Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: Both cinnarizine and amitriptyline effectively improved migraine symptoms in children and adolescents with migraine, but amitriptyline was a more preferable treatment option since it reduced headache frequency and duration more effectively than cinnarizine.

Major finding: Amitriptyline was more effective than cinnarizine in reducing headache frequency at 4 weeks (mean difference [MD] −8.81 attacks/months; P = .004) and headache duration at 4 (MD −123.0 minutes; P = .017), 8 (MD −110.3 minutes; P = .033), and 12 (MD −123.3 minutes; P = .018) weeks. However, there were no significant differences in headache severity and migraine-related disability between the groups at 4, 8, and 12 weeks (all P > .005).

Study details: Findings are from a randomized, double-blind controlled trial including 43 children with migraine (age 4-17 years) who were randomly assigned to receive cinnarizine (n = 22) and amitriptyline (n = 21).

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Olfat M, Hosseinpour S, Masoumi S, et al. A comparative study on prophylactic efficacy of cinnarizine and amitriptyline in childhood migraine: A randomized double-blind clinical trial. Cephalalgia. 2024 (Apr 20). doi: 10.1177/03331024241230963 Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: This cross-sectional study demonstrated a significant association between severe headache or migraine and erectile dysfunction (ED) in adult men in the US; however, the results should be interpreted carefully as it did not investigate the effects of depression and anxiety on ED.

Major finding: Presence vs absence of severe headache or migraine was associated with 51% increased risk of ED (adjusted odd ratio 1.51; P = .0036). Age of 40-60 years (P = 0.0292), body mass index < 25 kg/m² (P = .0406) or ≥30 kg/m² (P = .0222), metabolic disorders, such as hypertension (P = .0029), diabetes mellitus (P < .001), and hyperlipidemia (P = .0281), were significant risk factors for ED in those with severe headache or migraine.

Study details: This cross-sectional study included 3117 adult men with (n = 582) and without (n = 2535) history of ED from the US National Health and Nutrition Examination Survey (2001-2 and 2003-4), of whom 16.85% had severe headache or migraine.

Disclosures: This study was funded by National Natural Science Foundation of China. The authors declared no competing interests.

Source: Wu X, Zhang Y, Liu G, et al. Association between severe headache or migraine and erectile dysfunction in American adults: A cross-sectional of data study from the NHANES. Int J Impot Res. 2024 (Apr 12). doi: 10.1038/s41443-024-00867-w Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

Disclosures: The study did not disclose any funding. The authors declared no conflicts of interest.

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

Disclosures: The study did not disclose any funding. The authors declared no conflicts of interest.

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Presence of migraine poses a strong risk for incident venous thromboembolism (VTE), whereas VTE is modest risk factor for the onset of migraine.

Major finding: The risk of developing VTE was significantly higher in patients with vs without migraine (odds ratio [OR] 96.155; P = .004). Conversely, the risk for migraine was modestly higher in patients with vs without VTE (OR 1.002; P = .016).

Study details: This two-sample bidirectional Mendelian randomization study evaluated the causal association between migraine and VTE using single-nucleotide polymorphisms as instrumental variables obtained from large-scale Genome-Wide Association Studies public databases (IEU Open GWAS project, FinnGen).

Disclosures: The study did not disclose any funding. The authors declared no conflicts of interest.

Source: Wang Y, Hu X, Wang X, et al. Exploring the two-way link between migraines and venous thromboembolism: A bidirectional two-sample Mendelian randomization study. Thromb Haemost. 2024 (Apr 24). doi: 10.1055/a-2313-0311 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Very low-quality evidence showed that serum pituitary adenylates cyclase–activating polypeptide (PACAP) levels were lower in adults with a longer history of migraine.

Major finding: Serum levels of PACAP were inversely associated with history of migraine duration in adults with migraine (summary r −0.35; P < .01). It was also seen that serum PACAP levels were higher during the ictal vs interictal period in both adults and children with migraine (standardized mean difference 0.41; 95% CI 0.17-0.66).

Study details: Findings are from a meta-analysis of eight observational studies including 674 patients with migraine and 371 control individuals without migraine.

Disclosures: This study did not receive any funding. The authors declared no conflicts of interest.

Source: Zhu G, Wang M, Kong F. Blood serum levels of PACAP and migraine onset: A systematic review and meta-analysis of observational studies. Headache. 2024 (Apr 24). doi: 10.1111/head.14711 Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Rimegepant orally disintegrating tablet (ODT) offers pain relief within 2 hours of treatment in adults with migraine, with a tolerable safety profile.

Major finding: At 2 hours post dose, rimegepant was more effective than placebo in providing freedom from pain (risk difference 7.6; P = .0004) and the most bothersome symptom (risk difference 16.2; P < .0001). The overall rates of treatment-emergent adverse events were comparable between the rimegepant and placebo groups (15.2% and 16.4%, respectively).

Study details: This subgroup analysis of a double-blind, randomized, placebo-controlled phase 3 clinical trial included 1075 patients with acute migraine with or without aura (age ≥ 18 years) who were randomly assigned to receive either 75 mg rimegepant ODT (n = 538) or placebo (n = 537).

Disclosures: This study was funded by BioShin, a wholly owned subsidiary of Biohaven Pharmaceuticals, which was acquired by Pfizer. Pfizer provided writing support. Five authors declared being employees or stock owners of Biohaven, BioShin, or Pfizer. The remaining authors declared no conflicts of interest.

Source: Yu S, Guo A, Wang Z, et al. Rimegepant orally disintegrating tablet 75 mg for acute treatment of migraine in adults from China: A subgroup analysis of a double-blind, randomized, placebo-controlled, phase 3 clinical trial. J Headache Pain. 2024;25:57 (Apr 16). Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Combination therapy with two parenteral agents or monotherapy with either neuroleptics or metoclopramide can be considered as a first-line treatment option for the management of acute migraine pain in the emergency department (ED) settings.

Major finding: Combination therapy of two parenteral agents vs placebo was an effective treatment option in reducing pain intensity scores (mean difference −3.36; 95% CI −4.64 to −2.08) and increasing the rate of achievement of pain relief (risk ratio 2.83; 95% CI 1.74-4.61). Monotherapy with neuroleptics and metoclopramide also provided pain relief and helped patients achieve pain-free status prior to discharge from the ED but increased the risk for adverse events, especially akathisia.

Study details: This meta-analysis of 97 randomized controlled trials evaluated the effectiveness of various parenteral agents for pain relief in patients with acute migraine presenting to the ED.

Disclosures: This study was funded by the Emergency Medicine Research Group, Canada. The authors declared no conflicts of interest.

Source: Kirkland SW, Visser L, Meyer J, et al. The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: A systematic review and network analysis. Headache. 2024;64(4):424-447. doi: 10.1111/head.14704 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: Women with migraine tend to exclusively breastfeed their infants for a shorter duration than those without migraine.

Major finding: There was no significant difference between the proportions of women with and without migraine who did not breastfeed their infants (adjusted odds ratio [aOR] 1.03; 95% CI 0.74-1.27), but the odds of exclusively breastfeeding infants for 6 months and more were 16% lower in women with vs without migraine (aOR 0.84; 95% CI 0.71-0.99; P = .033).

Study details: Findings are from a cross-sectional study including 5282 women (age 20-49 years) who had given birth in the last 5 years, of whom 862 (16.3%) had migraine.

Disclosures: The study did not receive any specific funding. Christine Lay declared receiving research support from and serving on ad boards for various sources. The other authors declared no conflicts of interest.

Source: Vyas MV, Lee N, Lay C. Association between migraine and exclusive breastfeeding: A cross-sectional study. Headache. 2024 (Apr 21). doi: 10.1111/head.14713 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: In patients with migraine, greater severity of photophobia is significantly associated with worse sleep-related outcomes, such as sleep quality (SQ), sleep disturbance (SDi), sleep onset latency (SOL), sleep-related impairment (SRI), and insomnia.

Major finding: Compared with patients with migraine and without photophobia, those with migraine and photophobia presented significantly poorer SQ (β 0.15; P < .001), longer SOL (β 0.10; P = .011), higher levels of SDi (β 0.12; P < .001) and SRI (β 0.08; P = .020), and a higher prevalence of insomnia (β 0.11; P = .005).

Study details: This cross-sectional observational study evaluated the association between photophobia and sleep-related outcomes in 852 patients with migraine using data from the American Registry for Migraine Research.

Disclosures: This study did not receive any specific funding. Some authors declared receiving compensation for consulting from, serving as consultants for, or having other ties with various sources.

Source: Sharp N, Burish MJ, Digre KB, et al. Photophobia is associated with lower sleep quality in individuals with migraine: Results from the American Registry for Migraine Research (ARMR). J Headache Pain. 2024;25:55. doi: 10.1186/s10194-024-01756-9 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

Key clinical point: Patients with migraine had an increased risk for vascular dementia (VaD), with the risk being significantly higher in those with chronic vs episodic migraine.

Major finding: Compared with individuals without migraine, patients with migraine had a 1.21-fold higher risk for VaD (adjusted hazard ratio [aHR] 1.21; 95% CI 1.17-1.25), with the cumulative incidence of migraine being significantly higher in patients with chronic vs episodic migraine (log-rank P < .001).

Study details: This 10-year retrospective population-based cohort study included 212,836 patients with migraine and 5,863,348 participants without migraine, of whom 3914 (1.8%) and 60,259 (1.0%), respectively, were diagnosed with VaD during the follow-up period.

Disclosures: This study was funded by a grant from the National Research Foundation, Republic of Korea, and others. The authors declared no conflicts of interest.

Source: Shin H, Ha WS, Kim J, et al. Association between migraine and the risk of vascular dementia: A nationwide longitudinal study in South Korea. PLoS One. 2024;19:e0300379. doi: 10.1371/journal.pone.0300379 Source

For breast cancer survivors harboring BRCA1/2 gene mutations, the prospect of future pregnancy often raises concerns because of limited data on the safety of assisted reproductive techniques (ART) in this population. However, results from a large international study presented at the European Society for Medical Oncology (ESMO) Breast Cancer annual congress provide reassuring evidence that ART, such as in vitro fertilization, can be safely used by BRCA1/2 mutation carriers previously treated for breast cancer.

“Our primary aim was to evaluate the safety profile of ART in this high-risk population by comparing maternal and fetal outcomes between those who conceived spontaneously versus those using ART,” explained Matteo Lambertini, MD, PhD, during his talk at the conference. “We found no statistically significant differences in pregnancy complications or fetal abnormalities.” Dr. Lambertini is an associate professor and medical oncologist at the University of Genova and IRCCS Policlinico San Martino Hospital, Genova, Italy.
 

Unmet Fertility Needs for Women With Breast Cancer

With the rising rates of early-onset breast cancer and improved survival outcomes with new therapies, the number of long-term breast cancer survivors is increasing. Fertility preservation and future reproductive choices are important considerations for young patients with breast cancer, especially for high-risk patients carrying pathogenic BRCA1/2 mutations. During his talk, Dr. Lambertini explained that defects in DNA damage repair due to BRCA1/2 mutations, in addition to chemotherapy after breast cancer diagnosis, can lead to premature menopause.

According to Dr. Lambertini, physicians face challenges in counseling these patients regarding the potential risks and benefits of pursuing pregnancy after cancer treatment because of the limited evidence available on the safety of ART in BRCA1/2 mutation carriers.

“Clinicians have to counsel BRCA carriers based on very limited data about the safety of pursuing pregnancy with ART after a breast cancer diagnosis,” he said during his presentation.
 

Study Design and Patient Population

The retrospective cohort study pooled data from 78 centers worldwide to explore ART outcomes in BRCA1/2 mutation carriers. The analysis included 4732 women diagnosed with stage I-III breast cancer at age 40 years or younger, all harboring a pathogenic BRCA1 or BRCA2 variant.

Among these high-risk patients, 543 became pregnant after completing cancer treatment; of these, 436 conceived naturally and 107 used ART. In the ART group, 45.5% underwent oocyte or embryo cryopreservation at breast cancer diagnosis, 33.3% underwent ovarian stimulation for in vitro fertilization after cancer treatment, and 21.2% underwent embryo transfer following oocyte donation.

Dr. Janice Tsang, MD, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, highlighted that this is the largest study focusing on ART safety in young patients with BRCA1/2 mutations. “With over 500 BRCA1/2 mutation carriers studied across nearly 80 sites, the cohort analysis had sufficient statistical power and global representation to detect potential safety signals with ART utilization, unlike prior smaller studies,” she said. Dr. Tsang, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, served as a discussant, providing her expert opinion on the findings presented by Dr. Lambertini.
 

No Increased Risks for Pregnancy and Fetal Outcomes

Although women using ART had slightly higher miscarriage rates (11.3% versus 8.8%) and lower rates of induced abortion (0.9% versus 8.3%) than women with spontaneous conceptions, the analysis revealed no statistically significant differences in the frequency of pregnancy complications, delivery complications, or congenital abnormalities between those who received ART and those who conceived naturally.

Dr. Lambertini explained that variations in baseline characteristics, such as age, may have contributed to differences in miscarriage rates.

“Patients in the ART group tended to be older at the time of conception, with a median age of 37.1 years, compared with 34.3 years in the spontaneous pregnancy group,” he said, during his presentation. Women in the ART group also more frequently had hormone receptor–positive breast cancer (43.4% versus 30.8%) and longer median time from diagnosis to conception (4.2 versus 3.3 years).
 

No Adverse Effects on Breast Cancer Prognosis

At a median follow-up of 5.2 years from conception, there was no detrimental effect of ART on disease-free survival for carriers of pathogenic BRCA1/2 variants who were treated for breast cancer. The ART group showed 13 (13.1%) recurrence events, compared with 118 (27.1%) recurrences in the spontaneous pregnancy group (adjusted hazard ratio, 0.72; 95% CI, 0.38-1.33; P = .147).

“The risk of cancer recurrence was comparable between those using and not using ART to become pregnant after their breast cancer diagnosis and treatment, and the small number of recurrence events in the ART group mostly involved locoregional recurrences,” Dr. Lambertini noted during his talk.

Moreover, breast cancer–specific survival and overall survival appeared to be similar between the two groups, although the small number of deaths precluded the conduction of formal analysis.

“These survival data suggest that utilizing ART does not appear to negatively impact the prognosis or course of the underlying breast cancer,” Dr. Lambertini said during the discussion.
 

Clinical Implications and Future Work

According to Dr. Lambertini, these results are incredibly valuable for clinicians counseling young breast cancer survivors with pathogenic BRCA1/2 mutations who wish to have biological children.

“Given the interest of patients in having their own family and for some of them in avoiding the transmission of the BRCA1/2 pathogenic variants, our results are critical in improving the oncofertility counseling of young women with breast cancer,” said Dr. Lambertini during his presentation. “We can reassure patients that pursuing ART does not appear to worsen their cancer prognosis or compromise pregnancy outcomes compared to spontaneous conceptions.”

During her discussion session, Dr. Tsang echoed the clinical implications of these findings, emphasizing that, by incorporating this evidence into clinical practice, healthcare providers can better support patients in making informed choices regarding fertility preservation and family planning after cancer treatment.

“Though this study is [retrospective] with a relatively small number, these real-world findings make a major contribution to our limited evidence base on ART safety for cancer survivors carrying BRCA1/2 mutations,” she said.

She cautioned, however, that there remain several unanswered questions and uncertainties. “We need prospective data with a larger sample size to confirm the safety of ART in this population, as well as studies to assess whether different types of ART have different safety profiles.”

Dr. Lambertini concluded his talk by saying, “While waiting for prospective studies to confirm our results, fertility preservation at diagnosis of early breast cancer should be offered to all women interested in future fertility, including BRCA carriers.”

Dr. Lambertini reported financial relationships with Roche, AstraZeneca, Lilly, Novartis, Pfizer, Exact Sciences, MSD, Seagen, Gilead, Pierre Fabre, and Menarini (consulting or advisory roles); Takeda, Roche, Lilly, Novartis, Pfizer, AstraZeneca, Sandoz, Ipsen, Libbs, Knight, Dalichi Sankyo, Gilead, Menarini (honoraria); Gilead, Daiichi Sankyo, and Roche (travel support); and Gilead (research funding to the institution). Dr. Tsang reported financial relationships with AstraZeneca, Amgen, Daichi Sankyo, Eisai, Gilead, Lilly, Lucence, Novartis, Pfizer, and Veracyte (honoraria); De Novo (consulting or advisory roles); and Pfizer (grant panel reviewer).

For breast cancer survivors harboring BRCA1/2 gene mutations, the prospect of future pregnancy often raises concerns because of limited data on the safety of assisted reproductive techniques (ART) in this population. However, results from a large international study presented at the European Society for Medical Oncology (ESMO) Breast Cancer annual congress provide reassuring evidence that ART, such as in vitro fertilization, can be safely used by BRCA1/2 mutation carriers previously treated for breast cancer.

“Our primary aim was to evaluate the safety profile of ART in this high-risk population by comparing maternal and fetal outcomes between those who conceived spontaneously versus those using ART,” explained Matteo Lambertini, MD, PhD, during his talk at the conference. “We found no statistically significant differences in pregnancy complications or fetal abnormalities.” Dr. Lambertini is an associate professor and medical oncologist at the University of Genova and IRCCS Policlinico San Martino Hospital, Genova, Italy.
 

Unmet Fertility Needs for Women With Breast Cancer

With the rising rates of early-onset breast cancer and improved survival outcomes with new therapies, the number of long-term breast cancer survivors is increasing. Fertility preservation and future reproductive choices are important considerations for young patients with breast cancer, especially for high-risk patients carrying pathogenic BRCA1/2 mutations. During his talk, Dr. Lambertini explained that defects in DNA damage repair due to BRCA1/2 mutations, in addition to chemotherapy after breast cancer diagnosis, can lead to premature menopause.

According to Dr. Lambertini, physicians face challenges in counseling these patients regarding the potential risks and benefits of pursuing pregnancy after cancer treatment because of the limited evidence available on the safety of ART in BRCA1/2 mutation carriers.

“Clinicians have to counsel BRCA carriers based on very limited data about the safety of pursuing pregnancy with ART after a breast cancer diagnosis,” he said during his presentation.
 

Study Design and Patient Population

The retrospective cohort study pooled data from 78 centers worldwide to explore ART outcomes in BRCA1/2 mutation carriers. The analysis included 4732 women diagnosed with stage I-III breast cancer at age 40 years or younger, all harboring a pathogenic BRCA1 or BRCA2 variant.

Among these high-risk patients, 543 became pregnant after completing cancer treatment; of these, 436 conceived naturally and 107 used ART. In the ART group, 45.5% underwent oocyte or embryo cryopreservation at breast cancer diagnosis, 33.3% underwent ovarian stimulation for in vitro fertilization after cancer treatment, and 21.2% underwent embryo transfer following oocyte donation.

Dr. Janice Tsang, MD, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, highlighted that this is the largest study focusing on ART safety in young patients with BRCA1/2 mutations. “With over 500 BRCA1/2 mutation carriers studied across nearly 80 sites, the cohort analysis had sufficient statistical power and global representation to detect potential safety signals with ART utilization, unlike prior smaller studies,” she said. Dr. Tsang, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, served as a discussant, providing her expert opinion on the findings presented by Dr. Lambertini.
 

No Increased Risks for Pregnancy and Fetal Outcomes

Although women using ART had slightly higher miscarriage rates (11.3% versus 8.8%) and lower rates of induced abortion (0.9% versus 8.3%) than women with spontaneous conceptions, the analysis revealed no statistically significant differences in the frequency of pregnancy complications, delivery complications, or congenital abnormalities between those who received ART and those who conceived naturally.

Dr. Lambertini explained that variations in baseline characteristics, such as age, may have contributed to differences in miscarriage rates.

“Patients in the ART group tended to be older at the time of conception, with a median age of 37.1 years, compared with 34.3 years in the spontaneous pregnancy group,” he said, during his presentation. Women in the ART group also more frequently had hormone receptor–positive breast cancer (43.4% versus 30.8%) and longer median time from diagnosis to conception (4.2 versus 3.3 years).
 

No Adverse Effects on Breast Cancer Prognosis

At a median follow-up of 5.2 years from conception, there was no detrimental effect of ART on disease-free survival for carriers of pathogenic BRCA1/2 variants who were treated for breast cancer. The ART group showed 13 (13.1%) recurrence events, compared with 118 (27.1%) recurrences in the spontaneous pregnancy group (adjusted hazard ratio, 0.72; 95% CI, 0.38-1.33; P = .147).

“The risk of cancer recurrence was comparable between those using and not using ART to become pregnant after their breast cancer diagnosis and treatment, and the small number of recurrence events in the ART group mostly involved locoregional recurrences,” Dr. Lambertini noted during his talk.

Moreover, breast cancer–specific survival and overall survival appeared to be similar between the two groups, although the small number of deaths precluded the conduction of formal analysis.

“These survival data suggest that utilizing ART does not appear to negatively impact the prognosis or course of the underlying breast cancer,” Dr. Lambertini said during the discussion.
 

Clinical Implications and Future Work

According to Dr. Lambertini, these results are incredibly valuable for clinicians counseling young breast cancer survivors with pathogenic BRCA1/2 mutations who wish to have biological children.

“Given the interest of patients in having their own family and for some of them in avoiding the transmission of the BRCA1/2 pathogenic variants, our results are critical in improving the oncofertility counseling of young women with breast cancer,” said Dr. Lambertini during his presentation. “We can reassure patients that pursuing ART does not appear to worsen their cancer prognosis or compromise pregnancy outcomes compared to spontaneous conceptions.”

During her discussion session, Dr. Tsang echoed the clinical implications of these findings, emphasizing that, by incorporating this evidence into clinical practice, healthcare providers can better support patients in making informed choices regarding fertility preservation and family planning after cancer treatment.

“Though this study is [retrospective] with a relatively small number, these real-world findings make a major contribution to our limited evidence base on ART safety for cancer survivors carrying BRCA1/2 mutations,” she said.

She cautioned, however, that there remain several unanswered questions and uncertainties. “We need prospective data with a larger sample size to confirm the safety of ART in this population, as well as studies to assess whether different types of ART have different safety profiles.”

Dr. Lambertini concluded his talk by saying, “While waiting for prospective studies to confirm our results, fertility preservation at diagnosis of early breast cancer should be offered to all women interested in future fertility, including BRCA carriers.”

Dr. Lambertini reported financial relationships with Roche, AstraZeneca, Lilly, Novartis, Pfizer, Exact Sciences, MSD, Seagen, Gilead, Pierre Fabre, and Menarini (consulting or advisory roles); Takeda, Roche, Lilly, Novartis, Pfizer, AstraZeneca, Sandoz, Ipsen, Libbs, Knight, Dalichi Sankyo, Gilead, Menarini (honoraria); Gilead, Daiichi Sankyo, and Roche (travel support); and Gilead (research funding to the institution). Dr. Tsang reported financial relationships with AstraZeneca, Amgen, Daichi Sankyo, Eisai, Gilead, Lilly, Lucence, Novartis, Pfizer, and Veracyte (honoraria); De Novo (consulting or advisory roles); and Pfizer (grant panel reviewer).

For breast cancer survivors harboring BRCA1/2 gene mutations, the prospect of future pregnancy often raises concerns because of limited data on the safety of assisted reproductive techniques (ART) in this population. However, results from a large international study presented at the European Society for Medical Oncology (ESMO) Breast Cancer annual congress provide reassuring evidence that ART, such as in vitro fertilization, can be safely used by BRCA1/2 mutation carriers previously treated for breast cancer.

“Our primary aim was to evaluate the safety profile of ART in this high-risk population by comparing maternal and fetal outcomes between those who conceived spontaneously versus those using ART,” explained Matteo Lambertini, MD, PhD, during his talk at the conference. “We found no statistically significant differences in pregnancy complications or fetal abnormalities.” Dr. Lambertini is an associate professor and medical oncologist at the University of Genova and IRCCS Policlinico San Martino Hospital, Genova, Italy.
 

Unmet Fertility Needs for Women With Breast Cancer

With the rising rates of early-onset breast cancer and improved survival outcomes with new therapies, the number of long-term breast cancer survivors is increasing. Fertility preservation and future reproductive choices are important considerations for young patients with breast cancer, especially for high-risk patients carrying pathogenic BRCA1/2 mutations. During his talk, Dr. Lambertini explained that defects in DNA damage repair due to BRCA1/2 mutations, in addition to chemotherapy after breast cancer diagnosis, can lead to premature menopause.

According to Dr. Lambertini, physicians face challenges in counseling these patients regarding the potential risks and benefits of pursuing pregnancy after cancer treatment because of the limited evidence available on the safety of ART in BRCA1/2 mutation carriers.

“Clinicians have to counsel BRCA carriers based on very limited data about the safety of pursuing pregnancy with ART after a breast cancer diagnosis,” he said during his presentation.
 

Study Design and Patient Population

The retrospective cohort study pooled data from 78 centers worldwide to explore ART outcomes in BRCA1/2 mutation carriers. The analysis included 4732 women diagnosed with stage I-III breast cancer at age 40 years or younger, all harboring a pathogenic BRCA1 or BRCA2 variant.

Among these high-risk patients, 543 became pregnant after completing cancer treatment; of these, 436 conceived naturally and 107 used ART. In the ART group, 45.5% underwent oocyte or embryo cryopreservation at breast cancer diagnosis, 33.3% underwent ovarian stimulation for in vitro fertilization after cancer treatment, and 21.2% underwent embryo transfer following oocyte donation.

Dr. Janice Tsang, MD, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, highlighted that this is the largest study focusing on ART safety in young patients with BRCA1/2 mutations. “With over 500 BRCA1/2 mutation carriers studied across nearly 80 sites, the cohort analysis had sufficient statistical power and global representation to detect potential safety signals with ART utilization, unlike prior smaller studies,” she said. Dr. Tsang, a clinical oncology specialist and assistant professor at the University of Hong Kong who was not involved in this study, served as a discussant, providing her expert opinion on the findings presented by Dr. Lambertini.
 

No Increased Risks for Pregnancy and Fetal Outcomes

Although women using ART had slightly higher miscarriage rates (11.3% versus 8.8%) and lower rates of induced abortion (0.9% versus 8.3%) than women with spontaneous conceptions, the analysis revealed no statistically significant differences in the frequency of pregnancy complications, delivery complications, or congenital abnormalities between those who received ART and those who conceived naturally.

Dr. Lambertini explained that variations in baseline characteristics, such as age, may have contributed to differences in miscarriage rates.

“Patients in the ART group tended to be older at the time of conception, with a median age of 37.1 years, compared with 34.3 years in the spontaneous pregnancy group,” he said, during his presentation. Women in the ART group also more frequently had hormone receptor–positive breast cancer (43.4% versus 30.8%) and longer median time from diagnosis to conception (4.2 versus 3.3 years).
 

No Adverse Effects on Breast Cancer Prognosis

At a median follow-up of 5.2 years from conception, there was no detrimental effect of ART on disease-free survival for carriers of pathogenic BRCA1/2 variants who were treated for breast cancer. The ART group showed 13 (13.1%) recurrence events, compared with 118 (27.1%) recurrences in the spontaneous pregnancy group (adjusted hazard ratio, 0.72; 95% CI, 0.38-1.33; P = .147).

“The risk of cancer recurrence was comparable between those using and not using ART to become pregnant after their breast cancer diagnosis and treatment, and the small number of recurrence events in the ART group mostly involved locoregional recurrences,” Dr. Lambertini noted during his talk.

Moreover, breast cancer–specific survival and overall survival appeared to be similar between the two groups, although the small number of deaths precluded the conduction of formal analysis.

“These survival data suggest that utilizing ART does not appear to negatively impact the prognosis or course of the underlying breast cancer,” Dr. Lambertini said during the discussion.
 

Clinical Implications and Future Work

According to Dr. Lambertini, these results are incredibly valuable for clinicians counseling young breast cancer survivors with pathogenic BRCA1/2 mutations who wish to have biological children.

“Given the interest of patients in having their own family and for some of them in avoiding the transmission of the BRCA1/2 pathogenic variants, our results are critical in improving the oncofertility counseling of young women with breast cancer,” said Dr. Lambertini during his presentation. “We can reassure patients that pursuing ART does not appear to worsen their cancer prognosis or compromise pregnancy outcomes compared to spontaneous conceptions.”

During her discussion session, Dr. Tsang echoed the clinical implications of these findings, emphasizing that, by incorporating this evidence into clinical practice, healthcare providers can better support patients in making informed choices regarding fertility preservation and family planning after cancer treatment.

“Though this study is [retrospective] with a relatively small number, these real-world findings make a major contribution to our limited evidence base on ART safety for cancer survivors carrying BRCA1/2 mutations,” she said.

She cautioned, however, that there remain several unanswered questions and uncertainties. “We need prospective data with a larger sample size to confirm the safety of ART in this population, as well as studies to assess whether different types of ART have different safety profiles.”

Dr. Lambertini concluded his talk by saying, “While waiting for prospective studies to confirm our results, fertility preservation at diagnosis of early breast cancer should be offered to all women interested in future fertility, including BRCA carriers.”

Dr. Lambertini reported financial relationships with Roche, AstraZeneca, Lilly, Novartis, Pfizer, Exact Sciences, MSD, Seagen, Gilead, Pierre Fabre, and Menarini (consulting or advisory roles); Takeda, Roche, Lilly, Novartis, Pfizer, AstraZeneca, Sandoz, Ipsen, Libbs, Knight, Dalichi Sankyo, Gilead, Menarini (honoraria); Gilead, Daiichi Sankyo, and Roche (travel support); and Gilead (research funding to the institution). Dr. Tsang reported financial relationships with AstraZeneca, Amgen, Daichi Sankyo, Eisai, Gilead, Lilly, Lucence, Novartis, Pfizer, and Veracyte (honoraria); De Novo (consulting or advisory roles); and Pfizer (grant panel reviewer).