eating. If you do have acid reflux, trying to sleep with two pillows or a wedge pillow, that can help to keep the head of your bed elevated. Some of our patients have those really fancy adjustable beds that are also quite helpful for that. I think that sometimes things like basic cough drops actually can be quite wonderful and helpful. Drinking very cold or very warm water or tea, adding some honey to that if a patient isn't diabetic, things like that tend to really help with cough. We reinforce these measures when we start therapies like this. Jennifer Keeley, DPN: In terms of mitigation, I think it's really important on technique. This is why, as Mary had alluded to, it's so important to follow up closely with these patients, particularly our elderly patients who sometimes don't, if they have connective tissue disease or scleroderma, have a lot of good fine motor coordination. A couple of things that I wanted to touch on with regards to that… One, these inhalers are typically high resistance, low flow. So, these are not the type of patients that need to be taking in very forceful inhalations with these inhalers and thank goodness, because we're talking about patients that have inflammatory interstitial lung disease, as well as pulmonary vascular disease. So their degree of inspiratory effort is actually minimal to disperse that medication to the distal pulmonary bronchials. It's equivalent to them taking a deep breath in when you ask them to auscultate their lungs. So it's not a big forceful breath. The other thing is too, a lot of times, sometimes more variability in the disbursement of the drug is better in compliance with some patients. Dry-powdered inhalers, again, do not take a very big forceful effort, but some of them, because they are powder, some of the medication will actually hit the back of the throat as it goes down and can cause some irritation, whereas the nebulized form does have a variability in disbursement and can be more easily tolerated in some. The other issue is the technique itself. Oftentimes, we ask them in some of the inhaled therapies to lower the device itself so that the tongue doesn't protrude and get in the way, because if medication gets on the tongue, the next swallow that they take, that medication is going to hit their posterior pharynx, and they're going to probably cough pretty aggressively. I always start off by telling my patients, "Cough is not a bad thing. It's actually a protective reflex and it's involuntary. So, if you cough, don't actually negate it. Don't think it's a bad thing." It's actually a very protective mechanism that avoids irritation in most of our patients probably already irritated mucosa. So, that's how I like to start the conversation. There's so many good techniques that we can share with them over time, and I might add that each patient is different. Each patient needs to have a personalized plan. When we talk about giving patients warm tea, typically chamomile, chamomile tea in itself is anti-inflammatory. Then, when you add something like honey, which is also a soothing, anti-inflammatory natural remedy, you have to really think to yourself, "They're getting honey. If they're diabetic, we don't want to give them too much honey." But, you have to make sure that their swallowing technique is good. There's no aspiration there, particularly if we give them cough drops. Then, just simple things that actually numb or anesthetize the back of the throat are very, very helpful for elderly patients who do have very friable tissue and mucosa from previous therapies like inhaled corticosteroids, as I had talked about before. Dairy products, I tend to ask my patients to avoid those. They can produce a lot of mucus, which these coughs that we see in our inhaled therapy patients are typically tend to be dry coughs, but some patients that have concomitant asthma, COPD, along with their ILD that are using these inhaled therapies can actually have more of a congested mucoid cough. So, avoiding dairy before and after use is always very smart. Avoiding alcohol, avoiding acidic drinks like orange juice, also very, very helpful. Mary Whittenhall, MSN: The part about technique I think is so, so important here. Oftentimes, when patients start these therapies, when they are approved in that space, the specialty pharmacy has a nurse educator that will come out to the patient's home and provide education not only about the medication, but about the administration of that medication. In many cases, the patients will take their first dose while the nurse is present so that the nurse can then critique whether or not the patient took it appropriately and how they tolerated it. I'm going to give a shout out to our nurse educators from the specialty pharmacies, because they are also a really crucial set of eyes and ears for us out in the community. They do provide education to the patients in the home. We have had situations where the patient has done well while the nurse is there, and then two weeks later we get a call from the patient saying, "I can't do this. This isn't working for me." And I'll say, "Okay. Well, you have a couple options. We can have you come in to the clinic and I want you to bring your device with you, and I would like to watch you do a treatment, or I can have the nurse come out and see you again and go over that." And they'll say, "I already know what I'm doing. I don't need that." But in many instances, we have found that they have adjusted their technique. They might've gotten into some bad habit since the nurse has left them. So, really reinforcing that is important. The other thing that I wanted to bring up is that some of our patients with connective tissue disease also have thickness in their tongues. So, their tongues become thicker and more sclerotome as their connective tissue disease progresses. For some of those patients, it is actually hard for them to get their tongue flat enough so that they can get the medication down into their lungs. So, working with those patients to find strategies to help rectify that. I will say that it is not impossible, it just takes maybe a little extra work. Jennifer Keeley, DPN: Inhaled therapies in themselves are pretty portable. Mary had alluded to a little bit earlier, our patients with pulmonary vascular disease, PAH, that are on parenteral therapies, delivering the conventional pulmonary vasodilator therapies. As we get into the new disease modifying agents such as seralutinib, which are anti-fibrotic, anti-inflammatory, anti-prolific medications, these are portable therapies that are actually modifying the disease. So they're portable. They're easy to use. They're easy to use for our patients, again, that are elderly or are younger and are still working, they have a professional life, they don't have to wear a pump that's 24/7 oftentimes. They can use these inhaled therapies first to see if they can avoid parenteral therapy with prostacyclins. Their quality of life is improved immensely. When you can take an inhaled therapy two to four times a day and really improve quality of life, decrease cough, decrease dyspnea, or shortness of breath on exertion. Sometimes, these patients that do very, very well can actually reduce their supplemental oxygen needs. Just improving their walk distances without having to stop or have excessive dyspnea, improves their quality of life. More time spent with loved ones and more time spent in social environments rather than sitting at home. These wonderful inhaled portable therapies have significantly changed our patients' lives and improved their quality of lives. Mary Whittenhall, MSN: This community I think is phenomenal. It's made up of so many great people. There are many patients who have been a part of this space for a long time who really want to help other patients who may be newer to the journey than them. I'm a big advocate for support groups. We've had an extremely active support group in our area for a long time, and I often partner some of my patients that have been with me for quite some time with some of the new patients that may need a bit more help. I can tell them things and my colleagues can tell them things. Oftentimes, the same message doesn't resonate. It resonates differently, I think when it comes from a peer, a patient who may have experienced the same thing as them. One of the things that I really try to drive home with our patients is just that sense of empowerment. Connect with these other folks in the community. They want to help you. They remember what it feels like being newly diagnosed or starting a new therapy or transitioning from another therapy. What that change is like. One of the other things I tell my patients is that we all sit at the same table. I'm not better than you. Maybe I have this information, but this information is for you. It's for you to take and to improve your life. If that information doesn't work for you, then you come back to me with some feedback and we come up with something else that's going to be more helpful to you. I really think having an equal playing field with them and having a very open and honest dialogue is what is going to help our patients do the best. If patients don't feel comfortable reaching out to other local patients or connecting with an in-person support group, there are tons of online resources through the PHA, through phaware®, Team Phenomenal Hope, lots of great groups out there that do things virtually. I think in some ways for some patients, anonymity is important, so being able to protect that is an option for them, but to be able to still get what they need so they can become the best advocate for themselves that they can. Jennifer Keeley, DPN: I stress so importantly to my patients, we are here today in this great environment and we have the armamentarium of medications to treat because of patients just like you that have contributed to the science of the disease and implemented themselves and engaged in these clinical trials. Right now we have an ongoing clinical trial for seralutinib called PROSERA, that's enrolling as we speak. Patients are the best advocates, not only for themselves, but for other patients, and they talk. There's a lot of social media out there where patients communicate amongst themselves and they say, "Through the help of my provider and through the help of my family, I was hesitant to start this additional therapy." They do have, at this juncture, and I don't think it's such a bad thing, they do have a little bit of a pharmacy burden now. Again, these aren't our patients that are on one or two therapies. They're on four or more oftentimes. When you take in our ILD patients, they're also on disease modifying agents, as well, for their interstitial lung disease. So again, I think it's really important for patients to communicate amongst themselves and share their ups and downs in the disease, but also share the rewards that come with surviving and living with PAH. I think one thing that we really do have to understand though is like many other chronic diseases, PH is a personalized disease. You need to have a personalized approach for your patients. That's why it's so very important to do a really good history of your patients and understand not only what their baseline cough is, but who they are, what their personal history is. Are they working? Who's helping to care for them? Who's helping to make that chamomile tea with honey? Who's going to the store to get that? A personalized approach is so important for these patients, I can't stress that enough. Mary Whittenhall, MSN: Special thanks to everybody involved in this project. This was extremely exciting. To my co-podcaster, Jennifer Keeley, who is amazing, and all of us in the PH community are extremely lucky to have her. We are all aware that you are all rare, and we are grateful to be able to help you in this journey. Jennifer Keeley, DPN: Thank you so much, Mary, and what a pleasure it's been to speak with you about cough and inhaled therapies, and thank you to Gossamer Bio for this opportunity and for the opportunity that led to this podcast, which was a significant advisory board amongst specialists in our field, advanced practice providers and registered nurses who were able to convene in a great open space and talk about this. I think this moves our science forward. It helps us to talk about the disease and take better care of our patients. Again, my name is Jennifer Keeley. It's been such a pleasure to deal with my good friend Mary Whittenhall today, and we're aware that our patients are very rare. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Follow us on instagram, facebook and x.com @phaware. Engage for a cure: www.phaware.global/donate #phaware Share your story: info@phaware.com Like, Subscribe and Follow us: www.phawarepodcast.com. #phawareMD #PHILD @GossamerBio @AHNtoday

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net.Today on the emDOCs cast with Brit Long (@long_brit), we cover management of AE-ILD exacerbations. For more on evaluation, take a listen to Part 1. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play

The Derm on RheumNow podcast is a collection of Citations and Content curated for dermatologists – addressing Psoriasis, PsA, CLE, vasculitis, HS, other CTD skin disorders. dermatology drugs, biiologics, JAKs - their use, efficacy and side effects.  Features Dr. Jack Cush, Editor at RheumNow.com.  SHOW NOTES 1. Retrospective study of 39 pts w/ MDA5 + DM-ILD Rx w baricitinib. 31 (79.5%) had improvement in Gottron's, heliotrope, dyspnea, HRCT score, ferritin, LDH, steroid dose & 6 mo survival (87% vs. 70%, p = 0.047). https://t.co/RCTbBsCkeV 2. Pulse Steroids and Mycophenolate in Juvenile Dermatomyositis JAMA Dermatology has published a pilot study demonstrating the safety and efficacy of intermittent intravenous methylprednisolone pulse (IVMP) therapy plus mycophenolate in 28 patients with JDM. https://t.co/i2HBycbWY9 3. Myelodysplastic & chr myelomonocytic leukemia pts rarely get lupus. Review of 19 w/ SLE & 5 w/ CLE; these were older (65 yrs), more male (15M/9F), w/ less renal [10%] & articular [36%] Dz w/ less dsDNA [32%]. Thought to be clonal inflammatory, & not autoinflammatory, process. https://t.co/EAvkJm6GQs 4. Serious infections w/ adalimumab. Marketscan MarketScan claims study (1/17-12/20) of ADA Rx in Hidradenitis Supprativa (n 1650) or psoriasis(8699). Risk of SIE & hospitalization greater w/ HS (HR 1.53); esp for sepsis & GU infxnhttps://t.co/2qa7O2v6fm 5. No risk of MACE seen w/ initiation of IL-17(R)A inhib. French study of 34 241 ipts Rx IL-17(R)Ai and 381 MACEs. MACE risk was not elevated (OR, 1.25 [95% CI, 0.75-2.08] vs TNF-α inhibitors. https://t.co/WcjgRhr8mj 6. Genetic Risks and Severe Cutaneous Reactions to Allopurinol A matched cohort study shows that HLA-B*58:01 and HLA-A*34:02 are strongly associated with allopurinol-induced severe cutaneous adverse reactions (SCARs), these alleles were absent in more than one-third of those https://t.co/NLpHVhr9Ww 7. Western Australia study of 1854 SLE pts (median 40 yrs old). Interstitial lung disease was seen in in 3.8% of SLE, 26 fold more than controls. Risk factors for ILD included older age, smoking and serositis. SLE-ILD pts had higher mortality rates (MR 52.0, CI 37.0–71.1). 8. 25-Hydroxyvitamin D levels and Lupus Outcomes Lupus patients entering a prospective cohort study with low vitamin D levels faced doubled all-cause mortality risk and tripled risk for major cardiovascular events during follow-up averaging 6 years, researchers said. https://t.co/CYwVy7ls7y 9. ACR2025 Non-Renal Lupus Guidelines – from ACR Convergence 2025 10. 900,000 vs 9 It takes about 900,000 minutes to become a board-certified dermatologist. At that point, you might be very skilled and well-informed. It takes less than nine minutes to make your patient feel seen, understood and reassured. If you skip the 9 minutes, you wasted the 900,000  https://t.co/o7BaWjS4HB

Welcome to the emDOCs.net podcast! Join us as we review our high-yield posts from our website emDOCs.net.Today on the emDOCs cast with Brit Long (@long_brit), we cover interstitial lung disease and exacerbations. In Part 1, we discuss some background, presentation, and the ED evaluation. Part 2 will cover management. To continue to make this a worthwhile podcast for you to listen to, we appreciate any feedback and comments you may have for us. Please let us know!Subscribe to the podcast on one of the many platforms below:Apple iTunesSpotifyGoogle Play 

Listen to JCO's Art of Oncology article, "The Man at the Bow" by Dr. Alexis Drutchas, who is a palliative care physician at Dana Farber Cancer Institute. The article is followed by an interview with Drutchas and host Dr. Mikkael Sekeres. Dr. Drutchas shares the deep connection she had with a patient, a former barge captain, who often sailed the same route that her family's shipping container did when they moved overseas many times while she was growing up. She reflects on the nature of loss and dignity, and how oncologists might hold patients' humanity with more tenderness and care, especially at the end of life. TRANSCRIPT Narrator: The Man at the Bow, by Alexis Drutchas, MD  It was the kind of day that almost seemed made up—a clear, cerulean sky with sunlight bouncing off the gold dome of the State House. The contrast between this view and the drab hospital walls as I walked into my patient's room was jarring. My patient, whom I will call Suresh, sat in a recliner by the window. His lymphoma had relapsed, and palliative care was consulted to help with symptom management. The first thing I remember is that despite the havoc cancer had wreaked—sunken temples and a hospital gown slipping off his chest—Suresh had a warm, peaceful quality about him. Our conversation began with a discussion about his pain. Suresh told me how his bones ached and how his fatigue left him feeling hollow—a fraction of his former self. The way this drastic change in his physicality affected his sense of identity was palpable. There was loss, even if it was unspoken. After establishing a plan to help with his symptoms, I pivoted and asked Suresh how he used to spend his days. His face immediately lit up. He had been a barge captain—a dangerous and thrilling profession that took him across international waters to transport goods. Suresh's eyes glistened as he described his joy at sea. I was completely enraptured. He shared stories about mornings when he stood alone on the bow, feeling the salted breeze as the barge moved through Atlantic waves. He spoke of calm nights on the deck, looking at the stars through stunning darkness. He traveled all over the globe and witnessed Earth's topography from a perspective most of us will never see. The freedom Suresh exuded was profound. He loved these voyages so much that one summer, despite the hazards, he brought his wife and son to experience the journey with him. Having spent many years of my childhood living in Japan and Hong Kong, my family's entire home—every bed, sheet, towel, and kitchen utensil—was packed up and crossed the Atlantic on cargo ships four times. Maybe Suresh had captained one, I thought. Every winter, we hosted US Navy sailors docked in Hong Kong for the holidays. I have such fond memories of everyone going around the table and sharing stories of their adventures—who saw or ate what and where. I loved those times: the wild abandon of travel, the freedom of being somewhere new, and the way identity can shift and expand as experiences grow. When Suresh shared stories of the ocean, I was back there too, holding the multitude of my identity alongside him. I asked Suresh to tell me more about his voyages: what was it like to be out in severe weather, to ride over enormous swells? Did he ever get seasick, and did his crew always get along? But Suresh did not want to swim into these perilous stories with me. Although he worked a difficult and physically taxing job, this is not what he wanted to focus on. Instead, he always came back to the beauty and vitality he felt at sea—what it was like to stare out at the vastness of the open ocean. He often closed his eyes and motioned with his hands as he spoke as if he was not confined to these hospital walls. Instead, he was swaying on the water feeling the lightness of physical freedom, and the way a body can move with such ease that it is barely perceptible, like water flowing over sand. The resonances of Suresh's stories contained both the power and challenges laden in this work. Although I sat at his bedside, healthy, my body too contained memories of freedom that in all likelihood will one day dissipate with age or illness. The question of how I will be seen, compared to how I hoped to be seen, lingered in my mind. Years ago, before going to medical school, I moved to Vail, Colorado. I worked four different jobs just to make ends meet, but making it work meant that on my days off, I was only a chairlift ride away from Vail's backcountry. I have a picture of this vigor in my mind—my snowboard carving into fresh powder, the utter silence of the wilderness at that altitude, and the way it felt to graze the powdery snow against my glove. My face was windburned, and my body was sore, but my heart had never felt so buoyant. While talking with Suresh, I could so vividly picture him as the robust man he once was, standing tall on the bow of his ship. I could feel the freedom and joy he described—it echoed in my own body. In that moment, the full weight of what Suresh had lost hit me as forcefully as a cresting wave—not just the physical decline, but the profound shift in his identity. What is more, we all live, myself included, so precariously at this threshold. In this work, it is impossible not to wonder: what will it be like when it is me? Will I be seen as someone who has lived a full life, who explored and adventured, or will my personhood be whittled down to my illness? How can I hold these questions and not be swallowed by them? "I know who you are now is not the person you've been," I said to Suresh. With that, he reached out for my hand and started to cry. We looked at each other with a new understanding. I saw Suresh—not just as a frail patient but as someone who lived a full life. As someone strong enough to cross the Atlantic for decades. In that moment, I was reminded of the Polish poet, Wislawa Szymborska's words, "As far as you've come, can't be undone." This, I believe, is what it means to honor the dignity of our patients, to reflect back the person they are despite or alongside their illness…all of their parts that can't be undone. Sometimes, this occurs because we see our own personhood reflected in theirs and theirs in ours. Sometimes, to protect ourselves, we shield ourselves from this echo. Other times, this resonance becomes the most beautiful and meaningful part of our work. It has been years now since I took care of Suresh. When the weather is nice, my wife and I like to take our young son to the harbor in South Boston to watch the planes take off and the barges leave the shore, loaded with colorful metal containers. We usually pack a picnic and sit in the trunk as enormous planes fly overhead and tugboats work to bring large ships out to the open water. Once, as a container ship was leaving the port, we waved so furiously at those working on board that they all started to wave back, and the captain honked the ships booming horn. Every single time we are there, I think of Suresh, and I picture him sailing out on thewaves—as free as he will ever be. Mikkael Sekeres: Welcome back to JCO's Cancer Stories: The Art of Oncology. This ASCO podcast features intimate narratives and perspectives from authors exploring their experiences in oncology. I'm your host, Mikkael Sekeres. I'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. What a treat we have today. We're joined by Dr. Alexis Drutchas, a Palliative Care Physician and the Director of the Core Communication Program at the Dana-Farber Cancer Institute, and Assistant Professor of Medicine at Harvard Medical School to discuss her article, "The Man at the Bow." Alexis, thank you so much for contributing to Journal of Clinical Oncology and for joining us to discuss your article. Dr. Alexis Drutchas: Thank you. I'm thrilled and excited to be here. Mikkael Sekeres: I wonder if we can start by asking you about yourself. Where are you from, and can you walk us a bit through your career? Dr. Alexis Drutchas: The easiest way to say it would be that I'm from the Detroit area. My dad worked in automotive car parts and so we moved around a lot when I was growing up. I was born in Michigan, then we moved to Japan, then back to Michigan, then to Hong Kong, then back to Michigan. Then I spent my undergrad years in Wisconsin and moved out to Colorado to teach snowboarding before medical school, and then ended up back in Michigan for that, and then on the east coast at Brown for my family medicine training, and then in Boston for work and training. So, I definitely have a more global experience in my background, but also very Midwestern at heart as well. In terms of my professional career trajectory, I trained in family medicine because I really loved taking care of the whole person. I love taking care of kids and adults, and I loved OB, and at the time I felt like it was impossible to choose which one I wanted to pursue the most, and so family medicine was a great fit. And at the core of that, there's just so much advocacy and social justice work, especially in the community health centers where many family medicine residents train. During that time, I got very interested in LGBTQ healthcare and founded the Rhode Island Trans Health Conference, which led me to work as a PCP at Fenway Health in Boston after that. And so I worked there for many years. And then through a course of being a hospitalist at BI during that work, I worked with many patients with serious illness, making decisions about discontinuing dialysis, about pursuing hospice care in the setting of ILD. I also had a significant amount of family illness and started to recognize this underlying interest I had always had in palliative care, but I think was a bit scared to pursue. But those really kind of tipped me over to say I really wanted to access a different level of communication skills and be able to really go into depth with patients in a way I just didn't feel like I had the language for. And so I applied to the Harvard Palliative Care Fellowship and luckily and with so much gratitude got in years ago, and so trained in palliative care and stayed at MGH after that. So my Dana-Farber position is newer for me and I'm very excited about it. Mikkael Sekeres: Sounds like you've had an amazing career already and you're just getting started on it. I grew up in tiny little Rhode Island and, you know, we would joke you have to pack an overnight bag if you travel more than 45 minutes. So, our boundaries were much tighter than yours. What was it like growing up where you're going from the Midwest to Asia, back to the Midwest, you wind up settling on the east coast? You must have an incredible worldly view on how people live and how they view their health. Dr. Alexis Drutchas: I think you just named much of the sides of it. I think I realize now, in looking back, that in many ways it was living two lives, because at the time it was rare from where we lived in the Detroit area in terms of the other kids around us to move overseas. And so it really did feel like that part of me and my family that during the summers we would have home leave tickets and my parents would often turn them in to just travel since we didn't really have a home base to come back to. And so it did give me an incredible global perspective and a sense of all the ways in which people develop community, access healthcare, and live. And then coming back to the Midwest, not to say that it's not cosmopolitan or diverse in its own way, but it was very different, especially in the 80s and 90s to come back to the Midwest. So it did feel like I carried these two lenses in the world, and it's been incredibly meaningful over time to meet other friends and adults and patients who have lived these other lives as well. I think for me those are some of my most connecting friendships and experiences with patients for people who have had a similar experience in living with sort of a duality in their everyday lives with that. Mikkael Sekeres: You know, you write about the main character of your essay, Suresh, who's a barge captain, and you mention in the essay that your family crossed the Atlantic on cargo ships four times when you were growing up. What was that experience like? How much of it do you remember? Dr. Alexis Drutchas: Our house, like our things, crossed the Atlantic four times on barge ships such as his. We didn't, I mean we crossed on airplanes. Mikkael Sekeres: Oh, okay, okay. Dr. Alexis Drutchas: We flew over many times, but every single thing we owned got packed up into containers on large trucks in our house and were brought over to ports to be sent over. So, I'm not sure how they do it now, but at the time that's sort of how we moved, and we would often go live in a hotel or a furnished apartment for the month's wait of all of our house to get there, which felt also like a surreal experience in that, you know, you're in a totally different country and then have these creature comforts of your bedroom back in Metro Detroit. And I remember thinking a lot about who was crossing over with all of that stuff and where was it going, and who else was moving, and that was pretty incredible. And when I met Suresh, just thinking about the fact that at some point our home could have been on his ship was a really fun connection in my mind to make, just given where he always traveled in his work. Mikkael Sekeres: It's really neat. I remember when we moved from the east coast also to the Midwest, I was in Cleveland for 18 years. The very first thing we did was mark which of the boxes had the kids' toys in it, because that of course was the first one we let them close it up and then we let them open it as soon as we arrived. Did your family do something like that as well so that you can, you know, immediately feel an attachment to your stuff when they arrived? Dr. Alexis Drutchas: Yeah, I remember what felt most important to our mom was our bedrooms. I don't remember the toys. I remember sort of our comforters and our pillowcases and things like that, yeah, being opened and it feeling really settling to think, "Okay, you know, we're in a completely different place and country away from most everything we know, but our bedroom is the same." That always felt like a really important point that she made to make home feel like home again in a new place. Mikkael Sekeres: Yeah, yeah. One of the sentences you wrote in your essay really caught my eye. You wrote about when you were younger and say, "I loved those times, the wild abandon of travel, the freedom of being somewhere new, the way identity can shift and expand as experiences grow." It's a lovely sentiment. Do you think those are emotions that we experience only as children, or can they continue through adulthood? And if they can, how do we make that happen, that sense of excitement and experience? Dr. Alexis Drutchas: I think that's such a good question and one I honestly think about a lot. I think that we can access those all the time. There's something about the newness of travel and moving, you know, I have a 3-year-old right now, and so I think many parents would connect to that sense that there is wonderment around being with someone experiencing something for the first time. Even watching my son, Oliver, see a plane take off for the first time felt joyous in a completely new way, that even makes me smile a lot now. But I think what is such a great connection here is when something is new, our eyes are so open to it. You know, we're constantly witnessing and observing and are excited about that. And I think the connection that I've realized is important for me in my work and also in just life in general to hold on to that wonderment is that idea of sort of witnessing or having a writer's eye, many would call it, in that you're keeping your eye open for the small beautiful things. Often with travel, you might be eating ramen. It might not be the first time you're eating it, but you're eating it for the first time in Tokyo, and it's the first time you've had this particular ingredient on it, and then you remember that. But there's something that we're attuned to in those moments, like the difference or the taste, that makes it special and we hold on to it. And I think about that a lot as a writer, but also in patient care and having my son with my wife, it's what are the special small moments to hold on to and allowing them to be new and beautiful, even if they're not as large as moving across the country or flying to Rome or whichever. I think there are ways that that excitement can still be alive if we attune ourselves to some of the more beautiful small moments around us. Mikkael Sekeres: And how do we do that as doctors? We're trained to go into a room and there's almost a formula for how we approach patients. But how do you open your mind in that way to that sense of wonderment and discovery with the person you're sitting across from, and it doesn't necessarily have to be medical? One of the true treats of what we do is we get to meet people from all backgrounds and all walks of life, and we have the opportunity to explore their lives as part of our interaction. Dr. Alexis Drutchas: Yeah, I think that is such a great question. And I would love to hear your thoughts on this too. I think for me in that sentence that you mentioned, sitting at that table with sort of people in the Navy from all over the world, I was that person to them in the room, too. There was some identity there that I brought to the table that was different than just being a kid in school or something like that. To answer your question, I wonder if so much of the challenge is actually allowing ourselves to bring ourselves into the room, because so much of the formula is, you know, we have these white coats on, we have learners, we want to do it right, we want to give excellent care. There's there's so many sort of guards I think that we put up to make sure that we're asking the right questions, we don't want to miss anything, we don't want to say the wrong thing, and all of that is true. And at the same time, I find that when I actually allow myself into the room, that is when it is the most special. And that doesn't mean that there's complete countertransference or it's so permeable that it's not in service of the patient. It just means that I think when we allow bits of our own selves to come in, it really does allow for new connections to form, and then we are able to learn about our patients more, too. With every patient, I think often we're called in for goals of care or symptom management, and of course I prioritize that, but when I can, I usually just try to ask a more open-ended question, like, "Tell me about life before you came to the hospital or before you were diagnosed. What do you love to do? What did you do for work?" Or if it's someone's family member who is ill, I'll ask the kids or family in the room, "Like, what kind of mom was she? You know, what special memory you had?" Just, I get really curious when there's time to really understand the person. And I know that that's not at all new language. Of course, we're always trying to understand the person, but I just often think understanding them is couched within their illness. And I'm often very curious about how we can just get to know them as people, and how humanizing ourselves to them helps humanize them to us, and that back and forth I think is like really lovely and wonderful and allows things to come up that were totally unexpected, and those are usually the special moments that you come home with and want to tell your family about or want to process and think about. What about you? How do you think about that question? Mikkael Sekeres: Well, it's interesting you ask. I like to do projects around the house. I hate to say this out loud because of course one day I'll do something terrible and everyone will remember this podcast, but I fancy myself an amateur electrician and plumber and carpenter and do these sorts of projects. So I go into interactions with patients wanting to learn about their lives and how they live their lives to see what I can pick up on as well, how I can take something out of that interaction and actually use it practically. My father-in-law has this phrase he always says to me when a worker comes to your house, he goes, he says to me, "Remember to steal with your eyes." Right? Watch what they do, learn how they fix something so you can fix it yourself and you don't have to call them next time. So, for me it's kind of fun to hear how people have lived their lives both within their professions, and when I practiced medicine in Cleveland, there were a lot of farmers and factory workers I saw. So I learned a lot about how things are made. But also about how they interact with their families, and I've learned a lot from people I've seen who were just terrific dads and terrific moms or siblings or spouses. And I've tried to take those nuggets away from those interactions. But I think you can only do it if you open yourself up and also allow yourself to see that person's humanity. And I wonder if I can quote you to you again from your essay. There's another part that I just loved, and it's about how you write about how a person's identity changes when they become a patient. You write, "And in that moment the full weight of what he had lost hit me as forcefully as a cresting wave. Not just the physical decline, but the profound shift in identity. What is more, we all live, me included, so precariously at this threshold. In this work, it's impossible not to wonder, what will it be like when it's me? Will I be seen as someone who's lived many lives, or whittled down only to someone who's sick?" Can you talk a little bit more about that? Have you been a patient whose identity has changed without asking you to reveal too much? Or what about your identity as a doctor? Is that something we have to undo a little bit when we walk in the room with the stethoscope or wearing a white coat? Dr. Alexis Drutchas: That was really powerful to hear you read that back to me. So, thank you. Yeah, I think my answer here can't be separated from the illness I faced with my family. And I think this unanimously filters into the way in which I see every patient because I really do think about the patient's dignity and the way medicine generally, not always, really does strip them of that and makes them the patient. Even the way we write about "the patient said this," "the patient said that," "the patient refused." So I generally very much try to have a one-liner like, "Suresh is a X-year-old man who's a barge captain from X, Y, and Z and is a loving father with a," you know, "period. He comes to the hospital with X, Y, and Z." So I always try to do that and humanize patients. I always try to write their name rather than just "patient." I can't separate that out from my experience with my family. My sister six years ago now went into sudden heart failure after having a spontaneous coronary artery dissection, and so immediately within minutes she was in the cath lab at 35 years old, coding three times and came out sort of with an Impella and intubated, and very much, you know, all of a sudden went from my sister who had just been traveling in Mexico to a patient in the CCU. And I remember desperately wanting her team to see who she was, like see the person that we loved, that was fighting for her life, see how much her life meant to us. And that's not to say that they weren't giving her great care, but there was something so important to me in wanting them to see how much we wanted her to live, you know, and who she was. It felt like there's some important core to me there. We brought pictures in, we talked about what she was living for. It felt really important. And I can't separate that out from the way in which I see patients now or I feel in my own way in a certain way what it is to lose yourself, to lose the ability to be a Captain of the ship, to lose the ability to do electric work around the house. So much of our identity is wrapped up in our professions and our craft. And I think for me that has really become forefront in the work of palliative care and in and in the teaching I do and in the writing I do is how to really bring them forefront and not feel like in doing that we're losing our ability to remain objective or solid in our own professional identities as clinicians and physicians. Mikkael Sekeres: Well, I think that's a beautiful place to end here. I can only imagine what an outstanding physician and caregiver you are also based on your writing and how you speak about it. You just genuinely come across as caring about your patients and your family and the people you have interactions with and getting to know them as people. It has been again such a treat to have Dr. Alexis Drutchas here. She is Director of the Core Communication Program at Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School to discuss her article, "The Man at the Bow." Alexis, thank you so much for joining us. Dr. Alexis Drutchas: Thank you. This has been a real joy. Mikkael Sekeres: If you've enjoyed this episode, consider sharing it with a friend or colleague, or leave us a review. Your feedback and support helps us continue to save these important conversations. If you're looking for more episodes and context, follow our show on Apple, Spotify, or wherever you listen, and explore more from ASCO at ASCO.org/podcasts. Until next time, this has been Mikkael Sekeres for the ASCO podcast Cancer Stories: The Art of Oncology. 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. Show notes: Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr. Alexis Drutchas is a palliative care physician at Dana Farber Cancer Institute.

ILD in Patients with Connective Tissue Disease  Fiber and Methotrexate  RA ILD Prediction: simple as a dipstick?  "Leftover Pain in Inflammatory Arthritis" 

Kenny Kasnett, a seasoned executive and entrepreneur whose life took an unexpected turn with a diagnosis of interstitial lung disease (ILD) joins the podcast for a powerful episode. What began as a persistent cough during a round of golf soon unraveled into a life-threatening condition that would ultimately require a lung transplant. Kenny opens up about the diagnostic journey, the emotional toll of living with ILD, and the difficult road leading up to transplant surgery. He shares a behind-the-scenes look at the complexities of preparing for and receiving a lung transplant, from waiting on the national registry to the moment he received the life-changing call. But Kenny's story is more than medical, it's about resilience, gratitude, and the extraordinary gift of a second chance at life. He speaks candidly about the pain, fear, and vulnerability he faced along the way, and how he leaned on the unwavering support of family, friends, and a stellar medical team. We also explore the long-term realities of transplant recovery, from managing medications and monitoring for rejection to navigating new physical limitations with hope and strength. Kenny's insights offer a beacon of light for others navigating lung disease and chronic illness. Topics Covered: Early signs and diagnosis of interstitial lung disease (ILD) Understanding ILD and idiopathic pulmonary fibrosis (IPF) Emotional and physical impact of progressive lung failure Choosing a lung transplant center and navigating evaluations The day of the transplant: fears, preparations, and gratitude Recovery and rehab: from ICU to walking again Long-term care, medications, and monitoring for rejection How this journey reshaped Kenny's perspective on life Advice for newly diagnosed patients and caregivers The importance of organ donation and honoring the donor Guest Bio: Kenny Kasnett is an accomplished business leader with decades of experience in finance, homebuilding, and real estate. Beyond his professional roles, Kenny is a lung transplant recipient and fierce advocate for those living with interstitial lung disease. Through his story, Kenny offers hope, encouragement, and critical insights into navigating serious illness with courage and grace. Resources & Links: Learn more about Interstitial Lung Disease (American Lung Association) National Jewish Health - Interstitial Lung Disease (ILD) Program Organ Donor Registration – Donate Life During the interview, Beth referenced a previous episode of It Happened To Me where the inspiring Zach Ship shared about his experience of getting a kidney transplant, this was Episode #44. The following episode (#45) Zach joined us again to talk about his other medical challenge, experiencing blindness before the age of 30.    Stay tuned for the next new episode of “It Happened To Me”! In the meantime, you can listen to our previous episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “It Happened To Me”.    “It Happened To Me” is created and hosted by Cathy Gildenhorn and Beth Glassman. DNA Today's Kira Dineen is our executive producer and marketing lead. Amanda Andreoli is our associate producer. Ashlyn Enokian is our graphic designer.   See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, ItHappenedToMePod.com. Questions/inquiries can be sent to ItHappenedToMePod@gmail.com. 

Our final webinar in this month's Rheum to Breathe: ILD campaign brings together ILD experts to discuss best practices in diagnosis, screening, and monitoring, covering: tools, labs, and imaging; timing and frequency of screening; ILD screening in RA; and, referral strategies. Panelists: Shane Shapera, MD Elana Bernstein, MD Bryant England, MD Moderator: Jack Cush, MD

QD clinics on ILD - lessons from the Clinic; brought to during the "Rheum to Breathe" ILD campaign ILD QD Clinic #4 ILD QD Clinics - Worsening Breathlessness in SSc ILD: The Pressure Is On  ILD QD clinics on ILD #1 - Be Careful What you Look For 

In this episode, our guests Dr. Sabrina Hoa and Dr. Marie Hudson explore new insights into late-onset interstitial lung disease (ILD) in scleroderma. Using data from the Canadian Scleroderma Research Group, they discuss how ILD can still develop years after diagnosis, challenging traditional screening timelines. They cover key findings, clinical implications, treatment patterns, and the need for more inclusive trials. The conversation also touches on mentorship and what's next in scleroderma research. 

Rheum to Breathe Rx Update ILD Treatment and Guidelines Part 4: Rheum + Pulm Collaborations in ILD including The Rheumatologist and Pulmonologist: Different approaches to the same patient (Dr. Paul Dellaripa and Dr Rachel Putman).

QD clinics on ILD - lessons from the Clinic; brought to during the "Rheum to Breathe" ILD campaign ILD QD Clinic #3 ILD QD Clinic: Application of the ACR CHEST Guidelines to Two Cases   ILD QD Clinic: Progressive RA-ILD Management  ILD QD Clinic: Beyond the Numbers in Newly Diagnosed ILD 

In this journal club, we will discuss two pivotal studies in ILD, the FIBRONEER study and the RECITAL study: Nerandomilast in Patients with Progressive Pulmonary Fibrosis, Maher, T.M. et al. NEJM. 2025 May 19. doi: 10.1056 Rituximab versus intravenous cyclophosphamide in patients with connective tissue disease-associated interstitial lung disease in the UK (RECITAL): a double-blind, double-dummy, randomised, controlled, phase 2b trial, Maher T.M., et al. Lancet 2023 Jan;11(1). doi: 10.1016 Panelists: Toby Maher, MD Shervin Assassi, MD Jack Cush, Moderator

"QD clinics on ILD - lessons from the Clinic; brought to during the "Rheum to Breathe" ILD campaign. Here are the individual video titles and links: ILD QD Clinic: Stick or twist (when not to change treatment)  https://youtu.be/sdGPsvcfyzQ ILD QD Clinic: Interstitial Lung Disease with Positive SSA and Rash  https://youtu.be/1H10_VR8t_0 ILD QD Clinic Video: RA and Bronchiectasis  https://youtu.be/-StSi3v8ew8  

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com. Are their benefits to Diet/vegan diets?  Whats the effect of menopause on CTD?  Ro52 makes a big entrance with all our ILD coverage this month.

This webinar will review the ACR and EULAR guidelines on interstitial lung disease, with a focus on ‘where are we now and where are we going?' in regards to treatment strategies and emerging therapies in ILD care. Panelists: Sindhu Johnson, MD Shane Shapera, MD Scott Matson, MD Jack Cush, MD - Moderator https://youtube.com/live/Viexwyv0sxs?feature=share

"QD clinics on ILD - lessons from the Clinic; brought to during the "Rheum to Breathe" ILD campaign

Dr. Jack Cush reviews the news and journal reports from RheumNow. This week - unemployment, diagnosing Sjogrens and alot of ILD.

We break down pneumothorax: risks, diagnosis, and management pearls. Hosts: Christopher Pham, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Pneumothorax.mp3 Download Leave a Comment Tags: Chest Trauma, Pulmonary, Trauma Show Notes Risk Factors for Pneumothorax Secondary pneumothorax Trauma: rib fractures, blunt chest trauma (as in the case). Iatrogenic: central line placement, thoracentesis, pleural procedures. Primary spontaneous pneumothorax Young, tall, thin males (10–30 years). Connective tissue disorders: Marfan, Ehlers-Danlos. Underlying lung disease: COPD with bullae, interstitial lung disease, CF, TB, malignancy. Technically, anyone is at risk. Symptoms & Differential Diagnosis Typical PTX presentation: Dyspnea, chest pain, pleuritic discomfort. Exam clues: unilateral decreased breath sounds, focal tenderness/crepitus. Red flags (suggest tension PTX): JVD Tracheal deviation Hypotension, shock physiology Severe tachycardia, hypoxia Differential diagnoses: Pulmonary: asthma, COPD, pneumonia, pulmonary edema (SCAPE), ILD, infections. Cardiac: ACS, CHF, pericarditis. PE and other acute causes of dyspnea. Diagnostics Bloodwork: limited role, except type & screen if intervention likely. EKG: reasonable given chest pain/shortness of breath.