64 episodes

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.

Blood & Cancer MDedge Hematology & Oncology

    • Medicine

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.

    Treatment tips in CLL

    Treatment tips in CLL

    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
     

    • 22 min
    When to refer for CAR T-cell therapy

    When to refer for CAR T-cell therapy

    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.
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    Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia.
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    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
     
     
     

    • 21 min
    Understanding biosimilars

    Understanding biosimilars

    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.
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    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

    • 19 min
    ASH19 special report

    ASH19 special report

    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.
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    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.
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    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

    • 30 min
    Sickle cell update: Treating pain and progress toward cure

    Sickle cell update: Treating pain and progress toward cure

    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.
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    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.
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    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

    • 25 min
    Practice-changing research in GI cancer

    Practice-changing research in GI cancer

    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.  
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    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.
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    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

    • 24 min

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