Podcasts about mdedge hematology oncology

Systemic treatment for advanced urothelial cancer is quickly evolving. On this week’s podcast, Arjun Balar, MD, director of the genitourinary medical oncology program at New York University discusses his approach amid changing times with guest host Alan Lyss, MD, a community-based medical oncologist and clinical researcher in the St. Louis area before his recent retirement.  Chemotherapy or immunotherapy first line? With the negative phase 3 results for chemotherapy in combination with either pembrolizumab or atezolizumab, “if I use immunotherapy, I use it alone,” Dr. Balar said. Patients who need “a response right away” for aggressive disease get chemotherapy. In general, first-line chemotherapy “probably is the better route for a lot of people,” he said. There is a role for immunotherapy in the first line when chemotherapy can’t be tolerated because of age or other reasons, and in the second line, immunotherapy is standard of care. PD-1/PD-LI expression is too inconsistent to help guide the decision. It’s based instead on clinical judgement, given patient and disease characteristics. Antibody-drug conjugates The class includes enfortumab vedotin and sacituzumab govitecan, both approved for third-line treatment after chemo and immunotherapy. Essentially, they are homing molecules targeting cancer-specific antigens coupled with a potent cytotoxic payload. They have strong potential in combination with immunotherapy. “I think, in the next 3-5 years, we're going to find ADCs plus immunotherapy become the new standard of care,” Dr. Balar said. New enfortumab vedotin data show activity in the second line among medically frail patients ineligible for chemotherapy who were treated instead with immunotherapy for metastatic disease. “This drug can potentially rescue those patients as an option after immunotherapy,” said Dr. Balar, an enfortumab vedotin investigator. Next-generation sequencing There’s no role yet for sequencing in the first line, but it’s necessary in later lines to check eligibility for drugs aimed at specific mutations, such as the tyrosine kinase inhibitor erdafitinib for patients with susceptible FGFR3 or FGFR2 genetic alterations. Assays are available commercially from Foundation and other companies. Results can take up to 6 weeks, so “I do it early on. I know that information is potentially going to be useful in making treatment decisions,” Dr. Balar said. Enfortumabe vedotin adverse events Side effects can include hyperglycemia within the first one or two cycles. Sometimes it’s asymptomatic, sometimes it’s accompanied by acid-base disturbances, and in very rare cases, it’s fatal. The problem is possibly linked to higher baseline body mass index. At least half of patients develop a sunburn-like rash, also within the first one or two cycles, that spares the face and can be pruritic. It’s manageable by topical steroids, oral antihistamines, dose reductions, or dose interruptions. “If anything severe is going to happen, it's going to happen within the first one or two cycles. I see [patients at] every visit” in the first two cycles “primarily to catch anything untoward,” Dr. Balar said. Neuropathy is the “most significant dose-limiting toxicity, and tends to develop about 4 months into treatment,” he said. Show notes written by M. Alexander Otto. Dr. Balar disclosed research, advisory, and/or speaker relationships with Genentech, Incyte, Bristol-Myers Squibb, Janssen, Merck, Pfizer, AstraZeneca, and other companies. Dr. Lyss writes a column for MDedge Hematology/Oncology called “Clinical Insights” and had no other conflicts of interest.

Researchers have tracked the evolution of genetic germline testing in women with breast or ovarian cancer in recent years and reported the results in the Journal of Clinical Oncology. Study author Allison W. Kurian, MD, of Stanford (Calif.) University, describes the group’s findings (https://bit.ly/31RaSGR) to guest host Alan Lyss, MD, subprincipal investigator emeritus for Heartland Cancer Research NCORP, in this episode. Study rationale and methods Dr. Kurian said that an inflection point for breast cancer genetics was in 2013 when the U.S. Supreme Court ruled that gene patenting was not allowed for the purposes of genetic testing. As a result, the cost of testing BRCA1/2 genes fell, and testing became much more accessible. With their study, Dr. Kurian and colleagues aimed to look at trends following the increase in accessibility. The researchers used Surveillance, Epidemiology, and End Results Program (SEER) records of women aged 20 years and older who were diagnosed with breast or ovarian cancer from 2013 to 2017 in California or Georgia. The team linked these data to results of clinical germline testing through 2019. Dr. Kurian explained that the SEER data are comprehensive enough that all cancer cases in California and Georgia were likely included, the states provide a large catchment area of about 50 million people, and the states have different kinds of racial/ethnic diversity and urban/rural distribution. The researchers used the data to assess testing trends as well as rates of variants of uncertain significance (VUS) and pathogenic variants (PVs). Results by hypothesis Hypothesis 1: Multigene panels will entirely replace testing for BRCA1/2 only. This hypothesis was essentially correct. Testing of only two genes was almost totally replaced by testing many more genes. The number of genes tested for breast cancer increased annually by 28% over the study period. Hypothesis 2: Underutilization of testing patients with ovarian cancer will improve over time. It is standard of care to recommend genetic testing for all ovarian cancer patients. Based on 2013-2014 data, only one-third of women were tested. As tests became more accessible in subsequent years, the hope was that more women would be tested. Unfortunately, there was very little improvement in testing rates over the study period. Hypothesis 3: More patients will be tested at lower levels of pretest risk for PVs. In patients aged older than 60 years, testing rates increased for breast cancer (from 11% to 15%) and ovarian cancer (from 25% to 31%). Patients aged younger than 45 years had lower testing rates over time, however. Dr. Kurian noted that about 33% of ovarian cancer patients undergo genetic testing, but the goal is 100%. It is unclear if the goal should be 100% for breast cancer, Dr. Kurian said. Hypothesis 4: Sociodemographic difference in testing trends would not be seen. There was not much of a gap observed with breast cancer patients. For example, among patients with breast cancer, approximately 31% of those who had genetic testing were uninsured, 31% had Medicaid, and 26% had private insurance or Medicare. There is more of an equity issue with ovarian cancer. About 28% of those who had genetic testing were uninsured, 27% had Medicaid, and 39% had private insurance or Medicare. Dr. Kurian said disparities in ovarian cancer persist in patients who are uninsured and those in certain racial/ethnic groups, including African Americans. These patients are less likely to get genetic testing. Hypothesis 5: Detection of PVs and VUS will increase. The detection of VUS increased at a higher rate in comparison with PVs when more genes were being tested. This is likely because of the fact that, for every PV you find, you will find many more VUS, Dr. Kurian said. Hypothesis 6: Racial or ethnic disparities in rates of VUS will diminish over time. Disparities actually increased over the study period as more genes were tested. Some studies have suggested that VUS results lead to unnecessary prophylactic surgery, Dr. Kurian said. She added that the decision to undergo prophylactic surgery should not be based on a VUS because “the great majority of VUS turn out to be nothing.” Additional findings and implications for practice The study revealed that most PVs were in 20 genes associated with breast or ovarian cancer. Dr. Kurian and colleagues concluded that the way to improve testing is to focus on those 20 genes and ensure appropriate patients are being tested, rather than adding more genes to tests. Dr. Kurian said it is urgent to increase genetic testing in patients with ovarian cancer, as it is not being done at the rate it should be. Dr. Kurian also noted that one positive outcome of the COVID-19 pandemic has been an increase in telehealth visits and at-home genetic testing. Providing patients with these more convenient options could increase the use of genetic testing. Show notes written by Alesha Levenson, MD, a resident at Penn Medicine, Philadelphia. Disclosures Dr. Kurian disclosed relationships with Myriad Genetics, Ambry Genetics, Color Genomics, GeneDx/BioReference, InVitae, and Genentech. The study was supported by the National Cancer Institute, the Centers for Disease Control and Prevention, and the California Department of Public Health. Dr. Lyss writes a column for MDedge Hematology/Oncology called “Clinical Insights” (https://bit.ly/3m76xIP). He has no other conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Dr. Lyss on Twitter: @HeartlandOncDoc

A program called Drive By Flu-FIT has allowed for socially distanced colorectal cancer (CRC) screening during the COVID-19 pandemic. Armenta Washington, senior research coordinator at the University of Pennsylvania, describes the program to guest host Alan Lyss, MD, subprincipal investigator emeritus for Heartland Cancer Research NCORP, in this episode. What is Drive By Flu-FIT? Drive By Flu-FIT is a socially distanced version of the Flu-Fecal Immunochemical Test (Flu-FIT) program. Flu-FIT was designed to increase access to CRC screening by offering take-home FIT tests to patients at the time of their annual flu shots. The goal of Drive By Flu-FIT is to provide a COVID-safe approach to CRC screening and counteract the decrease in CRC screening seen during the pandemic. Drive By Flu-FIT is a joint effort of the University of Pennsylvania, the Einstein Healthcare Network, Chi Eta Phi Sorority, and Enon Tabernacle Baptist Church, the largest Baptist church in the Philadelphia region. How does Drive By Flu-FIT work? To participate in a Drive By Flu-FIT event, community members had to complete eligibility, registration, and demographic questionnaires online. Patients who were enrolled watched a short educational video on CRC and completed two questionnaires – one on CRC screening knowledge (14 items) and one on screening intentions (5 items) – before and after watching the video. At the Drive By Flu-FIT events, patients remained in their cars while physicians in personal protective equipment handed out FITs and explained how to use them and return them. Patients could also receive a flu vaccine at each event. Results: High return rate According to initial data, 335 patients registered for a Drive By Flu-FIT event, but 80 (23.9%) ultimately didn’t attend and 63 (18.8%) were found to be ineligible. A total of 192 patients attended and received a FIT (57.3%). Scores on both questionnaires increased after patients watched the educational video. Patients’ baseline knowledge of CRC was high but lacking in four areas: risk factors for CRC, the optimal frequency of FITs, the link between Lynch syndrome and CRC, and the relationship between physical activity and CRC risk. Of the 192 patients who received a FIT, 38 (19.7%) did not return it. There were 141 patients (73.4%) with a negative FIT result, while 13 (6.7%) had a positive FIT result and were referred for colonoscopy. Resources For more information on Flu-FIT, visit http://flufit.org/. For more details on Drive By Flu-FIT, see: AACR Virtual Meeting: COVID-19 and Cancer, Abstract S02-04: https://bit.ly/3szf0Hp. MDedge coverage of the meeting presentation: https://bit.ly/3szfrl1. Ms. Washington disclosed no conflicts of interest. The study was supported by the National Cancer Institute. The FITs were donated by Polymedco, and the flu vaccines were donated by the Philadelphia Public Health Department. Dr. Lyss writes a column for MDedge Hematology/Oncology called “Clinical Insights” (https://bit.ly/3m76xIP). He has no other conflicts of interest. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc Dr. Lyss on Twitter: @HeartlandOncDoc

TOPIC: Pharma Forecast 2021 LENGTH: 30:24GUESTS: Mike Guire, Tracey Sears, Devin GregorieHOST: Jason E. CarrisToday’s episode of AMM Conversation, the official podcast of the Association of Medical Media, concludes Season Three's exploration of the emerging trends in medical media as we race into 2021 and beyond.Our guests today are:Mike Guire, Vice President of Sales, Frontline Medical Communications. Mike has more than 25 years of experience in the publishing industry. Prior to joining FMC in 2016, he enjoyed sales leadership roles at Elsevier, Wolters Kluwer and Skyscape. He is a former President of the AMM.Tracey Sears is Publisher of Clinical Endocrinology Newsand Clinical Psychiatry News. She has more than 25 years of experience in HCP promotion, including advertising sales at the American Medical Association and media planning/buying at Ogilvy, KPR and Klemptner Advertising.Devin Gregorie is the National Sales Manager for MDedge Hematology Oncology, and Director of Sponsorships for MedscapeLive with a focus on Oncology and Hematology. Devin has 15 years experience in both Medical Marketing Media and Live Medical Conferences. Topical timestamps:2:07, Mike says that while the pandemic posed challenges to medical publishers, HCPs are seeking out "trusted partners" in record numbers3:12, Tracy explains why Frontline didn't miss a beat during this difficult period5:02, Devin discusses why his agencies want more "immersive" HCP experiences8:50, The important thing for medical marketers is to figure out the "mesh points" for HCPs and pharmaceutical marketing12:15, Mike explains how brands pulling back during the pandemic have been offset by brands reinvesting funds toward reaching HCPs in a non-personal way13:56, Merging with MedScape has helped Frontline fine tune the delivery of messages15:58, Tracey says some clients expect campaign analytics on a weekly basis, and Devin says real-time is not far away19:28, Devin is cautiously optimistic large medical meetings will return in the Fall 202121:23, It's much easier to Zoom with a media team these days vs. pre-pandemic23:18, Frontline's podcast portfolio is gaining a foothold, and Pharma is showing interest in advertising more in 202123:59, Tracey is looking forward business returning to normal in 202124:31, Devin is going stir crazy working in the home office, and is looking forward to the social aspects of the medical media industry25:53, Mike hopes 2021 affords his sales team the opportunity to get together, have a team meeting, and share experiences. Resources: Find additional medical media resources via AMM's Knowledge Exchange Center.Coming soon: Season 4 of AMM Conversation will explore “Effective Strategies for Engaging HCPs via Social and Multimedia.” Keep an out for Season 4 this spring. The easiest way to know when the next season drops is to subscribe or follow the podcast.  Contact us: AMM Conversation is the official podcast of the Association of Medical Media. Send questions and comments about this podcast series to jcarris525@gmail.com

There were a number of practice-changing and ground-breaking studies presented at the ESMO 2020 Virtual Congress, according to our guest in this episode. Alan P. Lyss, MD, subprincipal investigator for Heartland Cancer Research NCORP, joined host David H. Henry, MD, to review highlights from ESMO 2020. The pair discussed studies on gynecologic, breast, lung, gastrointestinal, and genitourinary cancers, as well as studies of anemia and COVID-19 in cancer patients. COVID-19 and cancer LBA77: Anti-SARS-CoV-2 antibody response in patients with cancer and oncology healthcare workers: A multicenter, prospective study. https://bit.ly/3cNNkar This study suggests SARS-CoV-2-specific IgG antibody response is not different between cancer patients (n = 61) and subjects without cancer (n = 105). Overall, 83.8% of subjects were IgG-positive, and there was no significant difference in IgG positivity between the cancer patients and the health care workers (P = .39). LBA83: Outcomes of the 2019 novel coronavirus in patients with or without a history of cancer: A multi-centre North London experience. https://bit.ly/2EJMpv4 This study suggests COVID-19 patients with a history of cancer may have a similar risk of death as COVID patients without a history of cancer, with exceptions. The odds ratio for mortality, comparing the cancer patients (n = 30) to the non-cancer patients (n = 90), was 1.05. The odds ratio for mortality was 4.05 for cancer patients who had received systemic therapy in the prior 28 days. Lung cancer: Radiotherapy LBA3_PR: An international randomized trial, comparing post-operative conformal radiotherapy (PORT) to no PORT, in patients with completely resected non-small cell lung cancer (NSCLC) and mediastinal N2 involvement: Primary end-point analysis of LungART (IFCT-0503, UK NCRI, SAKK) NCT00410683. https://bit.ly/3jtojUo This study enrolled 501 patients with completely resected NSCLC and mediastinal N2 involvement, and they were randomized to PORT or no PORT. There was no significant between-arm difference in disease-free survival (DFS) or overall survival (OS). The 3-year DFS rate was 47.1% with PORT and 43.8% with no PORT. The 3-year OS rate was 66.5% and 68.5%, respectively. These results suggest conformal PORT should not be standard care in all completely resected N2 NSCLC patients, according to Dr. Lyss. “This may have been the most obviously and immediately practice-changing study among those I heard presented,” he said. Endometrial cancer LBA28: A randomised double-blind placebo-controlled phase II trial of palbociclib combined with letrozole (L) in patients (pts) with oestrogen receptor-positive (ER+) advanced/recurrent endometrial cancer (EC): NSGO-PALEO / ENGOT-EN3 trial. https://bit.ly/2SanTX1 This study enrolled 77 patients with ER+ advanced or recurrent endometrial cancer, and they were randomized to palbociclib plus letrozole or placebo plus letrozole. The median progression-free survival (PFS) was 8.3 months in the palbociclib arm and 3 months in the control arm. Dr. Lyss called this a “small” but “important” study. He and Dr. Henry agreed that a confirmatory study is needed. Breast cancer LBA5_PR: Abemaciclib in high risk early breast cancer. https://bit.ly/3igxbvw This trial enrolled 5,637 women with hormone receptor-positive, HER2/neu oncogene-negative, early breast cancer. They were randomized to receive standard endocrine therapy (ET) alone or standard ET with abemaciclib. The 2-year invasive DFS rate was 92.2% with abemaciclib and 88.7% with ET alone (hazard ratio, 0.747; P = .0096). Dr. Lyss said these data suggest abemaciclib could have “the potential to save many thousands of lives.” However, he noted that 16% of patients discontinued abemaciclib prematurely due to adverse events, and more than 300 of the 463 patients who stopped abemaciclib also stopped ET – a “disaster,” according to Dr. Lyss. LBA12: PALLAS: A randomized phase III trial of adjuvant palbociclib with endocrine therapy versus endocrine therapy alone for HR+/HER2- early breast cancer. https://bit.ly/2GbuluE This trial enrolled 5,760 patients with hormone receptor-positive/HER2-negative early stage breast cancer. They were randomized to palbociclib plus ET or ET alone. Results from this trial run counter to results from the abemaciclib trial, in that adding palbociclib to ET did not improve invasive DFS. The 3-year invasive DFS rate was 88.2% in the palbociclib arm and 88.5% in the ET-alone arm (HR, 0.93). Dr. Lyss said he can see no explanation for the different results with abemaciclib and palbociclib, but longer follow-up and analyses of biospecimens may shed some light. LBA17: ASCENT: A randomized phase III study of sacituzumab govitecan (SG) vs treatment of physician’s choice (TPC) in patients (pts) with previously treated metastatic triple-negative breast cancer (mTNBC). https://bit.ly/3ilHwGd The study enrolled 529 patients with relapsed/refractory metastatic TNBC. They were randomized to SG or single-agent physician’s choice of therapy (capecitabine, eribulin, vinorelbine, or gemcitabine). SG outperformed physician's choice. The median PFS was 5.6 months with SG and 1.7 months with physician’s choice. The median OS was 12.1 months and 6.7 months, respectively. LBA16: IMpassion130: Final OS analysis from the pivotal phase III study of atezolizumab + nab-paclitaxel vs placebo + nab-paclitaxel in previously untreated locally advanced or metastatic triple-negative breast cancer. https://bit.ly/33fYYb7 This trial enrolled 902 patients with locally advanced or metastatic TNBC. They were randomized to first-line nab-paclitaxel plus placebo or nab-paclitaxel plus atezolizumab. The median OS was 21 months in the atezolizumab arm and 18.7 months in the control arm (HR, 0.87, P = .0770). The 3-year OS in PD-L1-positive patients was 36% and 22%, respectively. “I think anybody would choose the combination with atezolizumab with a difference like that,” Dr. Lyss said. LBA15: Primary results from IMpassion131, a double-blind placebo-controlled randomised phase III trial of first-line paclitaxel (PAC) ± atezolizumab (atezo) for unresectable locally advanced/metastatic triple-negative breast cancer (mTNBC). https://bit.ly/36iEoIS This trial enrolled 651 patients with locally advanced or metastatic TNBC. They were randomized to first-line paclitaxel plus placebo or paclitaxel plus atezolizumab. Dr. Lyss noted that, unlike IMpassion130, the results of IMpassion131 were “completely negative.” In the PD-L1-positive population, the median PFS was 5.7 months in the placebo arm and 6.0 months in the atezolizumab arm (HR, 0.82; P = .20). In the overall population, the median PFS was 5.6 months and 5.7 months, respectively (HR, 0.86). It’s unclear why results from IMpassion130 and IMpassion131 differ, Dr. Henry noted. Steroid use, study design, or chance might all play a role, according to a discussant at ESMO.   Urothelial cancer LBA24: TROPHY-U-01 cohort 1 final results: A phase II study of sacituzumab govitecan (SG) in metastatic urothelial cancer (mUC) that has progressed after platinum (PLT) and checkpoint inhibitors (CPI). https://bit.ly/3kYvq7R This study enrolled 113 patients with unresectable locally advanced or metastatic urothelial cancer. All patients received SG. The overall response rate was 27% in the overall population and 25% in patients with liver metastasis. The median PFS was 5.4 months, and the median OS was 10.5 months. Dr. Henry said the response and survival data were “rather impressive,” and Dr. Lyss noted that biomarker studies might allow for better selection of patients who should receive SG. Gastrointestinal cancer LBA6_PR: Nivolumab (nivo) plus chemotherapy (chemo) versus chemo as first-line (1L) treatment for advanced gastric cancer/gastroesophageal junction cancer (GC/GEJC)/esophageal adenocarcinoma (EAC): First results of the CheckMate 649 study. https://bit.ly/2GcOroj This study enrolled 1,581 patients with GC, GEJC, or EAC, and 60% of patients were PD-L1-positive with a combined positive score (CPS) of at least 5. Patients were randomized to first-line treatment with nivolumab plus chemotherapy or chemotherapy alone (XELOX or FOLFOX). In patients with PD-L1 CPS ≥ 5, the median OS was 14.4 months in the nivolumab arm and 11.1 months in the chemotherapy arm (HR, 0.71; P < .0001). The median PFS was 7.7 months and 6.2 months, respectively (HR, 0.68; P < .0001). Dr. Lyss noted that using checkpoint inhibitors in the frontline or even adjuvant setting appears beneficial in this patient population, as demonstrated by additional trials presented at ESMO 2020: LBA7_PR (https://bit.ly/2GfXW65) LBA8_PR (https://bit.ly/3kYokQM) LBA9_PR (https://bit.ly/3ikBaaa).   Lung cancer: Checkpoint inhibitors Dr. Henry briefly discussed three abstracts on checkpoint inhibitors in NSCLC — LBA51, LBA52, and LBA53. LBA51: KEYNOTE-024 5-year OS update: First-line (1L) pembrolizumab (pembro) vs platinum-based chemotherapy (chemo) in patients (pts) with metastatic NSCLC and PD-L1 tumour proportion score (TPS) ≥50%. https://bit.ly/2ELdNsE The 5-year OS rate was 31.9% with pembrolizumab and 16.3% with chemotherapy (HR, 0.62). LBA52: EMPOWER-Lung 1: Phase III first-line (1L) cemiplimab monotherapy vs platinum-doublet chemotherapy (chemo) in advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) ≥50%. https://bit.ly/3jjSiy9 The median OS was 22.1 months in the cemiplimab arm and 14.3 months in the chemotherapy arm (P = .002). LBA53: Precision immuno-oncology for advanced non-small cell lung cancer (NSCLC) patients (pts) treated with PD1/L1 immune checkpoint inhibitors (ICIs): A first analysis of the PIONeeR study. https://bit.ly/2GbjhO0 This study revealed biomarkers that might help guide treatment with immune checkpoint inhibitors. Renal cell carcinoma 696O_PR: Nivolumab + cabozantinib vs sunitinib in first-line treatment for advanced renal cell carcinoma: First results from the randomized phase III CheckMate 9ER trial. https://bit.ly/30lEMmg This study enrolled 651 patients with previously untreated metastatic renal cancer. They were randomized to cabozantinib plus nivolumab or sunitinib. The median PFS was 16.6 months with the combination and 8.3 months with sunitinib. The median OS was improved with the combination as well (HR, 0.61). Dr. Lyss said these results support the use of nivolumab plus cabozantinib in this patient population. However, he also expressed reservations related to tolerability, quality of life, eligibility criteria, and short follow-up. Anemia 1822P: Impact of iron-deficiency management on quality of life in cancer patients: A prospective cohort study (CAMARA study). https://bit.ly/2Sf1TdE This study enrolled 248 patients with solid tumors, including 74.5% with absolute iron deficiency (transferrin saturation coefficient < 20%) and 191 with anemia. Patients were treated with intravenous iron, and their quality of life (FACT-An scores) improved significantly between study enrollment and each assessment. Dr. Henry said the take-home message is that clinicians shouldn’t miss anemia or iron deficiency, and they shouldn’t transfuse patients automatically but, instead, consider iron supplementation. Disclosures: Dr. Henry has no financial disclosures relevant to this episode. Dr. Lyss writes a column for MDedge Hematology/Oncology called Clinical Insights. He has no other conflicts of interest. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

MDedge Hematology-Oncology news for the first week of September 2020.  Aspirin may accelerate cancer progression in older adults: https://bit.ly/2ENHRUc ASPREE trial: https://bit.ly/2QAsMYW Meta-analysis: https://bit.ly/2D6rXnl AsCaP: https://bit.ly/2G06X2I Black/White gap gone: ‘The only cancer where this has happened’: https://bit.ly/3jm8PBm Source: https://bit.ly/3lv4u0m Selpercatinib 'poised to alter the landscape' of RET+ cancers: https://bit.ly/34PYSbs Lung cancer results: https://bit.ly/3gB1FY7 Thyroid cancer results: https://bit.ly/2EHhCz5 Study confirms it's possible to get COVID-19 twice: https://bit.ly/3bd4wWg Email the show: podcasts@mdedge.com Learn more about MDedge and Blood & Cancer: https://www.mdedge.com/podcasts

The latest news from MDedge Hematology/Oncology:  In this episode:  MRI reliably identifies significant prostate cancer * Original MDedge article (https://bit.ly/3hgKT1h) * PROMIS analysis (https://bit.ly/3fLOiEN) Drug-drug interactions to avoid in patients with GI cancer * Original MDedge article (https://bit.ly/39eHi0G) ctDNA clearance tracks with PFS in NSCLC subtype * Original MDedge article (https://bit.ly/3eJKm6o) * Abstract from AACR 2020 (https://bit.ly/30uQQ3R) * TATTON results in The Lancet Oncology (https://bit.ly/3jq1L7J) COVID-19 symptoms can linger for months * Original MDedge article (https://bit.ly/3eNREG0) *  JAMA research letter (https://bit.ly/2WFS3UW) For more MDedge Podcasts go to https://mdedge.com/podcasts/ Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeHemOnc

What were the practice-changing studies presented at the 2020 ASCO Annual Meeting? Podcast host David H. Henry, MD, and retired oncologist Alan P. Lyss, MD, reviewed 12 studies and assessed their potential impact on treatment.  Breast cancer Three-year follow-up of neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2-blockade for HER2-positive breast cancer (TRAIN-2): A randomized phase III trial. (Abstract 501) The addition of anthracyclines did not improve event-free or overall survival. The results suggest patients can avoid the toxicities of anthracycline regimens without compromising efficacy, Dr. Henry said. KEYNOTE-355: Randomized, double-blind, phase III study of pembrolizumab + chemotherapy versus placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. (Abstract 1000) Pembrolizumab improved responses, particularly in patients with higher PD-L1 expression. Dr. Lyss noted that pembrolizumab was combined with a “broad range” of chemotherapy regimens in this study.   A randomized phase III trial of systemic therapy plus early local therapy versus systemic therapy alone in women with de novo stage IV breast cancer: A trial of the ECOG-ACRIN Research Group (E2108). (Abstract LBA2) Early local therapy did not improve disease-free survival or overall survival. “We probably should not be recommending planned treatment for the intact primary tumor in most women who have stage IV breast cancer,” Dr. Lyss said. Bladder cancer Maintenance avelumab + best supportive care (BSC) versus BSC alone after platinum-based first-line (1L) chemotherapy in advanced urothelial carcinoma (UC): JAVELIN Bladder 100 phase III interim analysis. (Abstract LBA1) Avelumab maintenance prolonged overall survival, although 12% of patients discontinued the treatment due to toxicity. Because avelumab “meaningfully prolongs overall survival … using it upfront makes a lot of sense,” Dr. Lyss said. Colorectal cancer Pembrolizumab versus chemotherapy for microsatellite instability-high/mismatch repair deficient metastatic colorectal cancer: The phase 3 KEYNOTE-177 study. (Abstract LBA4) Pembrolizumab improved responses and progression-free survival. All patients with colorectal cancer should be tested for microsatellite instability-high status “because these results really do influence practice immediately,” Dr. Lyss said. He suggested that pembrolizumab should probably be used as first-line treatment for these patients even though overall survival results are not yet available.   Short-course radiotherapy followed by chemotherapy before TME in locally advanced rectal cancer: The randomized RAPIDO trial. (Abstract 4006) Short-course radiotherapy followed by consolidative chemotherapy and surgery significantly reduced the rate of treatment failure. Dr. Lyss called the pathologic complete response rate “impressive” and said it may contribute to a higher rate of rectal preservation.   A randomized phase II/III trial comparing hepatectomy followed by mFOLFOX6 with hepatectomy alone for liver metastasis from colorectal cancer: JCOG0603 study. (Abstract 4005) There was no improvement in overall survival with mFOLFOX6. “The take-home to me … is this is probably not a necessary strategy and certainly not standard of care,” Dr. Henry said.   Hodgkin lymphoma KEYNOTE-204: Randomized, open-label, phase III study of pembrolizumab (pembro) versus brentuximab vedotin (BV) in relapsed or refractory classic Hodgkin lymphoma (R/R cHL). (Abstract 8005) Pembrolizumab improved progression-free survival. Dr. Henry marveled that pembrolizumab bested brentuximab vedotin, which previously produced impressive results in patients with relapsed/refractory Hodgkin lymphoma. Lung cancer Nivolumab + ipilimumab versus platinum-doublet chemotherapy as first-line treatment for advanced non-small cell lung cancer: Three-year update from CheckMate 227 Part 1. (Abstract 9500) Nivolumab plus ipilimumab improved overall survival but increased toxicity and treatment discontinuation. The combination is “not for the faint hearted” but is appropriate for certain patients, Dr. Lyss said, noting there is “room for clinical judgement.”   Osimertinib as adjuvant therapy in patients (pts) with stage IB–IIIA EGFR mutation positive (EGFRm) NSCLC after complete tumor resection: ADAURA. (Abstract LBA5) Osimertinib improved disease-free survival compared with placebo. It isn’t clear how osimertinib will impact overall survival, but “we should be using this drug” once it’s approved, Dr. Lyss said.   Smoking cessation (SC) and lung cancer (LC) outcomes: A survival benefit for recent-quitters? A pooled analysis of 34,649 International Lung Cancer Consortium (ILCCO) patients. (Abstract 1512) Quitting smoking can improve overall survival in lung cancer patients, even if they quit as little as 2 years prior to diagnosis. “Somewhat counterintuitively, convincing patients to quit smoking at any point in their trajectory, even just prior to their diagnosis, seems to make a difference in survival,” Dr. Lyss said.   Ovarian cancer Final overall survival (OS) results from SOLO2/ENGOT-ov21: A phase III trial assessing maintenance olaparib in patients (pts) with platinum-sensitive, relapsed ovarian cancer and a BRCA mutation. (Abstract 6002) Olaparib maintenance improved overall survival and time to next treatment. Significant benefits were seen in the olaparib arm in spite of a high rate of crossover, Dr. Henry noted. *  *  *   Disclosures: Dr. Henry, of Penn Medicine in Philadelphia, reported having no financial disclosures relevant to this episode. Dr. Lyss was a community-based medical oncologist and clinical researcher for more than 35 years before his recent retirement. He is a columnist for MDedge Hematology/Oncology. He has no other conflicts of interest. *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

Oncologists are now weighing the benefits of treating cancer patients against the risk of exposing them to SARS-CoV-2. David Kerr, MD, DSc, of University of Oxford (England) talks with podcast host David H. Henry, MD, of Pennsylvania Hospital in Philadelphia, about how to treat colorectal cancer patients in the COVID-19 era. Dr. Kerr cowrote an article on MDedge Hematology/Oncology that outlined recommendations for treating colorectal cancer patients during the pandemic. In this episode, Dr. Henry and Dr. Kerr review those recommendations and compare notes on U.K. and U.S. practices. Disclosures: Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Kerr has founded three university spin-out companies: COBRA Therapeutics, Celleron Therapeutics, and Oxford Cancer Biomarkers. *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter:@ilanayurkiewicz  

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

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

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

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

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

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

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

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

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

Contact us:  podcasts@mdedge.com Nick on Twitter: @tribnic David Henry, MD, is the host of Blood & Cancer, the official podcast of MDedge Hematology/Oncology. In this episode, Nick and Dr. Henry discuss advances and excitement in the oncology as well as the opportunities that podcast provides and tips for dealing with burnout.