Internal Medicine

Journal Club ft. NEJM publications

Questions discussed in this category

How do you identify which patients are at highest risk for decompensation and most likely to benefit from NIV for pre-oxygenation prior to intubation?

2 Answers available

Does the experience level of the intubation operator affect outcomes related to pre-oxygenation with NIV versus an oxygen mask?

2 Answers available

Does the use of NIV for pre-oxygenation delay the time to intubation?

2 Answers available

What are the logistical challenges and time constraints of implementing NIV for pre-oxygenation in emergency settings compared to oxygen masks?

1 Answer available

Would bag-mask ventilation with a PEEP valve be a reasonable alternative to NIV for pre-oxygenation prior to intubation in settings where NIV is not easily accessible?

1 Answer available

Is there a subset of patients in whom pre-oxygenation with NRB or BVM could be safely pursued?

1 Answer available

Does tolerance of prior BTKi therapy or specific agent used (e.g., ibrutinib, acalabrutinib) influence your starting dose of pirtobrutinib?

2 Answers available

How does pirtobrutinib compare to other available therapies for relapsed/refractory CLL after BTK inhibitor treatment, particularly in terms of efficacy and tolerability?

2 Answers available

What post-protocol therapies did patients on the BRUIN trial in CLL receive, and how did these therapies impact outcomes?

3 Answers available

How do CLL patients with downstream treatment-resistant mutations such as PLCG2 respond to pirtobrutinib?

Are there other mutations/biomarkers in CLL which may specifically predict for response or resistance to pirtobrutinib?

4 Answers available

How will your approach to screening and diagnosis of early dementia change given newly available therapies for early Alzheimer's disease?

5 Answers available

Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?

4 Answers available

How do you select systemic therapy for advanced HCC patients with portal vein thrombosis?

2 Answers available

What is your treatment approach for a patient with metastatic hepatocellular carcinoma with Child's Pugh B cirrhosis?

How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...

4 Answers available

Does the overall conclusion of the CHANCE-2 trial make ticagrelor + ASA a worthwhile transition given the data showing cumulative hazard of stroke diverged during the first week and was subsequently similar, which suggests the benefit of ticagrelor over clopidogrel is seen predominantly soon after stroke?

4 Answers available

Is there a risk of CYP2C19 gene testing only being adopted by wealthier health systems, thereby creating a disparity gap in treatment?

What is the cost and accessibility of CYP2C19 gene testing? Does the limited availability of rapid genotyping techniques limit the clinical applicabil...

3 Answers available

Would you generalize the data from the CHANCE-2 trial to a broader clinic population given that the study was specific to Han Chinese patients?

How do you plan to incorporate the results of the CHANCE-2 trial (Wang et al., PMID 34708996) in your own practice?

3 Answers available

Do you recommend genetic testing after a patient on clopidogrel has a stroke based on the results of the CHANCE-2 trial?

3 Answers available

What strategies can be employed to manage interstitial lung disease seen with trastuzumab deruxtecan?

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use? Do you feel the dosing used in...

2 Answers available

Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?

ADVOCATE trial

1 Answer available

Are there particular subsets of AAV patients in which avacopan is more effective?

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

1 Answer available

How should the results of the ADVOCATE trial be applied in AAV patients who receive rituximab induction and maintenance therapy?

In the ADVOCATE trial, patients were not re-dosed with rituximab.

1 Answer available

Is anticoagulation a relative contraindication to atezolizumab/bevacizumab for advanced HCC?

For example in a patient with a history of PE?

3 Answers available

For patients with HCC receiving atezo/bev, would you advise any other clinical investigations scheduled during treatment other than basic lab monitoring?

i.e. EGD surveillance for varices?

3 Answers available

Are there any biomarkers that might indicate who might be responders to atezolizumab/bevacizumab for HCC?

ex. VEGFR2 expression, inflammatory signature, PDL1, etc.

2 Answers available

How do you manage patients on atezolizumab/bevacizumab with advanced HCC who develop arterial thrombosis?

Do you continue atezolizumab alone? Would you avoid anticoagulation?

6 Answers available

For patients with HCC that have stable disease on immunotherapy alone, would you consider adding bevacizumab at the time of disease progression and continue immunotherapy?

2 Answers available

How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

2 Answers available

Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?

3 Answers available

Do you refer all of your patients for EGD prior to initiation of atezolizumab/bevacizumab for advanced HCC?

Do you screen even asymptomatic patients?

4 Answers available

Papers discussed in this category

Clin. Cancer Res., 2015 Oct 23

Safety and Pharmacokinetics of Lenvatinib in Patients with Advanced Hepatocellular Carcinoma.

Invest New Drugs, 2015 Apr 12

Sorafenib treatment in Child-Pugh A and B patients with advanced hepatocellular carcinoma: safety, efficacy and prognostic factors.

J Hepatol, 2021 May 26

CheckMate 040 cohort 5: A phase I/II study of nivolumab in patients with advanced hepatocellular carcinoma and Child-Pugh B cirrhosis.

N Engl J Med, 2020 May 14

Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma.

NEJM Evidence, 2022 June 6

Tremelimumab Plus Durvalumab in Unresectable Hepatocellular Carcinoma

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-04-10

Phase I and pharmacokinetic study of sorafenib in patients with hepatic or renal dysfunction: CALGB 60301.

Cancer, 2019-09-15

Nivolumab in patients with advanced hepatocellular carcinoma and Child-Pugh class B cirrhosis: Safety and clinical outcomes in a retrospective case series.

Liver Cancer, 2019 Sep 18

A New Treatment Option for Intermediate-Stage Hepatocellular Carcinoma with High Tumor Burden: Initial Lenvatinib Therapy with Subsequent Selective TACE.

N Engl J Med, 2021 Feb 18

Avacopan for the Treatment of ANCA-Associated Vasculitis.

N Engl J Med, 2021 Oct 28

Ticagrelor versus Clopidogrel in Loss-of-Function Carriers with Stroke or TIA.

The New England journal of medicine, 2018-07-19

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA.

N Engl J Med, 2013 Jun 26

Clopidogrel with aspirin in acute minor stroke or transient ischemic attack.

N Engl J Med,

Ticagrelor and Aspirin or Aspirin Alone in Acute Ischemic Stroke or TIA.

N Engl J Med, 2022 Oct 06

Trial of Intravenous Immune Globulin in Dermatomyositis.

Alzheimer's & dementia : the journal of the Alzheimer's Association, 2022 Aug 15

The AHEAD 3-45 Study: Design of a prevention trial for Alzheimer's disease.

The journal of prevention of Alzheimer's disease, 2022

Blood Biomarkers from Research Use to Clinical Practice: What Must Be Done? A Report from the EU/US CTAD Task Force.

The New England journal of medicine, 2022 Feb 24

Mechanisms of Resistance to Noncovalent Bruton's Tyrosine Kinase Inhibitors.

N Engl J Med, 2023 Jul 6

Pirtobrutinib after a Covalent BTK Inhibitor in Chronic Lymphocytic Leukemia.

Blood advances, 2023 Jun 27

BTK and PLCG2 remain unmutated in one-third of patients with CLL relapsing on ibrutinib.

Blood advances, 2022 Oct 25

Enrichment of BTK Leu528Trp mutations in patients with CLL on zanubrutinib: potential for pirtobrutinib cross-resistance.

The Lancet. Oncology, 2018-01

Venetoclax for chronic lymphocytic leukaemia progressing after ibrutinib: an interim analysis of a multicentre, open-label, phase 2 trial.

The New England journal of medicine, 2018-03-22

Venetoclax-Rituximab in Relapsed or Refractory Chronic Lymphocytic Leukemia.

Blood advances, 2024 Mar 26

Venetoclax-rituximab is active in patients with BTKi-exposed CLL, but durable treatment-free remissions are uncommon.

Haematologica, 2024 Jun 01

Pirtobrutinib venetoclax in covalent Bruton tyrosine kinase inhibitor-pretreated chronic lymphocytic leukemia: a matching-adjusted indirect comparison.

The New England journal of medicine, 2024 Jun 13

Noninvasive Ventilation for Preoxygenation during Emergency Intubation.

Critical care medicine, 2019 Apr

Compared Efficacy of Four Preoxygenation Methods for Intubation in the ICU: Retrospective Analysis of McGrath Mac Videolaryngoscope Versus Macintosh Laryngoscope (MACMAN) Trial Data.

European journal of anaesthesiology, 2015 Dec

Preoxygenation by spontaneous breathing or noninvasive positive pressure ventilation with and without positive end-expiratory pressure: A randomised controlled trial.

The American journal of emergency medicine, 2016 May 28

The utility of noninvasive nasal positive pressure ventilators for optimizing oxygenation during rapid sequence intubation.

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