Blood & Cancer

A number of groundbreaking and practice-changing studies were presented at the San Antonio Breast Cancer Symposium 2020. The RxPONDER, ADAPT, and PRIME-2 trials revealed patients who can forgo chemotherapy or radiotherapy, monarchE and PENELOPE-B showed conflicting results with CDK4/6 inhibitors, one study indicated that a new tool can guide adjuvant chemotherapy, and another study suggested that circulating tumor cells (CTCs) can predict overall survival (OS). Alan P. Lyss, MD, subprincipal investigator for Heartland Cancer Research NCORP, joined host David H. Henry, MD, to discuss these and other studies — their top 10 presentations from SABCS 2020 — in this episode. 1. Abstract GS3-07. Identifying patients whose symptoms are under-recognized during breast radiotherapy: Comparison of patient and physician reports of toxicity in a multicenter cohort. https://bit.ly/2MGCVEH This presentation could be one of the most important stories to emerge from SABCS 2020, according to Dr. Lyss. The trial included 9,868

In this episode, we bring you clips from the best Blood & Cancer shows of 2020. Blood & Cancer will be back with new episodes in 2021.  ESMO 2020: Late-breaking and practice-changing studies on COVID-19 and breast, lung, gastrointestinal, and other cancers https://bit.ly/3h7aWZM Beyond the lungs: How COVID-19 affects the blood, brain, gastrointestinal system, and other organ systems https://bit.ly/37GhV8Q EHA25: AML, myeloma, polycythemia vera, and COVID-19 with EHA President John Gribben https://bit.ly/3nS4592 VTE rate, 'COVID toes,' and Virchow's triad: What you need to know about COVID and coagulation https://bit.ly/3rizmnM ASCO 2020: Practice-changing studies in breast, lung, colorectal, and other cancers https://bit.ly/37EIbkg * * * 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

News from SABCS 2020: RxPONDER: Even more women may forgo chemo for breast cancer: https://bit.ly/2LIYjZt Breast surgery may be a gateway to addictive medication use: https://bit.ly/3gSWfJF Pregnancy after breast cancer is rockier but doesn’t increase recurrence risk: https://bit.ly/2KwlhCx Email Blood & Cancer at podcasts@mdedge.com. 

The ASH Research Collaborative COVID-19 Registry for Hematology was established earlier this year to study patients with hematologic malignancies diagnosed with COVID-19. Now, the registry also includes patients with nonmalignant hematologic disorders and hematologic manifestations of COVID-19. William Wood, MD, of the University of North Carolina at Chapel Hill, recently presented data from the registry at the ASH Annual Meeting. In this episode, Dr. Wood tells host David H. Henry, MD, how the registry came to be and reviews some of its findings. About the registry The registry is part of the ASH Research Collaborative, an organization established in 2018 to foster collaboration to accelerate progress in hematology. The registry houses data on patients with a COVID-19 diagnosis and hematologic disorders/malignancies or hematologic manifestations of COVID-19. Health care providers around the world can contribute data to the registry. Anyone can view summaries of the deidentified data on the registry website

News from ASH 2020: No benefit from tranexamic acid prophylaxis in blood cancers: https://bit.ly/2K3Mah1 ‘Practice changing’: Ruxolitinib as second-line in chronic GVHD: https://bit.ly/3gT4kyg  Durable responses with anti-BCMA CAR T-cell for multiple myeloma: https://bit.ly/381f1ut Five-minute SC injection of daratumumab in RRMM: https://bit.ly/3gKuZgx Email Blood & Cancer at podcasts@mdedge.com  

A pair of biomarkers are being used to guide treatment and predict mortality in patients with graft-versus-host disease (GVHD), according to James L.M. Ferrara, MD, DSc, of the Icahn School of Medicine at Mount Sinai, New York. In this episode, Dr. Ferrara explains how measuring these biomarkers – REG3-alpha and ST2 – can prevent over- and undertreatment of acute GVHD. The biomarkers have also been shown to predict nonrelapse mortality more accurately than a change in clinical symptoms. Before reviewing these findings, Dr. Ferrara tells host David H. Henry, MD, what GVHD is, how to recognize it, and how it’s typically treated. GVL and GVHD GVHD is “very tightly associated” with the graft-versus-leukemia (GVL) effect, Dr. Ferrara explained. The GVL effect refers to the ability of donor immune cells to eliminate host malignant cells after allogeneic hematopoietic stem cell transplant (allo-HSCT). The donor T cells respond to minor histocompatibility antigens on malignant cells but also on normal cells. When t

Blood & Cancer news stories: Black patients with ES-SCLC get less chemo but have better survival: https://bit.ly/33Rb5eB Should CTCs guide treatment choice in HR+, HER2– breast cancer?: https://bit.ly/3gn6shc New drug approved for relapsed/refractory neuroblastoma: https://bit.ly/2VMpvIy FDA approves first agent for PSMA-PET imaging in prostate cancer: https://bit.ly/36TAaY7 Contact Blood & Cancer at podcasts@mdedge.com.

Researchers are conducting the first U.S. trial of pressurized intraperitoneal aerosolized chemotherapy (PIPAC) for the treatment of peritoneal carcinomatosis in patients with gynecologic or gastrointestinal cancers. Coprincipal investigator Thanh H. Dellinger, MD, of City of Hope in Duarte, Calif., describes this trial and the PIPAC procedure to host David H. Henry, MD, in this episode. To start, the pair discuss a patient who might be eligible for PIPAC – one with stage 3 ovarian cancer. General approach to stage 3 ovarian cancer Therapy typically includes a combination of surgery and chemotherapy. The order in which chemotherapy is given, either pre- or postoperatively, depends on performance status and whether patients have extra-abdominal disease or parenchymal liver disease. Operative approaches, including debulking surgery, are pursued if believed to be optimal, meaning all gross residual disease can be resected. If all residual disease cannot be resected, patients are offered neoadjuvant chemotherapy

Blood & Cancer News Stories:  Immune checkpoint inhibitors don’t increase COVID-19 incidence or mortality, studies suggest: https://bit.ly/2JlP2FN HCC rates slow in cities, continue to climb in rural areas: https://bit.ly/2Jx6Ux1 Risk factors for severe immune-related AEs identified: https://bit.ly/3fO6Fd8 Contact Blood & Cancer at podcasts@mdedge.com  

In this episode, host David H. Henry, MD, highlights some recent articles from Blood, the Journal of Clinical Oncology, and the New England Journal of Medicine. Blood How I Treat series on hematologic complications in pregnancy. https://bit.ly/3fr5nV8 Mutational and phenotypic characterization of hereditary hemorrhagic telangiectasia. https://bit.ly/3nQvhF6 Journal of Clinical Oncology Hepatitis B Virus Screening and Management for Patients With Cancer Prior to Therapy: ASCO Provisional Clinical Opinion Update. https://bit.ly/3maTOE4 Related Blood & Cancer episode: Cancer and hepatitis B virus: ASCO's recommendations for HBV screening, monitoring for reactivation, and how to treat patients. https://bit.ly/3m0jjrF Chemotherapy and Venetoclax in Elderly Acute Myeloid Leukemia Trial (CAVEAT): A Phase Ib Dose-Escalation Study of Venetoclax Combined With Modified Intensive Chemotherapy. https://bit.ly/372FFCB Chemotherapy and COVID-19 Outcomes in Patients With Cancer. https://bit.ly/35WRLOi Related Bloo

In this episode, we discuss updated guidelines on the screening and management of hepatitis B virus (HBV) in patients about to start anticancer therapy. The guidelines come from an American Society of Clinical Oncology Provisional Clinical Opinion (PCO) published earlier this year. Jessica P. Hwang, MD, of MD Anderson Cancer Center, and Andrew Artz, MD, of City of Hope, are cochairs of the ASCO PCO. They joined host David H. Henry, MD, to discuss the guidelines. Epidemiology of HBV Data suggest chronic HBV infection affects 257 million people globally. In the United States, chronic HBV infection has a prevalence of less than 1%, but the prevalence of past HBV can be 5%-40% in high-risk populations. High-risk populations include people born in endemic areas (i.e., Africa, Asia, and South America), those with injection drug use, men who have sex with men, and people with household contacts who have HBV. In patients with cancer, the prevalence of past HBV infection is 5%-10%, with a 0.5% prevalence of chronic H

The Tomosynthesis Mammography Imaging Screening Trial (TMIST) was designed to see if 3-D mammography, or tomosynthesis, could help personalize screening and if 3-D is actually better than the less expensive 2-D mammography. TMIST is the largest breast cancer screening trial in the United States, with a cost of $100 million and a planned enrollment of 165,000 women. There's just one problem. The study is falling short on enrollment of patients and participating sites. Will this mean the death of TMIST? For more details, see coverage of TMIST on Medscape: NCI May 'Kill' Major Mammography Trial, Says Advisor https://www.medscape.com/viewarticle/937918 Email Blood & Cancer at podcasts@mdedge.com.

Can receiving all posttransplant care at home benefit patients undergoing hematopoietic stem cell transplant (HSCT)? Researchers are conducting phase 2 trials to find out. Anthony D. Sung, MD, of Duke University School of Medicine, described this research to host David H. Henry, MD. Dr. Sung outlined the process of receiving post-HSCT care at home and discussed Duke's clinical trials assessing the impact of home care on costs, quality of life, the microbiome, and graft-versus-host disease (GVHD). Dr. Sung also discussed another Duke trial investigating whether a probiotic can prevent COVID-19. Post-HSCT care at home: How it works Cell collection (if applicable), conditioning, and HSCT all take place in the outpatient setting. From day 1 after transplant onward, the patient receives all care at home. A nurse practitioner or physician assistant visits the patient every morning to draw labs, which are run at the hospital. A nurse visits every afternoon to give the patient supportive care. Patients are given the

Hematology Oncology News:  IMRT new standard of care for high-risk cervical cancer: https://bit.ly/3k7ji3y Real-world results with checkpoint inhibitors found inferior to trial results: https://bit.ly/35cIt0v Are HMAS appropriate for posttransplant maintenance in acute leukemias?: https://bit.ly/3lfqsE7 You can email the show at podcasts@mdedge.com.

In this episode, we review how PD-L1 inhibitors and COVID-19 have changed the management of non-small cell lung cancer (NSCLC). Jeffrey Crawford, MD, and Susan Blackwell, PA, both of Duke Cancer Institute, join host David H. Henry, MD, to discuss the use of pembrolizumab in NSCLC, two studies of PD-L1 inhibitors presented at ESMO 2020, and how COVID-19 has affected NSCLC care, particularly the use of granulocyte colony-stimulating factor (G-CSF). Diagnosis and treatment of NSCLC What information should be obtained from a biopsy? Is this lung cancer? If so, what kind of lung cancer is it: Small-cell lung cancer or NSCLC? Which subtype? Molecular studies for targets, including ALK, KRAS, EGFR, PD-L1. Treatment with pembrolizumab: If, for example, a patient has NSCLC and is positive for PD-L1, the treatment of choice is pembrolizumab. A multidisciplinary approach is essential to provide comprehensive education and care to patients taking pembrolizumab (and other immunotherapies). Pembrolizumab can have man

News from MDedge Hematology-Oncology: New estimates for breast cancer risk with HRT: https://bit.ly/37VT0Pt BMJ study: https://bit.ly/2TKDIVt Lancet meta-analysis: https://bit.ly/3kUdbRl Single and multifraction SBRT found comparable for lung metastases: https://bit.ly/2HS36pR Statins may lower risk of colorectal cancer: https://bit.ly/3kLbR37 Email Blood & Cancer at podcasts@mdedge.com.  Follow us on Twitter @MDedgeHemOnc.

In this episode, we review the latest guidelines on antiemetics from the American Society of Clinical Oncology (ASCO). Host David H. Henry, MD, is joined by ASCO guideline author Paul J. Hesketh, MD, of Lahey Hospital and Medical Center in Burlington, Mass. Dr. Hesketh explains the recommendations for antiemetic use in cancer patients receiving checkpoint inhibitors (CPIs) or high-, moderate-, or low-emetic-risk antineoplastic agents. Checkpoint inhibitors The update to ASCO’s guidelines was primarily driven by questions about antiemetic use in patients receiving CPIs, according to Dr. Hesketh. After a literature review, Dr. Hesketh and coauthors concluded that: Patients receiving CPIs alone do not require an antiemetic regimen. When CPIs are given with chemotherapy, there is no need to modify the antiemetic regimen. Dexamethasone does not compromise the efficacy of CPIs. High-emetic-risk antineoplastic agents Adults treated with cisplatin and other high-emetic-risk single agents should be offered a fo

Hematology-Oncology News:  National lung cancer screening guidelines may miss younger African American individuals at high risk: https://bit.ly/3e2CmhV  Standard treatment lacking in relapsed / refractory AML: https://bit.ly/3kzoUVh (03:08) Patients can read your clinical notes starting Nov. 2: https://bit.ly/3mnuudL (05:40) You can email the show at podcasts@mdedge.com.  

In this episode, we review three hematology cases. One case illustrates the work-up and treatment of immune thrombocytopenia (ITP). Another case demonstrates how to diagnose and manage heparin-induced thrombocytopenia (HIT). And the final case is a patient who presented with anemia, a new mitral valve murmur, and mild splenomegaly. Host David H. Henry, MD, reviews these cases with three residents from Pennsylvania Hospital in Philadelphia – Sheila De Young, DO; Ronak Mistry, DO; and Debika Shinohara, MD, PhD. Case 1: Suspected ITP with Sheila De Young, DO Patient presentation: A 50-year-old female with no past medical history and incidental platelet count of 4,000/microL (normal 150,000-450,000/microL [150-450 x 109/L]). On physical exam, there was no lymphadenopathy, and the spleen was nonpalpable. She had obvious petechiae on her legs. A urine pregnancy test was negative. Her hemoglobin and white blood cell counts were normal via complete blood count. ITP definition: Acquired thrombocytopenia caused by a

Hematology Oncology News: Study advances personalized treatment for older breast cancer patients (https://bit.ly/3dHieSk) Delayed cancer screening could cause increase in deaths, study says (https://bit.ly/34afIAS) Blood group O linked to decreased risk of SARS-CoV-2 infection (https://bit.ly/2T8qilF) Email Blood & Cancer at podcasts@mdedge.com or follow us on Twitter @MDedgeHemOnc.