Journal Club ft. NEJM publications&nbsp;&nbsp;&nbsp;

What is your preferred first line treatment regimen for patients with untreated transplant-ineligible MM?

Triplet v. Quadruplet? What regimen? How would this change for a patient with high risk cytogenetics?

6 Answers available

What clinical or logistical factors influence your choice of anti-CD38 antibody in first line treatment of Multiple Myeloma?

For example, per the IMROZ trial methodology, Isatuximab dosing does not change to monthly dosing until >18 cycles which can impact patient QoL and...

Are you still recommending autologous stem cell transplantation (ASCT) for all eligible myeloma patients who achieve remission after induction with a quadruplet regimen?

Or can we omit it in older patients given efficacy of these regimens? Is transplant-eligibility still an important distinction up front given options ...

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?

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

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

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

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?

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

How does one approach maintenance treatment in transplant ineligible patients with newly diagnosed multiple myeloma?

Do the IMROZ and BENEFIT trials inform choice? In IMROZ, the high-risk population received only revlimid/dexamethasone maintenance. Should they have g...

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

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

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

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?

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?

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

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...

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?

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...

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?

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

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...

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

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...

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.

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

For example in a patient with a history of PE?

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?