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Blood & Cancer

Author: MDedge Hematology & Oncology

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Interview-style hematology/oncology podcast from MDedge Hematology-Oncology. The show is hosted by Dr. David Henry with Pearls from Dr. Ilana Yurkiewicz for clinical hematology and oncology health care professionals. The information in this podcast is provided for informational and educational purposes only.
72 Episodes
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In the “new normal” of treating cancer patients during COVID-19, when do you decide to start treatment or pause it? Narjust Duma, MD, a thoracic oncologist at the University of Wisconsin, Madison, shares how she makes those decisions in partnership with her lung cancer patients and how the discussions are complicated by the fear and uncertainty around the pandemic. Later in the podcast, Dr. Duma and podcast host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, explore how telehealth changes patient encounters, use of liquid biopsies to keep patients out of the hospital, and the importance of checking in with mentees. Disclosures Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Duma reported having no financial disclosures relevant to this episode. *   *   *   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
As the nation’s health care system braces for COVID-19 cases, physicians who’ve faced the pandemic first have critical lessons for everyone. In this bonus episode, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region’s early outbreaks. And they share some creative approaches that are uniting Seattle’s critical care departments.
Zainab Shahid, MD, medical director of bone marrow transplant infectious diseases at the Levine Cancer Institute/Atrium Health in Charlotte, N.C., breaks down when cancer patients should seek testing for COVID-19 and how they should be treated. Dr. Shahid also compares notes with Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital in Philadelphia, on how the COVID-19 pandemic has changed the world of medical education. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, celebrates National Doctors Day amid the COVID-19 pandemic. Topics covered in this podcast: How the education of trainees as changed. Use of telehealth screening and visits. COVID-19 case volume and when oncology patients should seek testing. Which patients should be considered immunocompromised. *   *   *   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
Susan Dent, MD, codirector of the cardio-oncology program at Duke University in Durham, N.C., reflects on virtual grand rounds, telehealth, the screening of patients before clinic visits, and other new realities of cancer care in the age of COVID-19. Dr. Dent also discusses the importance of assessing breast cancer patients for cardiotoxicity. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the importance of advance directives. *  *  *   Cardiotoxicity in breast cancer treatment HER2 drugs (such as trastuzumab) and conjugates If given appropriately, these drugs have limited cardiotoxicity. The mechanism of cardiotoxicity is a “stunning of the heart.” If there is a significant drop in left ventricular ejection fraction, hold the drug. When problems arise, they tend to occur early on. Important to assess baseline risk factors. Older individuals with underlying hypertension, diabetes, and other conditions need monitoring. Anthracyclines The appropriate/safe dose of anthracyclines may be different for each person, based on risk factors such as age and underlying conditions. Assess patients at baseline using cardiac imaging and biomarkers, and risk factors. If no symptoms of cardiotoxicity, reassess 6-12 months after treatment. If a patient has poorly controlled hypertension or diabetes, those factors should be better managed to minimize the risk from anthracyclines. Liposomal anthracyclines These formulations are less cardiotoxic, but they have not been widely adopted in breast cancer. Immuno-oncology antibodies Myocarditis is one of many side effects seen with immunotherapy. It’s not a common side effect (about 1% or less), but when it does occur, it has a 50% fatality rate. Have a high level of suspicion for myocarditis if a patient on immunotherapy presents with shortness of breath and chest pain. *   *   *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
David Henry, MD, welcomes Bernard A. Mason, MD, to discuss Dr. Mason's favorite digital tools for working as a physician in part 1 of 2. Dr. Mason is an oncologist with the Pennsylvania Hospital and the University of Pennsylvania, both in Philadelphia.  Dr. Mason explains the actual benefits for doctors and health care providers for popular apps and services from storage to maps. He and Dr. Henry explore the following: One drive Google Drive Google Photos Google Maps Offline HERE WeGo This week's installment of Clinical Correlation, Ilana Yurkiewicz, MD, poses a complicated question about oncologist-patient relationships: Do they ever actually end? *  *  *   For more MDedge Podcasts, go to https://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry, MD, on Twitter: @davidhenrymd Ilana Yurkiewicz, MD, on Twitter: @ilanayurkiewicz
There’s an art to taking a thorough bleeding history. In this episode, Adam Cuker, MD, director of the Hemophilia and Thrombosis Center at the University of Pennsylvania, Philadelphia, shares the most important questions to ask and the challenges in assessing risk in patients about to undergo surgery and those with active bleeding. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about delivering good news to patients.    Practice points: Always take a thorough bleeding history. Ask patients about bleeding from head to toe. Even if the basic laboratory evaluation is normal, the patient may still have a bleeding disorder. *  *  *  Assessing bleeding risk before surgery  How do you advise patients about to go into surgery who say they bruise easily? This situation comes up frequently. In the case of emergency/urgent surgery, there’s not time for a prolonged evaluation. Take a careful bleeding history: Always ask patients about any history of spontaneous bleeding. Ask about epistaxis, gingival bleeding, rectal bleeding, heavy menstrual periods. Go down the body from head to toe. It’s also important to ask about hemostatic challenges. Has the patient had any prior surgeries? If it’s a woman, has she had pregnancies and deliveries? Did the patient experience abnormal bleeding with those challenges? Prompt patients to consider whether they have had surgery that they might not think about, such as tooth extraction, tonsil removal, or polyps removed from their colon. Seek to establish the time course: Is this a patient who has had abnormal bleeding for their entire life, or did it start later in life? This can provide clues about whether this is a congenital bleeding disorder or an acquired condition. Ask about such comorbidities as liver and kidney disease, which can be associated with an increased bleeding risk. Get a complete medication list. Anticoagulants and antiplatelets are the obvious culprits but consider fish oil and selective serotonin reuptake inhibitors (SSRIs) for bleeding. Ask about family history: Is there a family member who has a diagnosed bleeding disorder or even a history of abnormal bleeding? Ask about social history: Are you engaged in any activities associated with an increased risk of trauma? Challenges to taking a bleeding history: Some bleeding symptoms are very common to the normal population. A surprisingly high percentage of people with no bleeding disorders report easy bruising, frequent nose bleeds as a child, heavy menstrual bleeding. Laboratory work-up What’s the basic lab evaluation? Complete blood count (CBC) Prothrombin time (PT) and partial thromboplastin time (PTT) Comprehensive metabolic panel to make sure the patient doesn’t have liver or kidney disease If the basic lab evaluation is normal can they have a bleeding disorder? Yes. The most common conditions are von Willebrand disease and platelet function disorder. Less common are rare disorders of fibrinolysis or blood vessel disorders that can lead to abnormal bleeding. Assessing patients with active bleeding (post catheterization) Consider whether bleeding is a complication of the procedure or a bleeding disorder. An efficient but thorough bleeding history is critical. Order a basic lab work-up and review medications looking for antiplatelet medications in particular. This approach is a very similar to a patient without active bleeding who is going into surgery. Direct oral anticoagulants (DOACs) and bleeding PT and PTT are insensitive to DOACs but order them anyway if the patient is bleeding. If the test is prolonged, that could suggest that there are substantial levels of drug in circulation. If the test results come back normal, that doesn’t rule out the possibility that there are clinically meaningful levels of drug circulation that are contributing to bleeding. Getting a rapid anti-Xa assay could provide more information, but many clinicians don’t have access to that test. If you can’t get the definitive lab test and the patient is having a serious bleed, err on the side of giving the reversal agent. *  *  *  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
Ever read through a study and wondered how to apply the hazard ratio, or if you should change your practice because of a secondary endpoint finding? In this episode, Lauren M. Catalano, MD, of the University of Pennsylvania, Philadelphia, explains all the common terms and why they matter in the context of the KEYNOTE-024 trial.  In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about how to prepare for an unexpected bad outcome. Practice points: Don’t skip over the statistical analysis portion of a paper. Use Google to find simple definitions for unfamiliar biostatistics terms. Understanding the statistical elements is essential to determining the quality of the research. * * * Understanding statistics in the context of KEYNOTE-024 Article discussed: Updated analysis of KEYNOTE-024: Pembrolizumab versus platinum-based chemotherapy for advanced non–small cell lung cancer with PD-L1 tumor proportion score of 50% or greater. J Clin Oncol. 2019 Mar 1;37(7):537-46.  Primary endpoint: The outcome that is necessary to ensure the efficacy of the trial. What is the study’s objective? The primary endpoint is defined prior to starting the study, which influences how many patients need to be enrolled to ensure statistical significance. This paper’s primary endpoint: Time since random assignment to disease progression or death. Secondary endpoint: These are interesting trends or observations that the investigators were able to determine, but for which the original study may not have been powered, meaning that they may not have enough data to determine the statistical significance. This paper’s secondary endpoints: Objective response rate (confirmed complete and partial responses) and safety. Hazard ratio: “Ratio” suggests that this is a comparison between the intervention and control arm. HR is a measure of an effect or intervention on the outcome of interest over a period of time (risk per unit of time). The outcome can be positive or negative. Confidence interval: Since it is not possible to survey the entire population, a confidence interval provides a range of values where the true value most likely falls. If the confidence interval crosses “1” then there is no difference between the arms of the study. Kaplan-Meier curve: Often used to illustrate survival. This is a graphical representation of hazard ratio, usually drawn as a step function. P value: The degree of error that we are willing to accept. Often P = .05, which means we are willing to accept a 5% risk that the hypothesis is incorrect. Crossover: Patients assigned in one arm of the study (usually the control arm) can be reassigned to the other arm (usually the intervention group). Intention to treat: A technique used in randomized, controlled trials in which patient outcomes are compared within the group the patient was originally assigned to. This may not reflect the treatment that the patient actually received. If the patient is in a group that is treated but then leaves that group, they are still counted in the original group. Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
A diagnosis of acute myeloid leukemia (AML) was once an emergency, requiring immediate treatment. Today, the need to start treatment is still urgent, but many patients can benefit by waiting a few days for testing to reveal a fuller picture of the disease. That’s the advice of James M. Foran, MD, of the Mayo Clinic. He joins Blood & Cancer host David H. Henry, MD, of the Pennsylvania Hospital, Philadelphia, to walk through some patient scenarios and the newest treatment options. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about what patients do and do not remember from their visits. Practice points: Rapid testing results can drive important choices in the initial treatment of AML. Adjunctive therapies may improve survival by 7%-20% in appropriate patients. Although a total work-up may take up to 2 weeks, new research suggests it is feasible to get rapid sequencing/cytogenetic testing and assign treatment within 7 days. Treatment varies: Daunorubicin and cytarabine (Vyxeos) are still central treatment strategies, but there may be survival advantages (7%-20% improvement) by adding adjunctive therapies, if indicated. A few are listed below: Liposomal formulations of daunorubicin-cytarabine (CPX351) can have survival advantages in therapy-related AML or AML with myelodysplastic syndrome (MDS)-related changes. Gemtuzumab (Mylotarg) may be indicated for core binding factor (CBF) AML. Midostaurin (Rydapt) may improve survival in patients with FMS-like tyrosine kinase (FLT) 3 Enasidenib (Idhifa) may be indicated in patients with IDH mutations. Options for elderly patients: In a recent study, CC 486 (oral azacitidine) showed a significant survival advantage and remission duration in elderly patients with AML. The drug is not yet available but could eventually be a maintenance therapy option for patients who do not go on to transplant. Azacitidine, plus or minus an IDH2 inhibitor, showed much higher remission rates in elderly patients, but did not translate into a survival advantage. AML in the outpatient setting: Many patients with AML are being increasingly managed as outpatients, which ultimately will require a different kind of support infrastructure in our hospitals and clinics. Show notes by Debika Biswal Shinohara, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. Dr. Henry and Dr. Yurkiewicz reported having no financial conflicts relevant to this episode. Dr. Foran reported advisory board membership with Pfizer, Jazz Pharma, and Novartis.  * * *  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
Treatment tips in CLL

Treatment tips in CLL

2020-02-2023:11

The million-dollar question in the treatment of chronic lymphocytic leukemia (CLL) is what to do after a patient relapses following treatment with venetoclax. Anthony Mato, MD, and Lindsey Roeker, MD, both of Memorial Sloan Kettering in New York, join podcast host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to explore the evidence about this question and to review the initial patient work-up and treatment strategies. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses patients compliance and how clinician biases can influence compliance. Practice points: For patients with CLL with unmutated immunoglobulin variable heavy chain gene (IgVH), novel agents are the first therapy. Evidence is limited about the best treatment approach after relapse on venetoclax.  * * *  Initial work-up in patients with CLL The initial work-up for patients with CLL is often fluorescent in situ hybridization (FISH), looking for trisomy 12, as well as deletion of 13q, 17p, and 11q. Next-generation sequencing is used to look for mutations in TP53 and IgVH mutational analysis is done to recognize whether a patient is mutated. IgVH-mutated patients tend to respond better to therapy. When to treat Henry recommends the “if it bothers you, it bothers me” approach, noting that indications for treatment include fever, chills, night sweats, lumps and bumps in the neck, large liver and spleen, and high creatine. Progression If a patient is IgVH unmutated, that takes chemoimmunotherapy combinations off the table, regardless of whether the patient is young or fit. Instead, they are on a pathway to receive a novel agent as first therapy. The choices for novel agents keep expanding. Some standards include ibrutinib plus or minus obinutuzumab, venetoclax plus obinutuzumab, and acalabrutinib plus or minus obinutuzumab. Each of these combinations has different adverse event profiles and dose schedules. Patient preferences and comorbidities should drive decision making on novel combinations. Relapse The million-dollar question: What is the best treatment following relapse on venetoclax? The answer is unclear but there are generally two choices: Re-treat with the same regimen or switch to a Bruton’s tyrosine kinase (BTK) inhibitor. There are limited data on re-treatment and emerging data on BTK inhibitors after venetoclax that points to success. * * * 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  
Chimeric antigen receptor (CAR) T-cell therapy is one of the hottest advances in lymphoma treatment, but who should get it and what does the process look like? Allison Winter, MD, of the Cleveland Clinic helps answer those questions on the podcast. She joins Blood & Cancer host David H. Henry, MD, of the Pennsylvania Hospital, Philadelphia, to break down the side effects and look ahead to possible off-the-shelf products. In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, discusses optimism bias. She recalls a time when a patient’s drive for optimism affected what she told them and whether that was a good or bad thing.  Practice points: The time to refer a patient for CAR T-cell therapy is at relapse. CAR T-cell therapy side effects are serious and include cytokine release syndrome and neurotoxicity. CAR T-cell therapy use in lymphoma  For patients with diffuse large B-cell lymphoma, treatment after relapse typically involves salvage therapy, and if they are chemotherapy-sensitive, autologous transplant. The time to refer a patient for CAR T-cell therapy (or other clinical trial options) is at the time of relapse. CAR T cells are currently approved after two lines of therapy. What is the process for a patient to get CAR T-cell therapy? Evaluation by physicians. Approval of insurance. Collection of the patient’s T cells. Shipment of T cells for genetic modification (takes several weeks). Reception of genetically modified T cells by patients. Administration of lymphodepleting chemotherapy. Admission to the hospital for CAR T-cell infusion. The median time to get CAR T cells is 26 days. Allogeneic CAR T-cell products (called off-the-shelf) are in the clinical trial stage. The two major side effects of immunotherapy include cytokine release syndrome and neurotoxicity. Reference: Axicabtagene ciloleucel CAR T-cell therapy in refractory large B-cell lymphoma. N Engl J Med. 2017 Dec 28; 377:2531-44. *  *  * Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz      
Think of biosimilars as your mother’s minestrone soup: It’s the same recipe and ingredients every time, but not every batch is chemically identical, even if it tastes about the same. That’s how Brian T. Hill, MD, PhD, of the Cleveland Clinic, describes biosimilars. He joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss how biosimilars are made and approved, and how they differ from generic drugs.  In Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about percentages -- what they mean, what they don’t mean, and how they can be interpreted in oncology.  * * * What are biosimilars? Monoclonal antibodies and biologics are complex and large proteins that are made in cells and bioreactors. Because they are made in “nature” instead of a synthetic reaction (discussed with generics), slight differences can be expected in the molecular structure.  Those slight variances do not create clinically meaningful differences between the biosimilar and the original product.  Biosimilars go through very stringent review by the Food and Drug Administration and head-to-head clinical trials with the originator drug.  Biosimilar vs. generic drug This is in contrast to a “generic” drug. In generic drugs, the chemical composition of all brands is synthesized identically.  An insurance company may approve a biosimilar, but not the originator drug.  Monoclonal biosimilars are on the way as the patent expires; this could soon mean that Herceptin (trastuzumab) will have a biosimilar.  Points: Insurance driven or otherwise, both Dr. Hill and Dr. Henry would be comfortable using biosimilars.  Show notes by Ronak Mistry, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
ASH19 special report

ASH19 special report

2020-01-3031:42

Blood & Cancer takes you behind the podium at the American Society of Hematology annual meeting for an in-depth look at the latest developments in anemia and myelodysplastic syndrome, chimeric antigen receptor (CAR) T-cell therapy for mantle cell lymphoma, use of novel agents in follicular lymphoma, and a range of new advances being explored in chronic lymphocytic leukemia. Guests on the podcast include Brian T. Hill, MD, PhD, and Allison Winter, MD, both with the Cleveland Clinic, and Anthony Mato, MD, and Lindsey E. Roeker, MD, of Memorial Sloan Kettering Cancer Center in New York. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the gratitude that can come from surviving cancer. *  *  *  ASH19 abstracts discussed in this podcast: Abstract 843: Roxadustat in the treatment of anemia in patients with lower-risk myelodysplastic syndrome and low red blood cell transfusion burden. Abstract 754: (03:45) KTE:X19, an anti-CD19 CAR T-cell therapy in patients with relapsed/refractory mantle cell lymphoma: Results of the phase 2 ZUMA-2 trial. Abstract 3982: (08:28) Comparative outcomes of relapsed follicular lymphoma patients treated with novel agents: A multi-center analysis. Abstract 31: (13:45) ELEVATE TN: Phase 3 study of acalabrutinib combined with obinutuzumab or alone versus obinutuzumab plus chlorambucil in patients with treatment-naïve chronic lymphocytic leukemia. Abstract 33: (19:01) Ibrutinib and rituximab provides superior clinical outcome compared to FCR in younger patients with chronic lymphocytic leukemia: Extended follow-up from the E1912 trial. Abstract 36: Quantitative analysis of minimal residual disease shows high rates of undetectable MRD after fixed-duration chemotherapy-free treatment and serves as surrogate marker for progression-free survival: A prospective analysis of the randomized CLL14 trial. Abstract 355: Four-year analysis of Murano study confirms sustained benefit of time-limited venetoclax-rituximab in relapsed/refractory chronic lymphocytic leukemia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
When it comes to treating pain related to sickle cell disease, consider the underlying factors, from constipation to compression spine deformity. That’s just some of the advice from Ifeyinwa Osunkwo, MD, of Atrium Health and Levine Cancer Institute in Charlotte, N.C. She joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss her tips for treating pain and other complications of sickle cell disease. Dr. Osunkwo also provides an update on progress toward a cure in sickle cell disease that could be available to a large number of patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about why treating patients with cancer doesn’t make her sad. *  *  * Treating pain in sickle cell: In sickle cell disease, patients have acute episodes of vaso-occlusive crisis, as well as chronic pain. Consider whether the pain symptoms are an acute exacerbation of their chronic pain, an independent acute episode of pain, or chronic pain. In her practice, Dr. Osunkwo has moved to less chronic opioid use and more adjuvant use. She says treat the pain but look for the reason underlying it. The pain could be a result of bone damage, a compression spine deformity, constipation, or other factors related to their disease or the treatment. Consider the impact of opioid withdrawal after receiving a high dose in the hospital. Treating acute chest syndrome: Acute chest syndrome is usually not subtle in its presentation. It is acute and includes fever, pain, difficulty breathing or shortness of breath, hypoxia, and the patient looks sick. Consider their last chest x-ray and look for changes. Is this a new pulmonary infiltrate? This is a patient who should be transfused to get them out of distress. Most of acute chest syndrome cases happen 3 days into a hospital admission. Developments in sickle cell treatment: Two new drugs to treat sickle cell symptoms were approved in the United States in 2019: voxelotor (Oxbryta) to increase hemoglobin and crizanlizumab-tmca (Adakveo) to reduce the frequency of vaso-occlusive crisis. What is coming next? Researchers are working on potential cures for sickle cell that would be available to patients on a widespread basis. That includes haploidentical transplant and gene therapy. American Society of Hematology guidelines on the treatment of sickle cell complications. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Daniel G. Haller, MD, of the University of Pennsylvania, Philadelphia, joins Blood & Cancer host David H. Henry, MD, also of the University of Pennsylvania, to review the top three GI cancer trials presented at the 2019 ESMO World Congress on Gastrointestinal Cancer, and how they are changing practice.  Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, talks about the difficulty in using age to guide cancer treatment.   *  *  * BEACON trial for colorectal cancer Patients with BRAF mutations have a poor prognosis and typically fail treatment prior to second line therapy. BEACON is a phase 3 trial that was designed to test BRAF/MEK combination targeted therapies in patients with BRAF-mutated metastatic colorectal cancer. The study found that the three-drug combination of encorafenib, binimetinib, and cetuximab significantly improved overall survival in patients with BRAF-mutated metastatic colorectal cancer. The response rate for targeted triple therapy was 26%, compared with 2% for controls. It may be important for all patients with colorectal cancer to be tested for BRAF. IDEA trial in colon cancer Use of oxaliplatin in chemotherapy treatment regimens results in improvement in outcomes for patents with stage III colon cancer. However, treatment with oxaliplatin can cause disabling neuropathy, which is directly proportional to the cumulative dose administered. The IDEA (International Duration Evaluation of Adjuvant Therapy) trial combines data from six trials, in which patients with stage III colon cancer were randomized to receive 3 months or 6 months of adjuvant chemotherapy with a fluoropyrimidine plus oxaliplatin. The incidence of peripheral neuropathy was significantly reduced with the 3-month regimen, as compared with 6- month treatment. Survival data for 3 months of treatment with oxaliplatin are still pending. In patients with positive circulating tumor DNA (ctDNA) prior to adjuvant therapy, 6 months of treatment was preferable. Pembrolizumab, plus or minus chemotherapy, in gastric cancer This was a well-balanced three-arm study which included groups of patients treated upfront with pembrolizumab alone, chemotherapy alone, or a combination of pembrolizumab with chemotherapy. The primary endpoint was overall survival. Pembrolizumab was noninferior to chemotherapy if the combined positive score (CPS) was greater than 1. Pembrolizumab plus chemotherapy was not superior, even for CPS greater than 0.85. When pembrolizumab is started alone, patients drop off quickly. However, the responders to pembrolizumab have a long duration of response. It may be beneficial to start with chemotherapy and switch to targeted therapy when the side effects of chemotherapy become too great. Show notes by Debika Biswal Shinohara, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Thomas LeBlanc, MD, of Duke Cancer Institute in Durham, N.C., joins host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to discuss the evolution of the palliative care field and some of the underrecognized ways that it can improve care for hematology-oncology patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a patient who put aside her own desire for hospice because of family pressure to pursue curative treatment. *  *  * Palliative medicine has evolved tremendously over the past decade; it used to be synonymous with hospice and dying. It is now a sophisticated medical subspecialty with growing and large evidence base.  Palliative treatments are aimed at maximizing patient's quality of life and can be provided alongside other curative treatments.  Physicians, physician assistants, and nurse practitioners form an interdisciplinary team along with patients and their families.  Palliative care specialists can work alongside oncologists to optimize symptom management in patients with multiple or refractory/severe symptoms, including chemotherapy-induced nausea and pain neuropathy.  Palliative care specialists also can help provide a safe space and an extra layer of support to patients having difficulty coping with illness.  The American Society of Clinical Oncology (ASCO) has developed a guideline that all patients with advanced cancer should be receiving dedicated palliative care services concurrent with active treatment.  Workforce shortages in palliative care are limiting access for patients with cancer. Resource: Integration of palliative care into standard oncology care: ASCO Practice Guideline update (2017) Show notes by Debika Biswal Shinohara, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. *  *  * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
In this special edition podcast, we bring you the best of Clinical Correlation, a segment on the human side of hematology-oncology care. Clinical Correlation is written, recorded, and produced by Ilana Yurkiewicz, MD, of Stanford (Calif.) University. This episode includes five of our favorite Clinical Correlation segments.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
In this special edition podcast, Blood & Cancer revisits an interview with Ilana Yurkiewicz, MD, of Stanford (Calif.) University. Dr. Yurkewicz is the writer and producer of the podcast’s Clinical Correlation segment, which puts a human face on hematology-oncology care. She sits down with MDedge producer Nick Andrews for a wide-ranging interview that covers everything from the best advice she’s ever gotten to her favorite science fiction writer. The interview first aired on our sister podcast, Postcall.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Howard “Skip” Burris, MD, chief medical officer of Sarah Cannon Cancer Institute in Nashville, Tenn., joins the podcast to talk about what it’s like to be the 2019-2020 president of the American Society of Clinical Oncology. Dr. Burris joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to share his priorities as president and how he finds the time for advocacy, research, and clinical practice. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares the story of a couple who had cancer at the same time.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
David Mintzer, MD, of the University of Pennsylvania, Philadelphia, joins the podcast to discuss noteworthy drug approvals in hematology-oncology in 2019. Dr. Mintzer and Blood & Cancer host, David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, discuss what these new treatment options mean for clinicians and patients. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, is at the annual meeting of the American Society of Hematology with a reminder that the way we talk about patients matters. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * *  Dr. Mintzer’s review of new drug approvals in 2019: https://www.mdedge.com/hematology-oncology/article/211340/mixed-topics/2019-glance-hem-onc-us-drug-approvals?channel=27979 More articles on FDA approvals in hematology-oncology: https://www.mdedge.com/hematology-oncology/news-fda/cdc * * *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Matt Kalaycio, MD, of the Cleveland Clinic joins Blood & Cancer host David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to preview the potentially practice changing research that will be reported at the 2019 annual meeting of the American Society of Hematology. Plus, in Clinical Correlation, Ilana Yurkiewicz, MD, of Stanford (Calif.) University, addresses the isolation that comes from dealing with a serious chronic illness, especially around the holidays. *  *  *  Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *  FDA approves atezolizumab combo as first line for advanced NSCLC Atezolizumab is a monoclonal antibody and is already approved for adults with metastatic NSCLC with disease progression. By Laura Nicolaides The Food and Drug administration as approved atezolizumab in combination with paclitaxel and carboplatin chemotherapy for first-line treatment of adults with metastatic, nonsquamous non-small cell lung cancer with no EGFR or ALK genomic tumor aberrations.  *  *  *  ASH abstracts discussed in the podcast: Abstract 1: Post-transplantation cyclophosphamide after allogeneic hematopoietic stem cell transplantation: Results of the prospective randomized HOVON-96 trial in recipients of matched related and unrelated donors. Abstract 261: Superior survival with post-remission pediatric-inspired chemotherapy compared to myeloablative allogeneic hematopoietic cell transplantation in adolescents and young adults with Ph-negative acute lymphoblastic leukemia in first complete remission: Comparison of CALGB 10403 to patients reported to the CIBMTR. Abstract 322: Nonmyeloablative allogeneic transplantation confers an overall survival benefit with similar nonrelapse mortality when compared with autologous stem transplantation for patients with relapsed follicular lymphoma. Abstract 6: Mosunetuzumab induces complete remissions in poor prognosis non-Hodgkin lymphoma patients, including those who are resistant to or relapsing after chimeric antigen receptor T-cell therapies, and is active in treatment through multiple lines. Abstract LBA-5: Validation of BCL11A as therapeutic target in sickle cell disease: Results from the adult cohort of a pilot/feasibility gene therapy trial inducing sustained expression of fetal hemoglobin using posttranscriptional gene silencing. Abstract LBA-6: Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for the treatment of patients with relapsed or refractory multiple myeloma: Primary analysis results from the randomized, open-label, phase 3 study Candor. Abstract 1588: A randomized trial of EPOCH-based chemotherapy with vorinostat for highly aggressive HIV-associated lymphomas: Updated results evaluating the impact of diagnosis-to-treatment interval and pre-protocol systemic therapy on outcomes. Abstract 940: Elucidating the role of IL6 in stress erythropoiesis and in the development of anemia under inflammatory conditions. Abstract 57: Patient harm from repetitive blood draws and blood waste in the ICU: A retrospective cohort study. Abstract 59: Impact of iron supplementation on patient outcomes in women undergoing gynecologic procedures: Systematic review and meta-analysis of randomized trials. Abstract 126: Polatuzumab vedotin plus obinutuzumab and lenalidomide in patients with relapsed/refractory follicular lymphoma: Primary analysis of the full efficacy population in a phase Ib/II trial. Abstract 168: Risk of hemorrhage in patient with polycythemia vera exposed to aspirin in combination with anticoagulants: Results of a prospective, multicenter, observational cohort study (REVEAL). Abstract 326: Safety and effectiveness of apixaban, LMWH, and warfarin among venous thromboembolism patients with active cancer: A retrospective analysis using four U.S. claims databases. Abstract 327: Safety and effectiveness of apixaban, LMWH and warfarin among venous thromboembolism patients with active cancer: A subgroup analysis of VTE risk scale. Abstract 566: Phase II study of oral rigosertib combined with azacytidine as first line therapy in patients with higher-risk myelodysplastic syndromes.   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
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