Host: Matt Birnholz, MD

Guest: James Januzzi MD

The financial and human burden of heart failure in the United States is substantial and growing. This condition represents the most common cause of hospitalizations and readmissions among Medicare beneficiaries, and these numbers are poised to grow substantially over the coming years with the aging of the population. Although evidence from community-based studies of heart failure patients demonstrates that hospitalization rates have declined over the past decade, these analyses also indicate that the management of this patient population is far from optimal. Until recently, available treatments have demonstrated only variable success in improving presenting signs and symptoms, but none have significantly altered post-discharge outcomes for patients presenting with chronic heart failure. Physicians who treat patients with chronic heart failure must possess a good working knowledge of clinical data for prognostic factors, recognize the considerations for individualizing treatment to meet patients’ needs, and understand the benefits and limitations of newer treatment approaches.

Individual detection of 14 high risk human papilloma virus genotypes by the PapType test for the prediction of high grade cervical lesions. Cuzick J, Ho L, Terry G, Kleeman M, Giddings M, Austin J, Cadman L, Ashdown-Barr L, Costa MJ, Szarewski A. J Clin Virol. 2014 May;60(1):44-9. doi: 10.1016/j.jcv.2014.02.002. Epub 2014 Feb 14. Abstract BACKGROUND: HR HPV genotypes when assayed collectively, achieve high sensitivity but low specificity for the prediction of CIN2+. Knowledge of the specific genotypes in an infection may facilitate the use of HR HPV detection in routine clinical practice. OBJECTIVES: To compare the rate of HR HPV detection and the accuracy of CIN2+ prediction between PapType test (Genera Biosystems) and other commercially available HR HPV assays, and to examine the value of full HPV genotyping. STUDY DESIGN: PreservCyt samples from 1099 women referred for abnormal cervical cytology were used. CIN2+ was chosen as the primary end-point but CIN3+ was also evaluated. A hierarchy of HR HPV genotypes was created using PPV and this was used to create 3 groups of genotypes with potentially different management. RESULTS: The PapType assay has a specificity of 22.4% and a sensitivity of 94.6% for CIN2+ prediction. Classification into Groups A (HPV33 ...

CME credits: 0.50

Valid until: 08-05-2019

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Drs. Caballero, Choy, and Fleischmann discuss the patient-unique pathologies that underlie RA, the importance of physician-patient communication in maintaining treatment compliance as well as the mechanisms of action of the biologics used in managing RA. Finally, they discuss the new options for RA currently in clinical development.

Host: Thomas C. Wright, Jr., MD

A study of HPV typing for the management of HPV-positive ASC-US cervical cytologic results. Schiffman M, Vaughan LM, Raine-Bennett TR, Castle PE, Katki HA, Gage JC, Fetterman B, Befano B, Wentzensen N. Gynecol Oncol. 2015 Sep;138(3):573-8. doi: 10.1016/j.ygyno.2015.06.040. Epub 2015 Jul 4. Abstract BACKGROUND: In US cervical screening, immediate colposcopy is recommended for women with HPV-positive ASC-US(equivocal) cytology. We evaluated whether partial typing by Onclarity™ (BD) might identify HPV-positive women with low enough CIN3+ risk to permit 1-year follow-up instead. METHODS: The NCI-Kaiser Permanente Northern California Persistence and Progression cohort includes a subset of 13,890 women aged 21+ with HC2 (Qiagen)-positive ASC-US at enrollment; current median follow-up is 3.0years. Using stratified random sampling, we typed 2079 archived enrollment specimens including 329 women subsequently diagnosed with CIN3+, 563 with CIN2, and 1187 with <CIN2. Adjusting for sampling, we computed 3-year cumulative CIN3+ risks for each Onclarity typing channel, using Kaplan-Meier methods. RESULTS: The 3-year CIN3+ risk for all HC2-positive women with ASC-US was 5.2%; this establishes the "benchmark" risk for colposcopic referral. Hierarchically, 3-year cumulative risks for each typing channel were 16.0% for HPV16, 7.4% for HPV18, 7.0% for HPV31, 7.1% for grouped HPV33/58, 4.3% for HPV52, 3.9% for HPV45, 2.7% ...

Guest: Everett E. Vokes, MD

In this Grand Rounds recorded live at ASCO, Dr. Vokes introduces the concept of T-cell blockade and Checkpoint Inhibition as rationale for considering use of anti-PD-1 anti-CTLA-4 agents in the management of non-small cell lung cancer (NSCLC). Also discussed will be data reflective of the use of tumor biomarkers when selecting treatment strategies for patients with NSCLC, specifically those with elevated expression of PD-L1.

Guest: Richard S. Finn, MD

Hormone receptor–positive (HR+) disease is the most commonly diagnosed subset of breast cancer. Although endocrine therapy is the cornerstone of treatment for patients with HR+ advanced breast cancer, not all cases respond to first-line endocrine therapy, and disease that does respond eventually relapses. Because endocrine therapy–resistant HR+ disease is a significant problem, new therapeutic strategies to enhance the efficacy of endocrine therapy are being studied. Several CDK 4/6 inhibitors have shown promising results in the treatment of breast cancer, particularly HR+, HER2-negative metastatic disease. However, clinicians may not be familiar with the mechanisms of CDK 4/6 inhibition and why it is relevant in the treatment of breast cancer. Similarly, clinicians may not be familiar with the efficacy and safety of approved and emerging CDK 4/6 inhibitors in the treatment of breast cancer that is resistant to endocrine therapy. This Virtual Grand Rounds initiative is designed to close these knowledge gaps and provide clinicians with up-to-date information about approved and emerging therapies so that they can make informed choices regarding the management of breast cancer. Topics covered in this activity include the development of endocrine resistance in breast cancer; the significance of CDK inhibition; and the relevant clinical trial data about ...

Host: Prathima Setty, MD

Guest: JoAnn V. Pinkerton, MD

Guest: Andrew M. Kaunitz, MD, FACOG

Guest: Andre B. Lalonde, MD

This educational program is intended to educate healthcare practitioners who treat postmenopausal women about the accurate interpretation of data from the Women’s Health Initiative hormone therapy clinical trials, while increasing awareness that a significant amount of data exist to support the appropriate use of hormone therapy as an option for treating postmenopausal symptoms in the appropriate women.

Host: Matt Birnholz, MD

Guest: Everett E. Vokes, MD

Dr. Birnholz and Dr. Vokes will be discussing some of the exciting new data presented at ASCO 2016 on the management of non-small cell lung cancer.

Guest: Lars Bode, PhD

Guest: Sharon Groh-Wargo PhD, RD, LD

Guest: Terry S. Johnson, RNC, APN, NNP-BC, CLEC, MN

Drs. Lars Bode and Sharon Groh-Wargo and Neonatal Nurse Practitioner Terry Johnson discuss the key components of human milk that enhance infant immunity and digestive function.Topics to be covered include the key components of human milk that enhance infant immunity, the impact of prebiotic Human Milk Oligosaccharides (HMOs) on developing infant immunity and digestive function, safety and efficacy of prebiotic HMOs, obesity and weight loss with breast-fed versus formula-fed infants, and limitations of using infant formula containing palm olein and other plant derived palmitic acid sources.

Guest: Lars Bode, PhD

Guest: Sharon Groh-Wargo PhD, RD, LD

Guest: Terry S. Johnson, RNC, APN, NNP-BC, CLEC, MN

Drs. Lars Bode and Sharon Groh-Wargo and Neonatal Nurse Practitioner Terry Johnson discuss the key components of human milk that enhance infant immunity and digestive function.Topics to be covered include the key components of human milk that enhance infant immunity, the impact of prebiotic Human Milk Oligosaccharides (HMOs) on developing infant immunity and digestive function, safety and efficacy of prebiotic HMOs, obesity and weight loss with breast-fed versus formula-fed infants, and limitations of using infant formula containing palm olein and other plant derived palmitic acid sources.