109 episodes

The ASCO eLearning Podcast is an educational series focused on helping learners identify knowledge gaps and stay up-to-date with the latest in new drug developments, cancer treatments and patient care approaches.

The purpose of this podcast is to educate and to inform. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. It is no substitute for professional care by a doctor or other qualified medical professional and is not intended for use in the diagnosis or treatment of individual conditions. Guests who speak in this podcast express their own opinions, experience and conclusions. Neither American Society of Clinical Oncology nor any of its affiliates endorses, supports or opposes any particular treatment option or other matter discussed in this podcast. The mention of any product, service, organization, activity or therapy on the Podcast should not be construed as an ASCO endorsement.

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    • Medicine

The ASCO eLearning Podcast is an educational series focused on helping learners identify knowledge gaps and stay up-to-date with the latest in new drug developments, cancer treatments and patient care approaches.

The purpose of this podcast is to educate and to inform. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. It is no substitute for professional care by a doctor or other qualified medical professional and is not intended for use in the diagnosis or treatment of individual conditions. Guests who speak in this podcast express their own opinions, experience and conclusions. Neither American Society of Clinical Oncology nor any of its affiliates endorses, supports or opposes any particular treatment option or other matter discussed in this podcast. The mention of any product, service, organization, activity or therapy on the Podcast should not be construed as an ASCO endorsement.

    ASCO Guidelines: Molecular Biomarkers in Localized Prostate Cancer Guideline

    ASCO Guidelines: Molecular Biomarkers in Localized Prostate Cancer Guideline

    An interview with Dr. Scott Eggener of University of Chicago Medicine on "Molecular Biomarkers in Localized Prostate Cancer: ASCO Guideline." This guideline provides recommendations for available tissue-based prostate cancer biomarkers geared toward patient selection for active surveillance, identification of clinically significant disease, choice of postprostatectomy adjuvant versus salvage radiotherapy, and to address emerging questions such as the relative value of tissue biomarkers compared with MRI. 
    Read the full guideline at www.asco.org/genitourinary-cancer-guidelines 

    • 9 min
    ASCO Guidelines: Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards

    ASCO Guidelines: Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards

    An interview with Dr. Melissa Dillmon on the Patient-Centered Standards for Medically Integrated Dispensing: ASCO/NCODA Standards. The interview covers the findings of the systematic review, which were consistent with the NCODA patient-centered standards for patient relationships and education, adherence, safety, collection of data, documentation and other areas. NCODA standards were adopted and used as basis for these ASCO/NCODA standards. Additional information is available at www.asco.org/mid-standards.

    • 6 min
    Management of Immune-related Adverse Events Refractory to Standard Therapies

    Management of Immune-related Adverse Events Refractory to Standard Therapies

    Dr. Doug Johnson, clinical director of the melanoma program and assistant professor of medicine at Vanderbilt University Medical Center, discusses the management of immune-related adverse events refractory to standard therapies.

    If you enjoyed this podcast, make sure to subscribe for more weekly education content from ASCO University. We truly value your feedback and suggestions, so please take a minute to leave a review. If you are an oncology professional and interested in contributing to the ASCO University Weekly Podcast, email ascou@asco.org for more information.
    TRANSCRIPT
    [INTRO MUSIC PLAYING]
    Welcome to the ASCO University Weekly Podcast. My name is Doug Johnson. I'm the clinical director of the melanoma program, assistant professor of medicine at Vanderbilt University Medical Center. Today we'll discuss management of immune-related adverse events refractory to standard therapies.

    As a background to today's discussion, immune checkpoint inhibitor are active therapies and FDA approved in 15 different cancer types. Responses in patients who do respond can be quite durable. And these are enhanced further by combining immune checkpoint inhibitors-- specifically combining anti PD-1, or nivolumab or pembrolizumab, with anti CTLA-4, ipilimumab.

    The side effect from these treatments, called immune-related adverse events, are caused by unleashing T cells not only against tumor but against host tissues. These inflammatory toxicities can affect any organ and may occasionally be life threatening. The cornerstone of managing immune-related adverse events in patients involves corticosteroid treatment, which are usually effective. More clinically severe events are treated with high-dose steroids.

    For example, prednisone or methylprednisolone, 1 to 2 milligrams per kilogram per day. And less severe side effects may be managed by dose withholding, symptomatic management, or low-dose steroids-- 0.5 milligrams per kilogram or less. In addition, certain side effects have fairly well-established second line treatments. For example, patients with colitis that does not improve with steroids within three days should be considered for infliximab treatment. Similarly, hepatitis that fails to improve should also receive mycophenolate mofetil. For more information about steroid dosing, definitions of mild versus severe toxicities, and established second line treatments for refractory toxicities, please visit the ASCO Clinical Guidelines for managing immune checkpoint inhibitor toxicities.
    So, as I mentioned, corticosteroids and established second line regimens are fairly effective. So what is the problem? What is the knowledge gap? Well, again, though most events fail to respond to corticosteroids, a subset fails to improve and requires even additional treatment regimens. Actually, approximately 1% of patients treated with combination ipilimumab and nivolumab actually experience fatal toxicities. Further, a small subset of patients develop chronic toxicities, such as neuropathy or arthritis, those developing more effective treatment regimens and more effectively using the treatment regimens we have is a real unmet need.

    So let's talk about the data. Well, first of all, even the data for steroids for using steroids for these immune-related toxicities, as well as the fairly well-established second line treatments, like infliximab and mycophenolate, are largely based on anecdotal evidence and clinical experience. Thus, the data for use of additional agents on top of that for the very refractory toxicities are even more limited. But with that being said, let's discuss some approaches.
    First, some general principles. Most immune therapy toxicities have a similar syndrome that's encountered outside of immune checkpoint inhibitor treatment. For example, immune checkpoint inhibitor colitis is quite similar to inflammatory bowel dis

    • 5 min
    ASCO Guidelines: Disease Management for Patients With Advanced HER2 Positive Breast Cancer and Brain Metastases Guideline

    ASCO Guidelines: Disease Management for Patients With Advanced HER2 Positive Breast Cancer and Brain Metastases Guideline

    An interview with Dr. Naren Ramakrishna from University of Florida Health Cancer Center at Orlando Health on the guideline update which addresses management of brain metastases for patients with human epidermal growth factor receptor 2–positive advanced breast cancer. Read the full guideline at www.asco.org/breast-cancer-guidelines 

    • 7 min
    ASCO Guidelines: Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx Guideline

    ASCO Guidelines: Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx Guideline

    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

    Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Shlomo Koyfman from the Cleveland Clinic, lead author on "Management of the Neck in Squamous Cell Carcinoma of the Oral Cavity and Oropharynx: ASCO Clinical Practice Guideline." Thank you for being here today, Dr. Koyfman.

    It's a pleasure.

    So first, can you give us a general overview of what this guideline covers?

    Yeah, so this is an exciting guideline because it covers a topic that we don't usually think about in head and neck cancer in a formal way, and that is management of the neck in squamous cell cancer of the oral cavity and the oropharynx. So there's a lot of literature and guidelines out there on how to manage oropharynx cancer, which is becoming a more and more common cancer, especially in the HPV-positive era, less so on oral cavity. But a lot of times it's focused on people who don't get surgery, chemoradiation, or people who do get surgery and TORS, Transoral Robotic Surgery, and different approaches. But rarely do we have something focus on management of the neck per se, which is really, really important in these cancers and often overlooked in favor of the primary tumor itself. So these guidelines really take us through some salient questions in how to manage the neck in these two cancers.

    And what are the key recommendations of this guideline?

    The recommendations came off of six fundamental questions, three in oral cavity and three in oropharynx. There are some commonalities between the two and some differences. A lot of the fundamental questions revolve around surgical quality, and neck dissection is the standard surgical approach for management of the neck in these patients. And as we enter the quality era, how do we define benchmarks of surgical quality, which is one thing that it deals with.
    The other is when to do adjuvant therapy like adjuvant radiation or chemoradiation. We also deal with when to do surgery for the neck or to do nonoperative approaches like radiation or chemoradiation. And then lastly, how do you follow patients after you've treated them? So those are kind of the salient issues that we dealt with.
    And what we came out with was nothing earth shatteringly new, but I think the way it was organized and systematically put together, I think it's going to be really, really helpful for people. So some of the most important findings that this recommendation does, I think this is the first that incorporates surgical quality, as I mentioned before. So specifically neck dissection should have 18 or more nodes as multiple studies have shown that that's associated with better outcomes. And similarly we define for different diseases of oral cavity and oropharynx, and depending on what kind of tumor it is and where, what nodal levels should be dissected or treated, whether surgically or nonsurgically, and when to do just one side of the neck versus both sides of the neck. So I think there's a lot of good guidance there in terms of the surgical quality.
    From a standpoint of adjuvant therapy, we define pretty clearly indications for when after surgery for oral cavity cancer, for example, when radiation should be added and when chemoradiation should be added, and I think that's very helpful. And especially for the neck itself, there's been confusion about what happens if I have 30 nodes taken out and they're all negative but I have a big, large primary tumor. What do I do with the

    • 13 min
    ASCO Guidelines: Antimicrobial Prophylaxis for Adult Patients with Cancer-Related Immunosuppression Guideline

    ASCO Guidelines: Antimicrobial Prophylaxis for Adult Patients with Cancer-Related Immunosuppression Guideline

    The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
    Hello and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin, and today I'm interviewing Dr. Randy Taplitz from UC San Diego Health, lead author on Antimicrobial Prophylaxis for Adult Patients With Cancer-Related Immunosuppression: ASCO and IDSA Clinical Practice Guideline Update.
    Thank you for being here, Dr. Taplitz.
    Thank you.
    So first, can you give us a general overview of what this guideline covers?
    Yes. I mean, I think we're all aware that infection in the setting of neutropenia associated with cancer chemotherapy is really a major cause of morbidity in these patients. And it's also important to be aware that prevention and appropriate management of febrile neutropenia and infection should thus be a critical focus in cancer care. So the focus of this particular guideline was to evaluate the risk and benefits of antimicrobial prophylaxis in these patients and really to determine evidence-based best practices for prevention of infection and how to go about doing that. So
    In this guideline, what we do is we identify the groups at risk for febrile neutropenia and really recommend settings for which prophylaxis with antibacterial, antifungal, antiviral medications are indicated. And then as well make recommendations for consideration of vaccination and other measures such as respiratory etiquette, and hand hygiene, and the like that will help reduce the risk of infection in these vulnerable patients.
    So since this is an update of a 2013 guideline, what are the major changes? And can you tell us a little bit about the research that informed this update?
    Yes. Really, when you update a guideline, one is informed by review of articles that encompass, in this setting, randomized clinical trials as well as meta analysis of interventions to prevent microbial infections in patients with neutropenia or other types of immunosuppression.
    And one example of this-- I think one of the better examples-- is we reviewed a large meta analysis of antibiotic prophylaxis in neutropenic patients after chemotherapy that showed that for fluoroquinolone prophylaxis resulted in really significant reductions in all cause mortality and febrile episodes, particularly in patients who were high risk, meaning the hematologic malignancy population and stem cell transplant population. And in that particular population, in fact, the number needed to treat to prevent one death was 29. So therefore, in that high risk population, really as with prior guidelines, the fluoroquinolone prophylaxis is recommended.
    However, we also reviewed other articles that include emerging data on some of the risks of fluoroquinolone prophylaxis. So for instance, the effect of fluoroquinolone on the intestinal microbiome and its association with selection of fluoroquinolone-resistant bacteria such as Gram-negative rods, as well as selection of organisms such as Clostridium difficile and enterococcus. And then we also reviewed fluoroquinolone toxicities.
    So what is added to this guideline are some qualifying statements alerting clinicians to really be aware for these concerns and to consider what the clinical spectrum of things like Clostridium difficile infection, et cetera, look like.
    In terms of antifungal prevention, including pneumocystis prevention, we really haven't made any major changes to this guideline with the exception that in this new guideline, the panel has also started looking at complications associated with immunotherapy and actually makes

    • 10 min

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