Recap

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

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Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

--

Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Endocrine therapy (ET) has long been the therapeutic backbone for the treatment of HR+/HER2- breast cancer. However, for patients who already have advanced HR+/HER2- disease at the time of diagnosis, studies have shown that addition of a CDK4/6 inhibitor significantly improves outcomes compared with ET alone.

In this ReCAP, Dr Kevin Kalinsky, director of the Glenn Family Breast Center at Winship Cancer Institute in Atlanta, Georgia, examines important considerations in the frontline treatment of HR+/HER2- advanced breast cancer.

First, he reviews the PALOMA-2 data, which looked at the overall survival of the CDK4/6 inhibitor palbociclib plus letrozole. He then compares that data with the overall survival data of other CDK4/5 inhibitors.

Dr Kalinsky then examines the findings of MONALEESA-7, which looked at premenopausal patients with HR+/HER2- advanced breast cancer treated with ET plus or minus ribociclib. In that study population, the combination of ET and ribociclib showed an overall survival advantage.

Finally, he discusses data from the Right Choice trial, which found that patients did better when given hormonal therapy plus a CDK4/6 inhibitor as opposed to doublet chemotherapy.

--

Kevin Kalinsky, MD, Director, Glenn Family Breast Center, Winship Cancer Institute, Atlanta, Georgia

Kevin Kalinsky, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Pfizer; Eli Lilly; Novartis ; Eisai; AstraZeneca; Daiichi Sankyo; Puma; 4D Pharma; Oncosec; Immunomedics; Merck; Seattle Genetics

Spouse holds stock in: Grail; Array Biopharma; Pfizer (prior employee)

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease that typically begins in infancy or childhood but can manifest at any age. 

It is characterized by the irreversible and progressive degeneration of motor neurons in the spinal cord and brainstem. This results in a wide range of symptoms, in addition to which there is substantial variation in the rate of progression and disease prognosis. 

Although early diagnosis and timely therapy can slow or prevent disease progression, disease-modifying therapies since 2016 have significantly advanced the management of SMA. 

In a clinically focused program, Dr Perry Shieh, a neuromuscular neurologist from the University of California, Los Angeles, discusses the three medications currently approved by the US Food and Drug Administration: nusinersen, risdiplam, and onasemnogene abeparvovec. 

He weighs the clinical benefits and key considerations for the use of each drug and emphasizes the need for shared decision-making with the patient. 

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Professor, Departments of Neurology and Pediatrics, University of California, Los Angeles; Neuromuscular Neurologist, Ronald Reagan UCLA Medical Center, Los Angeles, California 

Perry Shieh, MD, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Grifolis; Biogen; Genentech; CSL Behring; Alexion; Argenx; Catalyst 

Received income in an amount equal to or greater than $250 from: Sarepta; Novartis; Biogen; Genentech; Alexion; Argenx; Catalyst; UCB 

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease that typically begins in infancy or childhood but can manifest at any age. 

It is characterized by the irreversible and progressive degeneration of motor neurons in the spinal cord and brainstem. This results in a wide range of symptoms, in addition to which there is substantial variation in the rate of progression and disease prognosis. 

Although early diagnosis and timely therapy can slow or prevent disease progression, disease-modifying therapies since 2016 have significantly advanced the management of SMA. 

In a clinically focused program, Dr Perry Shieh, a neuromuscular neurologist from the University of California, Los Angeles, discusses the three medications currently approved by the US Food and Drug Administration: nusinersen, risdiplam, and onasemnogene abeparvovec. 

He weighs the clinical benefits and key considerations for the use of each drug and emphasizes the need for shared decision-making with the patient. 

--

Professor, Departments of Neurology and Pediatrics, University of California, Los Angeles; Neuromuscular Neurologist, Ronald Reagan UCLA Medical Center, Los Angeles, California 

Perry Shieh, MD, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Grifolis; Biogen; Genentech; CSL Behring; Alexion; Argenx; Catalyst 

Received income in an amount equal to or greater than $250 from: Sarepta; Novartis; Biogen; Genentech; Alexion; Argenx; Catalyst; UCB 

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease that typically begins in infancy or childhood but can manifest at any age. 

It is characterized by the irreversible and progressive degeneration of motor neurons in the spinal cord and brainstem. This results in a wide range of symptoms, in addition to which there is substantial variation in the rate of progression and disease prognosis. 

Although early diagnosis and timely therapy can slow or prevent disease progression, disease-modifying therapies since 2016 have significantly advanced the management of SMA. 

In a clinically focused program, Dr Perry Shieh, a neuromuscular neurologist from the University of California, Los Angeles, discusses the three medications currently approved by the US Food and Drug Administration: nusinersen, risdiplam, and onasemnogene abeparvovec. 

He weighs the clinical benefits and key considerations for the use of each drug and emphasizes the need for shared decision-making with the patient. 

--

Professor, Departments of Neurology and Pediatrics, University of California, Los Angeles; Neuromuscular Neurologist, Ronald Reagan UCLA Medical Center, Los Angeles, California 

Perry Shieh, MD, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Grifolis; Biogen; Genentech; CSL Behring; Alexion; Argenx; Catalyst 

Received income in an amount equal to or greater than $250 from: Sarepta; Novartis; Biogen; Genentech; Alexion; Argenx; Catalyst; UCB 

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that typically presents as inflamed nodules, abscesses, and sinus tracts in the apocrine gland–bearing regions.  

Chronic pain, fatigue, and social isolation put patients with HS at risk for psychiatric comorbidities, with the prevalence of depression estimated to be as high as 43%. Work productivity and sexual relationships may also be affected.  

Early treatment of the condition, as well as screening for depression, may help alleviate the psychosocial burden of HS.  

In this ReCAP, Dr Jennifer Hsiao from Keck School of Medicine, University of Southern California, Los Angeles, outlines mental health screening tools that dermatologists can use to help recognize at-risk patients and potentially refer them to mental health experts.  

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Jennifer Hsiao, MD, Associate Professor, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California  

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Boehringer Ingelheim; Novartis; UCB 

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie 

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that typically presents as inflamed nodules, abscesses, and sinus tracts in the apocrine gland–bearing regions.  

Chronic pain, fatigue, and social isolation put patients with HS at risk for psychiatric comorbidities, with the prevalence of depression estimated to be as high as 43%. Work productivity and sexual relationships may also be affected.  

Early treatment of the condition, as well as screening for depression, may help alleviate the psychosocial burden of HS.  

In this ReCAP, Dr Jennifer Hsiao from Keck School of Medicine, University of Southern California, Los Angeles, outlines mental health screening tools that dermatologists can use to help recognize at-risk patients and potentially refer them to mental health experts.  

--

Jennifer Hsiao, MD, Associate Professor, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California  

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Boehringer Ingelheim; Novartis; UCB 

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie 

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that typically presents as inflamed nodules, abscesses, and sinus tracts in the apocrine gland–bearing regions.  

Chronic pain, fatigue, and social isolation put patients with HS at risk for psychiatric comorbidities, with the prevalence of depression estimated to be as high as 43%. Work productivity and sexual relationships may also be affected.  

Early treatment of the condition, as well as screening for depression, may help alleviate the psychosocial burden of HS.  

In this ReCAP, Dr Jennifer Hsiao from Keck School of Medicine, University of Southern California, Los Angeles, outlines mental health screening tools that dermatologists can use to help recognize at-risk patients and potentially refer them to mental health experts.  

--

Jennifer Hsiao, MD, Associate Professor, Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, California  

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Boehringer Ingelheim; Novartis; UCB 

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie 

Members of the United States military who served in Vietnam between 1961 and 1971 risked exposure to the weaponized chemical defoliant known as Agent Orange. Among the components of Agent Orange, benzene and tetrachlorodibenzo-p-dioxin (TCDD) are known carcinogens linked to several cancers. They include multiple myeloma, Hodgkin and non-Hodgkin lymphoma, as well as bladder, prostate, and lung cancer. 

In this ReCAP, Dr Timothy O'Brien, section chief of hematology at the Louis Stokes Cleveland VA Medical Center, examines the evidence that suggests a link between service-related Agent Orange exposure and acute myeloid leukemia (AML). He discusses preclinical models that show a relationship between benzene and TCDD exposure and the development of AML. 

Dr O'Brien also explains the factors that have limited researchers' ability to positively connect Agent Orange and AML. For example, there is a dwindling cohort of affected patients to study because dioxins can lie latent in fat cells for more than a decade, delaying the development of AML. During that time, many veterans will have died from unrelated causes. 

More research is needed for veterans to receive service-connected benefits for AML diagnoses. However, as Dr O'Brien notes, the PACT Act provides coverage for veterans who developed AML after exposure to benzene-contaminated water at Camp Lejeune. 

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Timothy O'Brien, MD, Associate Professor, Case Western Reserve University School of Medicine; Chief of Hematology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio  

Timothy O'Brien, MD, has disclosed no relevant financial relationships. 

Members of the United States military who served in Vietnam between 1961 and 1971 risked exposure to the weaponized chemical defoliant known as Agent Orange. Among the components of Agent Orange, benzene and tetrachlorodibenzo-p-dioxin (TCDD) are known carcinogens linked to several cancers. They include multiple myeloma, Hodgkin and non-Hodgkin lymphoma, as well as bladder, prostate, and lung cancer. 

In this ReCAP, Dr Timothy O'Brien, section chief of hematology at the Louis Stokes Cleveland VA Medical Center, examines the evidence that suggests a link between service-related Agent Orange exposure and acute myeloid leukemia (AML). He discusses preclinical models that show a relationship between benzene and TCDD exposure and the development of AML. 

Dr O'Brien also explains the factors that have limited researchers' ability to positively connect Agent Orange and AML. For example, there is a dwindling cohort of affected patients to study because dioxins can lie latent in fat cells for more than a decade, delaying the development of AML. During that time, many veterans will have died from unrelated causes. 

More research is needed for veterans to receive service-connected benefits for AML diagnoses. However, as Dr O'Brien notes, the PACT Act provides coverage for veterans who developed AML after exposure to benzene-contaminated water at Camp Lejeune. 

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Timothy O'Brien, MD, Associate Professor, Case Western Reserve University School of Medicine; Chief of Hematology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio  

Timothy O'Brien, MD, has disclosed no relevant financial relationships. 

Members of the United States military who served in Vietnam between 1961 and 1971 risked exposure to the weaponized chemical defoliant known as Agent Orange. Among the components of Agent Orange, benzene and tetrachlorodibenzo-p-dioxin (TCDD) are known carcinogens linked to several cancers. They include multiple myeloma, Hodgkin and non-Hodgkin lymphoma, as well as bladder, prostate, and lung cancer. 

In this ReCAP, Dr Timothy O'Brien, section chief of hematology at the Louis Stokes Cleveland VA Medical Center, examines the evidence that suggests a link between service-related Agent Orange exposure and acute myeloid leukemia (AML). He discusses preclinical models that show a relationship between benzene and TCDD exposure and the development of AML. 

Dr O'Brien also explains the factors that have limited researchers' ability to positively connect Agent Orange and AML. For example, there is a dwindling cohort of affected patients to study because dioxins can lie latent in fat cells for more than a decade, delaying the development of AML. During that time, many veterans will have died from unrelated causes. 

More research is needed for veterans to receive service-connected benefits for AML diagnoses. However, as Dr O'Brien notes, the PACT Act provides coverage for veterans who developed AML after exposure to benzene-contaminated water at Camp Lejeune. 

--

Timothy O'Brien, MD, Associate Professor, Case Western Reserve University School of Medicine; Chief of Hematology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio  

Timothy O'Brien, MD, has disclosed no relevant financial relationships. 

More than 280,000 women in the United States will be diagnosed with invasive breast cancer this year. For those with metastatic breast cancer with distant spread, the 5-year survival rate is approximately 28%. Whether advanced disease is discovered at initial diagnosis or in relapsed disease, it is imperative to understand the molecular characteristics of the metastatic tumor.  

Dr Susan Domchek, from the University of Pennsylvania, discusses the importance of retesting for estrogen receptor, progesterone receptor, and HER2/neu on a metastatic tumor focus in order to identify potential discordance between the primary cancer and metastatic disease. 

Additionally, Dr Domchek discusses the importance of molecular testing for targetable mutations, including P13K and germline BRCA1/2, for which approved therapies have shown survival benefit. 

The list of targetable mutations in breast cancer continues to expand. In the tumor-agnostic studies, pembrolizumab has shown survival benefit in tumors that have mismatch repair deficiency and microsatellite instability, and TRK inhibitors have shown efficacy in tumors positive for NTRK fusions. Numerous clinical trials are available looking at additional molecular-based therapies. 

--

Susan M. Domchek, MD, Basser Professor, Department of Oncology; Executive Director, Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Susan M. Domchek, MD, has disclosed the following relevant financial relationships: 
Received income in an amount equal to or greater than $250 from: AstraZeneca; Clovis; Bristol Myers Squibb 

More than 280,000 women in the United States will be diagnosed with invasive breast cancer this year. For those with metastatic breast cancer with distant spread, the 5-year survival rate is approximately 28%. Whether advanced disease is discovered at initial diagnosis or in relapsed disease, it is imperative to understand the molecular characteristics of the metastatic tumor.  

Dr Susan Domchek, from the University of Pennsylvania, discusses the importance of retesting for estrogen receptor, progesterone receptor, and HER2/neu on a metastatic tumor focus in order to identify potential discordance between the primary cancer and metastatic disease. 

Additionally, Dr Domchek discusses the importance of molecular testing for targetable mutations, including P13K and germline BRCA1/2, for which approved therapies have shown survival benefit. 

The list of targetable mutations in breast cancer continues to expand. In the tumor-agnostic studies, pembrolizumab has shown survival benefit in tumors that have mismatch repair deficiency and microsatellite instability, and TRK inhibitors have shown efficacy in tumors positive for NTRK fusions. Numerous clinical trials are available looking at additional molecular-based therapies. 

--

Susan M. Domchek, MD, Basser Professor, Department of Oncology; Executive Director, Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Susan M. Domchek, MD, has disclosed the following relevant financial relationships: 
Received income in an amount equal to or greater than $250 from: AstraZeneca; Clovis; Bristol Myers Squibb 

More than 280,000 women in the United States will be diagnosed with invasive breast cancer this year. For those with metastatic breast cancer with distant spread, the 5-year survival rate is approximately 28%. Whether advanced disease is discovered at initial diagnosis or in relapsed disease, it is imperative to understand the molecular characteristics of the metastatic tumor.  

Dr Susan Domchek, from the University of Pennsylvania, discusses the importance of retesting for estrogen receptor, progesterone receptor, and HER2/neu on a metastatic tumor focus in order to identify potential discordance between the primary cancer and metastatic disease. 

Additionally, Dr Domchek discusses the importance of molecular testing for targetable mutations, including P13K and germline BRCA1/2, for which approved therapies have shown survival benefit. 

The list of targetable mutations in breast cancer continues to expand. In the tumor-agnostic studies, pembrolizumab has shown survival benefit in tumors that have mismatch repair deficiency and microsatellite instability, and TRK inhibitors have shown efficacy in tumors positive for NTRK fusions. Numerous clinical trials are available looking at additional molecular-based therapies. 

--

Susan M. Domchek, MD, Basser Professor, Department of Oncology; Executive Director, Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia

Susan M. Domchek, MD, has disclosed the following relevant financial relationships: 
Received income in an amount equal to or greater than $250 from: AstraZeneca; Clovis; Bristol Myers Squibb 

Only about one third of patients with major depressive disorder achieve full remission with antidepressant therapy. Another third are considered nonresponders, and the remaining one third are partial responders. The latter group of patients are those who have seen some improvement but have not achieved full remission.

Dr Michael Thase at the Perelman School of Medicine, University of Pennsylvania, discusses the symptomatic burden and risk for relapse faced by partial responders, who present a significant treatment challenge.

Dr Thase explores the therapeutic options available when a first-choice treatment option proves incompletely effective. In addition to medication optimization, adjunctive treatment and alternative approaches are considered.

--

Michael E. Thase, MD, Professor, Department of Psychiatry, Mood and Anxiety Disorders Treatment and Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Michael E. Thase, MD, has disclosed the following relevant financial relationships:

Serve(d) as an advisor or consultant for: Acadia, Inc; Akili, Inc;

Alkermes PLC; Allergan, Inc; Axsome Therapeutics, Inc; BioHaven, Inc; Bocemtium Consulting, SL; Boehringer Ingelheim International; CatalYm GmbH; Clexio Biosciences; Gerson Lehrman Group, Inc; H Lundbeck, A/S; Jazz Pharmaceuticals; Janssen; Johnson & Johnson; Luye Pharma Group, Ltd; Merck & Company, Inc; Otsuka Pharmaceuticals Company, Ltd; Pfizer, Inc; Sage Pharmaceuicals; Seelos Pharmaceuticals; Sunovion Pharmaceuticals, Inc; Takeda Pharmaceutical Company, Ltd

Receive research funding from: Acadia, Inc; Allergan, Inc; AssureRx; Axsome Therapeutics, Inc; BioHaven, Inc; Intracellular, Inc; Johnson & Johnson; Otsuka Pharmaceuticals Company, Ltd; Patient-Centered Outcomes Research Institute (PCORI); Takeda Pharmaceutical Company, Ltd

Receive royalties from: American Psychiatric Foundation; Guilford Publications; Herald House; Kluwer-Wolters; W W Norton & Company, Inc

Only about one third of patients with major depressive disorder achieve full remission with antidepressant therapy. Another third are considered nonresponders, and the remaining one third are partial responders. The latter group of patients are those who have seen some improvement but have not achieved full remission.

Dr Michael Thase at the Perelman School of Medicine, University of Pennsylvania, discusses the symptomatic burden and risk for relapse faced by partial responders, who present a significant treatment challenge.

Dr Thase explores the therapeutic options available when a first-choice treatment option proves incompletely effective. In addition to medication optimization, adjunctive treatment and alternative approaches are considered.

--

Michael E. Thase, MD, Professor, Department of Psychiatry, Mood and Anxiety Disorders Treatment and Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Michael E. Thase, MD, has disclosed the following relevant financial relationships:

Serve(d) as an advisor or consultant for: Acadia, Inc; Akili, Inc;

Alkermes PLC; Allergan, Inc; Axsome Therapeutics, Inc; BioHaven, Inc; Bocemtium Consulting, SL; Boehringer Ingelheim International; CatalYm GmbH; Clexio Biosciences; Gerson Lehrman Group, Inc; H Lundbeck, A/S; Jazz Pharmaceuticals; Janssen; Johnson & Johnson; Luye Pharma Group, Ltd; Merck & Company, Inc; Otsuka Pharmaceuticals Company, Ltd; Pfizer, Inc; Sage Pharmaceuicals; Seelos Pharmaceuticals; Sunovion Pharmaceuticals, Inc; Takeda Pharmaceutical Company, Ltd

Receive research funding from: Acadia, Inc; Allergan, Inc; AssureRx; Axsome Therapeutics, Inc; BioHaven, Inc; Intracellular, Inc; Johnson & Johnson; Otsuka Pharmaceuticals Company, Ltd; Patient-Centered Outcomes Research Institute (PCORI); Takeda Pharmaceutical Company, Ltd

Receive royalties from: American Psychiatric Foundation; Guilford Publications; Herald House; Kluwer-Wolters; W W Norton & Company, Inc

Only about one third of patients with major depressive disorder achieve full remission with antidepressant therapy. Another third are considered nonresponders, and the remaining one third are partial responders. The latter group of patients are those who have seen some improvement but have not achieved full remission.

Dr Michael Thase at the Perelman School of Medicine, University of Pennsylvania, discusses the symptomatic burden and risk for relapse faced by partial responders, who present a significant treatment challenge.

Dr Thase explores the therapeutic options available when a first-choice treatment option proves incompletely effective. In addition to medication optimization, adjunctive treatment and alternative approaches are considered.

--

Michael E. Thase, MD, Professor, Department of Psychiatry, Mood and Anxiety Disorders Treatment and Research Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

Michael E. Thase, MD, has disclosed the following relevant financial relationships:

Serve(d) as an advisor or consultant for: Acadia, Inc; Akili, Inc;

Alkermes PLC; Allergan, Inc; Axsome Therapeutics, Inc; BioHaven, Inc; Bocemtium Consulting, SL; Boehringer Ingelheim International; CatalYm GmbH; Clexio Biosciences; Gerson Lehrman Group, Inc; H Lundbeck, A/S; Jazz Pharmaceuticals; Janssen; Johnson & Johnson; Luye Pharma Group, Ltd; Merck & Company, Inc; Otsuka Pharmaceuticals Company, Ltd; Pfizer, Inc; Sage Pharmaceuicals; Seelos Pharmaceuticals; Sunovion Pharmaceuticals, Inc; Takeda Pharmaceutical Company, Ltd

Receive research funding from: Acadia, Inc; Allergan, Inc; AssureRx; Axsome Therapeutics, Inc; BioHaven, Inc; Intracellular, Inc; Johnson & Johnson; Otsuka Pharmaceuticals Company, Ltd; Patient-Centered Outcomes Research Institute (PCORI); Takeda Pharmaceutical Company, Ltd

Receive royalties from: American Psychiatric Foundation; Guilford Publications; Herald House; Kluwer-Wolters; W W Norton & Company, Inc

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent boils, abscesses, and nodules that can progress to narrow channels that form under the skin. An estimated 1%-4% of the US population has the condition, and women are affected more commonly than men.

Treatment of HS is challenging and the pathogenesis is still under investigation. Many believe that the disease involves follicular occlusion that leads to perifollicular cyst development followed by ruptures of the cyst contents. Many drug classes, including antibiotics and topical therapies, as well as lifestyle modifications, have been used to successfully treat mild to moderate HS. Management of moderate to severe HS has been less successful, however.

Dr Jennifer Hsiao, from the University of Southern California, highlights the various approaches to HS treatment, including medical, procedural, and emerging options.

--

Jennifer Hsiao, MD, Associate Professor, Physician, Department of Dermatology, University of Southern California, Los Angeles, California

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Novartis; UCB

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent boils, abscesses, and nodules that can progress to narrow channels that form under the skin. An estimated 1%-4% of the US population has the condition, and women are affected more commonly than men.

Treatment of HS is challenging and the pathogenesis is still under investigation. Many believe that the disease involves follicular occlusion that leads to perifollicular cyst development followed by ruptures of the cyst contents. Many drug classes, including antibiotics and topical therapies, as well as lifestyle modifications, have been used to successfully treat mild to moderate HS. Management of moderate to severe HS has been less successful, however.

Dr Jennifer Hsiao, from the University of Southern California, highlights the various approaches to HS treatment, including medical, procedural, and emerging options.

--

Jennifer Hsiao, MD, Associate Professor, Physician, Department of Dermatology, University of Southern California, Los Angeles, California

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Novartis; UCB

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by recurrent boils, abscesses, and nodules that can progress to narrow channels that form under the skin. An estimated 1%-4% of the US population has the condition, and women are affected more commonly than men.

Treatment of HS is challenging and the pathogenesis is still under investigation. Many believe that the disease involves follicular occlusion that leads to perifollicular cyst development followed by ruptures of the cyst contents. Many drug classes, including antibiotics and topical therapies, as well as lifestyle modifications, have been used to successfully treat mild to moderate HS. Management of moderate to severe HS has been less successful, however.

Dr Jennifer Hsiao, from the University of Southern California, highlights the various approaches to HS treatment, including medical, procedural, and emerging options.

--

Jennifer Hsiao, MD, Associate Professor, Physician, Department of Dermatology, University of Southern California, Los Angeles, California

Jennifer Hsiao, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Novartis; UCB

Serve(d) as a speaker or a member of a speakers bureau for: AbbVie

Myasthenia gravis (MG) is an autoimmune disease leading to muscle weakness and fatigue. Medical therapy for MG has traditionally focused on treatments to alleviate symptoms, but a range of new therapies are improving outcomes.  

Dr Raghav Govindarajan, from HSHS Medical Group in O'Fallon, Illinois, reports on therapeutic advances for patients with MG presented at the American Academy of Neurology 2022 annual meeting.  

First, Dr Govindarajan discusses interim results from the ADAPT+ study, an ongoing 3-year extension of ADAPT that evaluated the long-term safety, tolerability, and efficacy of efgartigimod.  

Next, he highlights CHAMPION MG, an open-label extension trial that looked at the long-term efficacy and safety profile of ravulizumab in adults with anti-acetylcholine receptor antibody–positive generalized MG.  

Dr Govindarajan concludes by reviewing a phase 2 study on nipocalimab, a monoclonal antibody that targets the IgG binding site on FcRn with high affinity, therefore reducing serum levels of total IgG and pathogenic IgG autoantibodies — the underlying cause of MG. This study evaluated efficacy data including myasthenia gravis activities of daily living score evaluated efficacy data including myasthenia gravis activities of daily living.  

--

Raghav Govindarajan, MD, Staff neurologist, Stroke Director, HSHS Medical Group-St Elizabeth, O'Fallon, Illinois 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion 

Received research grant from: Alexion 

Received income in an amount equal to or greater than $250 from: Alexion 

Myasthenia gravis (MG) is an autoimmune disease leading to muscle weakness and fatigue. Medical therapy for MG has traditionally focused on treatments to alleviate symptoms, but a range of new therapies are improving outcomes.  

Dr Raghav Govindarajan, from HSHS Medical Group in O'Fallon, Illinois, reports on therapeutic advances for patients with MG presented at the American Academy of Neurology 2022 annual meeting.  

First, Dr Govindarajan discusses interim results from the ADAPT+ study, an ongoing 3-year extension of ADAPT that evaluated the long-term safety, tolerability, and efficacy of efgartigimod.  

Next, he highlights CHAMPION MG, an open-label extension trial that looked at the long-term efficacy and safety profile of ravulizumab in adults with anti-acetylcholine receptor antibody–positive generalized MG.  

Dr Govindarajan concludes by reviewing a phase 2 study on nipocalimab, a monoclonal antibody that targets the IgG binding site on FcRn with high affinity, therefore reducing serum levels of total IgG and pathogenic IgG autoantibodies — the underlying cause of MG. This study evaluated efficacy data including myasthenia gravis activities of daily living score evaluated efficacy data including myasthenia gravis activities of daily living.  

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Raghav Govindarajan, MD, Staff neurologist, Stroke Director, HSHS Medical Group-St Elizabeth, O'Fallon, Illinois 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion 

Received research grant from: Alexion 

Received income in an amount equal to or greater than $250 from: Alexion 

Myasthenia gravis (MG) is an autoimmune disease leading to muscle weakness and fatigue. Medical therapy for MG has traditionally focused on treatments to alleviate symptoms, but a range of new therapies are improving outcomes.  

Dr Raghav Govindarajan, from HSHS Medical Group in O'Fallon, Illinois, reports on therapeutic advances for patients with MG presented at the American Academy of Neurology 2022 annual meeting.  

First, Dr Govindarajan discusses interim results from the ADAPT+ study, an ongoing 3-year extension of ADAPT that evaluated the long-term safety, tolerability, and efficacy of efgartigimod.  

Next, he highlights CHAMPION MG, an open-label extension trial that looked at the long-term efficacy and safety profile of ravulizumab in adults with anti-acetylcholine receptor antibody–positive generalized MG.  

Dr Govindarajan concludes by reviewing a phase 2 study on nipocalimab, a monoclonal antibody that targets the IgG binding site on FcRn with high affinity, therefore reducing serum levels of total IgG and pathogenic IgG autoantibodies — the underlying cause of MG. This study evaluated efficacy data including myasthenia gravis activities of daily living score evaluated efficacy data including myasthenia gravis activities of daily living.  

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Raghav Govindarajan, MD, Staff neurologist, Stroke Director, HSHS Medical Group-St Elizabeth, O'Fallon, Illinois 

Serve(d) as a speaker or a member of a speakers bureau for: Alexion 

Received research grant from: Alexion 

Received income in an amount equal to or greater than $250 from: Alexion 

Patients with chronic obstructive pulmonary disease (COPD) typically have emphysema, which involves destruction of alveoli and reduction of elasticity leading to airflow obstruction, air trapping, and hyperinflation. Over time, these changes cause low respiratory reserve volume and increased residual volume, which cause dyspnea.  

One of the newest treatment options for patients who have advanced COPD with severe emphysema is a minimally invasive procedure called bronchoscopic lung volume reduction (BLVR). Most recently, the FDA approved the use of endobronchial valves for this procedure, which are implanted in the airways of the lungs to reduce air trapping and hyperinflation. 

In certain patients, BLVR has been shown to improve lung function, facilitate easier breathing, enhance exercise tolerance, and lead to better quality of life. 

In this ReCAP, Dr. Javier Diaz-Mendoza, program director of the Interventional Pulmonology Fellowship at Henry Ford Health System in Detroit, discusses the benefits of BLVR in patients who have advanced COPD with emphysema. He discusses the procedure, patient outcomes, and which patients should be considered for BLVR.  

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Associate Professor of Medicine, Henry Ford Hospital, Wayne State University; Program Director, Interventional Pulmonology Fellowship, Henry Ford Health System, Detroit, MI

Javier Diaz-Mendoza, MD, FCCP, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Ion Intuitive Serve(d) as a speaker or a member of a speakers bureau for: Association of Interventional Pulmonology Program Directors

Patients with chronic obstructive pulmonary disease (COPD) typically have emphysema, which involves destruction of alveoli and reduction of elasticity leading to airflow obstruction, air trapping, and hyperinflation. Over time, these changes cause low respiratory reserve volume and increased residual volume, which cause dyspnea.  

One of the newest treatment options for patients who have advanced COPD with severe emphysema is a minimally invasive procedure called bronchoscopic lung volume reduction (BLVR). Most recently, the FDA approved the use of endobronchial valves for this procedure, which are implanted in the airways of the lungs to reduce air trapping and hyperinflation. 

In certain patients, BLVR has been shown to improve lung function, facilitate easier breathing, enhance exercise tolerance, and lead to better quality of life. 

In this ReCAP, Dr. Javier Diaz-Mendoza, program director of the Interventional Pulmonology Fellowship at Henry Ford Health System in Detroit, discusses the benefits of BLVR in patients who have advanced COPD with emphysema. He discusses the procedure, patient outcomes, and which patients should be considered for BLVR.  

--

Associate Professor of Medicine, Henry Ford Hospital, Wayne State University; Program Director, Interventional Pulmonology Fellowship, Henry Ford Health System, Detroit, MI

Javier Diaz-Mendoza, MD, FCCP, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Ion Intuitive Serve(d) as a speaker or a member of a speakers bureau for: Association of Interventional Pulmonology Program Directors

Patients with chronic obstructive pulmonary disease (COPD) typically have emphysema, which involves destruction of alveoli and reduction of elasticity leading to airflow obstruction, air trapping, and hyperinflation. Over time, these changes cause low respiratory reserve volume and increased residual volume, which cause dyspnea.  

One of the newest treatment options for patients who have advanced COPD with severe emphysema is a minimally invasive procedure called bronchoscopic lung volume reduction (BLVR). Most recently, the FDA approved the use of endobronchial valves for this procedure, which are implanted in the airways of the lungs to reduce air trapping and hyperinflation. 

In certain patients, BLVR has been shown to improve lung function, facilitate easier breathing, enhance exercise tolerance, and lead to better quality of life. 

In this ReCAP, Dr. Javier Diaz-Mendoza, program director of the Interventional Pulmonology Fellowship at Henry Ford Health System in Detroit, discusses the benefits of BLVR in patients who have advanced COPD with emphysema. He discusses the procedure, patient outcomes, and which patients should be considered for BLVR.  

--

Associate Professor of Medicine, Henry Ford Hospital, Wayne State University; Program Director, Interventional Pulmonology Fellowship, Henry Ford Health System, Detroit, MI

Javier Diaz-Mendoza, MD, FCCP, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Ion Intuitive Serve(d) as a speaker or a member of a speakers bureau for: Association of Interventional Pulmonology Program Directors

The expanding range of therapies and interventions available for treatment of non–small cell lung cancer (NSCLC) has brought medical oncologists and interventional pulmonologists into closer partnership.

Oncologist Dr. Joy Feliciano and interventional pulmonologist Dr. A. Christine Argento, both colleagues at Johns Hopkins University, comment on their evolving relationship as a team.

Pulmonologists now often serve as the "gatekeepers into thoracic oncology," says Dr. Argento. Recent advances in technology, including endobronchial ultrasound, navigational bronchoscopy, and robotic-assisted bronchoscopy, allow for diagnosis, staging, and collection of sufficient tissue for advanced studies into molecular markers and genetic studies necessary to guide treatment decisions for metastatic NSCLC.

In resectable disease, patients who might have gone straight to surgery in the past now can be considered for neoadjuvant treatments. Here again, says Dr. Feliciano, it is critical for oncologists to understand the biomarkers and molecular profile of the tumor before considering an intervention, and the role of bronchoscopy is key.

A multidisciplinary practice of NSCLC specialists, who have access to on-site or virtual tumor boards, sometimes on an international scale, helps ensure optimal treatment for patients in the increasingly complex NSCLC arena.

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A. Christine Argento, MD, Associate Professor of Medicine, Department of Pulmonary and Critical Care Medicine, Johns Hopkins University; Director of Bronchoscopy, Department of Interventional Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, Maryland

A. Christine Argento, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biodesix; Olympus; Cook; Intuitive; Boston Scientific

Josephine L. Feliciano, MD, Associate Professor, Clinical Director, Sidney Kimmel Cancer Center, Johns Hopkins University Hospital, Baltimore, Maryland

Josephine L. Feliciano, MD, has disclosed the following relevant financial relationships:

Received research grant from: Bristol-Myers; Pfizer; AstraZeneca.

Received income in an amount equal to or greater than $250 from: Genentech; AstraZeneca; Eli Lilly; Merck; Regeneron; Coherus; Takeda; Bristol-Myers

The expanding range of therapies and interventions available for treatment of non–small cell lung cancer (NSCLC) has brought medical oncologists and interventional pulmonologists into closer partnership.

Oncologist Dr. Joy Feliciano and interventional pulmonologist Dr. A. Christine Argento, both colleagues at Johns Hopkins University, comment on their evolving relationship as a team.

Pulmonologists now often serve as the "gatekeepers into thoracic oncology," says Dr. Argento. Recent advances in technology, including endobronchial ultrasound, navigational bronchoscopy, and robotic-assisted bronchoscopy, allow for diagnosis, staging, and collection of sufficient tissue for advanced studies into molecular markers and genetic studies necessary to guide treatment decisions for metastatic NSCLC.

In resectable disease, patients who might have gone straight to surgery in the past now can be considered for neoadjuvant treatments. Here again, says Dr. Feliciano, it is critical for oncologists to understand the biomarkers and molecular profile of the tumor before considering an intervention, and the role of bronchoscopy is key.

A multidisciplinary practice of NSCLC specialists, who have access to on-site or virtual tumor boards, sometimes on an international scale, helps ensure optimal treatment for patients in the increasingly complex NSCLC arena.

--

A. Christine Argento, MD, Associate Professor of Medicine, Department of Pulmonary and Critical Care Medicine, Johns Hopkins University; Director of Bronchoscopy, Department of Interventional Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, Maryland

A. Christine Argento, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biodesix; Olympus; Cook; Intuitive; Boston Scientific

Josephine L. Feliciano, MD, Associate Professor, Clinical Director, Sidney Kimmel Cancer Center, Johns Hopkins University Hospital, Baltimore, Maryland

Josephine L. Feliciano, MD, has disclosed the following relevant financial relationships:

Received research grant from: Bristol-Myers; Pfizer; AstraZeneca.

Received income in an amount equal to or greater than $250 from: Genentech; AstraZeneca; Eli Lilly; Merck; Regeneron; Coherus; Takeda; Bristol-Myers

The expanding range of therapies and interventions available for treatment of non–small cell lung cancer (NSCLC) has brought medical oncologists and interventional pulmonologists into closer partnership.

Oncologist Dr. Joy Feliciano and interventional pulmonologist Dr. A. Christine Argento, both colleagues at Johns Hopkins University, comment on their evolving relationship as a team.

Pulmonologists now often serve as the "gatekeepers into thoracic oncology," says Dr. Argento. Recent advances in technology, including endobronchial ultrasound, navigational bronchoscopy, and robotic-assisted bronchoscopy, allow for diagnosis, staging, and collection of sufficient tissue for advanced studies into molecular markers and genetic studies necessary to guide treatment decisions for metastatic NSCLC.

In resectable disease, patients who might have gone straight to surgery in the past now can be considered for neoadjuvant treatments. Here again, says Dr. Feliciano, it is critical for oncologists to understand the biomarkers and molecular profile of the tumor before considering an intervention, and the role of bronchoscopy is key.

A multidisciplinary practice of NSCLC specialists, who have access to on-site or virtual tumor boards, sometimes on an international scale, helps ensure optimal treatment for patients in the increasingly complex NSCLC arena.

--

A. Christine Argento, MD, Associate Professor of Medicine, Department of Pulmonary and Critical Care Medicine, Johns Hopkins University; Director of Bronchoscopy, Department of Interventional Pulmonary Medicine, Johns Hopkins Hospital, Baltimore, Maryland

A. Christine Argento, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Biodesix; Olympus; Cook; Intuitive; Boston Scientific

Josephine L. Feliciano, MD, Associate Professor, Clinical Director, Sidney Kimmel Cancer Center, Johns Hopkins University Hospital, Baltimore, Maryland

Josephine L. Feliciano, MD, has disclosed the following relevant financial relationships:

Received research grant from: Bristol-Myers; Pfizer; AstraZeneca.

Received income in an amount equal to or greater than $250 from: Genentech; AstraZeneca; Eli Lilly; Merck; Regeneron; Coherus; Takeda; Bristol-Myers