Blood & Cancer

How does the community oncologist treat multiple myeloma? Gustavo A. Fonseca, MD, of Florida Cancer Specialists, shares his approach to myeloma treatment with host David H. Henry, MD. At the start of this episode, Dr. Fonseca and Dr. Henry discuss their love of podcasts, mentioning shows that have proven useful to them personally and professionally. The pair then move on to discuss hypothetical myeloma cases and advances in treatment. They cover triple-agent therapy, transplant, and bone-modifying agents. They also discuss the management of anemia, what to do after treatment failure, and how far myeloma treatment has come in recent years. Disclosures: Dr. Fonseca and Dr. Henry have 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

Subscribe to Blood & Cancer: Apple Podcasts, Spotify, Google Podcasts   This week in HemOnc News: Higher death rate seen in cancer patients with nosocomial COVID-19 Article: https://bit.ly/2XjRLDq Source: https://bit.ly/3goLGgF Robotic renal surgery bests open partial nephrectomy Article: https://bit.ly/2PhHS4MSource: https://bit.ly/3gqXXBd Large cohort study: Bevacizumab safe, effective for severe HHT bleeds Article: https://bit.ly/2XpuZdjSource: https://bit.ly/2BXHVQg For more MDedge Podcasts, click this link: http://bit.ly/2CfnY52   Email the show: podcasts@mdedge.com   Follow Dr. David Henry on Twitter @DavidHenryMD  

COVID-19 can have a negative impact on systems throughout the body, beyond just the lungs, according to a review published in Nature Medicine. Two authors of the review joined host David H. Henry, MD, to discuss their article, “Extrapulmonary manifestations of COVID-19.”  Aakriti Gupta, MD, of Columbia University Irving Medical Center, and Kartik Sehgal, MD, of Dana Farber Cancer Institute, discussed: ACE2, the entry receptor for SARS-CoV-2 Neurologic and gastrointestinal manifestations of COVID-19 Mechanisms of coagulation and thromboprophylaxis COVID-19 in cancer patients The impact of quarantine on cardiology patients The lasting effects of COVID-19 and the need for follow-up The importance of international collaboration for clinical trials. For more details on how COVID-19 can affect the body, see the full review in Nature Medicine: Gupta A. et al. Nat Med. 2020 Jul;26(7):1017-1032.  Disclosures: Dr. Henry and Dr. Sehgal have no financial disclosures relevant to this episode. Dr. Gupta disclosed relati

Subscribe to Blood & Cancer: Apple Podcasts, Spotify, Google Podcasts This week in HemOnc News: PSMA PET/CT may be new 'gold standard' for prostate cancer staging Source: https://bit.ly/2CRaq2t Study: https://bit.ly/3f18YHL Analysis of early-onset cancer suggests need for genetic testing Source: https://bit.ly/2WZSIR3 AACR Abstract: https://bit.ly/3f18YHL Early screening may halve breast cancer mortality in childhood cancer survivors Source: https://bit.ly/2WZSIR3 Study: https://bit.ly/39DoJUf COVID-19: Heavy toll from ongoing cancer referral delays Source: https://bit.ly/3g6DiSF First study: https://bit.ly/2WZSVnj Second study: https://bit.ly/30375Gp For more MDedge Podcasts, click this link: http://bit.ly/2CfnY52   Email the show: podcasts@mdedge.com   Follow Dr. David Henry on Twitter @DavidHenryMD

While relaxing on the Jersey Shore, host and MDedge Hematology/Oncology Editor-in-Chief, David Henry, MD, dove into the July 10, 2020, issue of the Journal of Clinical Oncology. In episode 82, we do the same.   J Clin Oncol. 2020 Jul 10. 38(20). 2217-2361. (https://bit.ly/2ZQEJ27)   You can follow along with the following articles: Lumpectomy Margins for Invasive Breast Cancer and Ductal Carcinoma in Situ: Current Guideline Recommendations, Their Implications, and Impact (https://bit.ly/39m5P3W) Accelerated Partial Breast Irradiation and Intraoperative Partial Breast Irradiation: Reducing the Burden of Effective Breast Conservation (https://bit.ly/2Bm9McB) Partial Breast Irradiation Is the Preferred Standard of Care for a Majority of Women With Early‐Stage Breast Cancer (https://bit.ly/3jqAxhj) Whole-Breast Irradiation Is the Preferred Standard of Care for the Majority of Patients With Early-Stage Breast Cancer (https://bit.ly/3jwRma3) Regional Nodal Management in Patients With Clinically Node-N

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

Cancer patients often ask what they should eat, but it’s just as important to know when they should eat, according to Dawn Lemanne, MD, of Oregon Integrative Oncology, Ashland, and the University of Arizona, Tucson. Dr. Lemanne tells host David H. Henry, MD, how cancer patients may benefit from fasting. The pair discuss immune system suppression, insulinlike growth factor I (IGF-I), and blood glucose monitoring. Fasting and the immune system Fasting before and after chemotherapy can put part of the immune system “to sleep,” thereby protecting it from the deleterious effects of treatment, Dr. Lemanne says. A study of patients on platinum-based chemotherapy suggested that fasting for at least 48 hours (divided pre- and post chemo) led to decreased DNA damage in leukocytes (BMC Cancer. 2016 Jun 10;16:360). Based on this study and preclinical results, Dr. Lemanne advises fasting in patients receiving emetogenic and immunosuppressive chemotherapies. Lemanne defines fasting as consuming no (or few) calories. Patie

The latest news for hematology and oncology professionals. In this episode:  USPSTF: Earlier lung cancer screening can double eligibility * Review and comment on the USPSTF site: https://bit.ly/3fppiD7* National Lung Screening Trial https://bit.ly/2CvNRQt  Lifestyle choices may reduce breast cancer risk regardless of genetics* Read the article on MDedge: https://bit.ly/2ZrsWqN * Read the original research: https://bit.ly/3etRLGx (JAMA Netw Open. 2020;3(4):e203760). FDA approves oral therapy for myelodysplastic syndromes, CMML * Read the FDA news release: https://bit.ly/2WeUIVb Commentary: 'Doc, Can I Get a Mask Exemption?' * Read the full commentary from Dr. Rizzo: https://wb.md/2Wfoh9i* Read the CDC Recommendations: https://bit.ly/304OTed * Read more about Dr. Albert Rizzo: https://bit.ly/3j2QDgW For more MDedge Podcasts go to https://www.mdedge.com/podcasts/ Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeHemOnc  

Oncologist Don S. Dizon, MD, joins the podcast to discuss how the COVID-19 pandemic has affected him personally and professionally. Dr. Dizon is the director of women’s cancers at Lifespan Cancer Institute and director of medical oncology at Rhode Island Hospital, both in Providence. Dr. Dizon tells host David H. Henry, MD, how COVID-19 affected his patients, colleagues, and research as well as his personal life. Dr. Dizon chronicled some of these developments in a series of columns published on Medscape. Disclosures: Dr. Dizon has relationships with Regeneron, Astra-Zeneca, Clovis, Bristol-Myers Squibb, and Kazia. He is a columnist for Medscape, which is owned by the same parent company as MDedge News. Dr. Henry has no relevant disclosures. * * * 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, MD, recorded dozens of Clinical Correlation segments for Blood & Cancer for more than a year. She also hosted a three-part series on difficult conversations that trainees have with their patients. In this episode, we revisit the best of Dr. Yurkiewicz.   'How long do I have left?' 02:59 Anxiety 17:02 Optimism Bias 20:21 Social Support 23:51 Family Dynamics 26:07 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

EHA25 highlights: EHA President John Gribben talks AML, myeloma, polycythemia vera, and COVID-19 What were the late-breaking and practice-changing presentations at EHA25 Virtual? John Gribben, MD, DSc, president of the European Hematology Association, highlighted some of them in this podcast. Dr. Gribben and host David H. Henry, MD, discussed presentations on acute myeloid leukemia (AML), multiple myeloma, polycythemia vera (PV), and COVID-19. Videos of these and other presentations will be available on the EHA25 website until Oct. 15.  Randomized, double-blind, placebo-controlled study of venetoclax with azacitidine vs. azacitidine in treatment-naïve patients with acute myeloid leukemia ineligible for intensive therapy—VIALE-A: Adding venetoclax to azacitidine improved survival, response, and transfusion independence in older patients with treatment-naïve AML.  Older AML patients have seen “very little progress” in outcomes for decades, but advances such as these are “really moving the field,” Dr. Gribben

The Food and Drug Administration has approved dozens of drugs for new hematology/oncology indications this year. Host David Henry, MD, was joined by David Mintzer, MD, and other colleagues at Penn Medicine in Philadelphia – Justine Cohen, DO, and Ingrid Kohut, DO – to discuss some of these approvals. Dr. Mintzer reviewed: The “game-changing” approval of niraparib (Zejula) in advanced ovarian, fallopian tube, or primary peritoneal cancer. The “exciting” approval of sacituzumab govitecan-hziy (Trodelvy) in metastatic triple-negative breast cancer. The “COVID-relevant” approval of a new dosing regimen for pembrolizumab (Keytruda) – 400 mg every 6 weeks – across all approved adult indications. The “niche” approval of mitomycin (Jelmyto) for adults with low-grade upper tract urothelial cancer. And several other approvals the FDA granted this year. Details on all approvals are available on the FDA website. *  *  *   Disclosures: Dr. Henry and all guests reported having no relevant disclosures.   *  *  *   Fo

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

Jack West, MD, joins the podcast to discuss how he chooses first-line treatment in new patients with non–small cell lung cancer (NSCLC). Dr. West is an associate clinical professor in medical oncology at City of Hope Comprehensive Cancer Center in Duarte, Calif., and a thought leader in thoracic oncology. Dr. West also explores how the COVID-19 pandemic influences treatment approaches, the usefulness of liquid biopsy, and how he weighs the potentially higher risk for COVID-19 complications from checkpoint inhibitors.   Check out Dr. West’s last two appearances on the podcast: https://www.mdedge.com/podcasts/blood-cancer/immunotherapy-lung-cancer-dr-jack-west-part-1 https://www.mdedge.com/podcasts/blood-cancer/immunotherapy-lung-cancer-dr-jack-west-part-2   Disclosures: Dr. Henry reported having no financial disclosures relevant to this episode. Dr. West has a full list of his financial disclosures here. *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Inter

David H. Henry, MD, answers the question, "Would you choose oncology again?" This question was asked of oncologists surveyed for the Medscape Oncologist Compensation Report 2020, and 96% of oncologists said they would still choose oncology as their specialty. Later, William J. Gradishar, MD, of Northwestern University in Chicago, joined Dr. Henry to discuss recent developments in breast cancer. Dr. Gradishar reviewed three trials presented at the 2019 San Antonio Breast Cancer Symposium (SABCS), two of which will be updated at the ASCO Annual Meeting. *  *  *   SABCS highlights HER2CLIMB trial: This trial led to the recent U.S. approval of tucatinib in combination with trastuzumab and capecitabine. The phase 2 trial enrolled patients with heavily pretreated, HER2-positive, metastatic breast cancer (N Engl J Med. 2020 Feb 13; 382:597-609). Patients who received tucatinib plus trastuzumab and capecitabine had superior progression-free and overall survival, compared with patients who received placebo plus

Adam C. Cuker, MD, joins host David H. Henry, MD, to discuss recent findings regarding coagulation in COVID-19 patients. Both Dr. Cuker and Dr. Henry both practice at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Cuker cited data suggesting at least 25%-30% of patients with COVID-19 develop venous thromboembolism (VTE), despite receiving prophylactic anticoagulation. Furthermore, COVID-19 patients have presented with “lots of different thrombotic manifestations,” he said. This includes stroke and “COVID toes syndrome,” a condition in which patients present with ischemic toes, which appears to have a thromboembolic etiology. Dr. Cuker suggested that all three aspects of Virchow’s triad may be at play in patients with COVID-19 who have thrombotic manifestations, including: Circulatory stasis (in patients who are immobilized/sedated/prone/paralyzed). Hypercoagulability (inflammation, high levels of factor VIII and fibrinogen, neutrophil extracellular traps). Endothelial injury (SARS-CoV-2

In this episode, Matthew Watto, MD, an internist at Pennsylvania Hospital in Philadelphia, tells host David H. Henry, MD, also of Pennsylvania Hospital, how the COVID-19 pandemic has affected him personally and professionally. Dr. Watto recounts how COVID-19 has impacted patient volume, shifts, teaching, and interactions between patients and staff. Dr. Watto also discusses his internal medicine podcast, The Curbsiders, which, he says, provides listeners with “clinical pearls, practice-changing knowledge, and bad puns.” Disclosures: Dr. Henry has no financial disclosures relevant to this episode. Dr. Watto has 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

How should oncologists be treating genitourinary malignancies during the COVID-19 pandemic? Aly-Khan A. Lalani, MD, of McMaster University in Hamilton, Ontario, and colleagues recently published recommendations that help answer that question (Can Urol Assoc J. 2020 May;14[5]:e154-8). In this episode, Dr. Lalani reviews some of these recommendations with podcast host David H. Henry, MD, of Pennsylvania Hospital in Philadelphia. The pair discuss when and how to use androgen receptor axis-targeted therapies and radium-223 in metastatic prostate cancer, platinum-based chemotherapy in advanced urothelial carcinoma, and checkpoint inhibitors in patients with urothelial carcinoma or renal cell carcinoma. *  *  *   Disclosures: Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Lalani has relationships with Astellas Pharma, Bayer, Bristol-Myers Squibb, Merck, Novartis, Pfizer, Roche/Genentech, TerSera, AbbVie, Eisai, Ipsen, and Janssen. *  *  *   For more MDedge Podcasts, go to mdedge.co

The American Society of Clinical Oncology is gearing up for its first-ever virtual meeting at the end of May 2020. ASCO’s president Howard A. “Skip” Burris, III, MD, joins David H. Henry, MD, of Pennsylvania Hospital, Philadelphia, to explain how the virtual meeting will work, from releasing research to earning continuing medical education credits. Dr. Burris also explores how the society is responding to COVID-19. Later in the podcast, Bernard A. Mason, MD, an oncologist with Pennsylvania Hospital and the University of Pennsylvania, both in Philadelphia, is back with some bonus technology tips for taking notes and syncing them across devices, sharing large files, and best practices for backing up files. Disclosures: Dr. Henry reported having no financial disclosures relevant to this episode. Dr. Burris has a full list of his financial disclosures here. Dr. Mason reported having no financial disclosures relevant to this episode. *  *  *  For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: pod

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:@ila