Podcast 297: Forget about all that vitamin D testing!!

07/28/22 • 12 min

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

THE USUAL AUDIO FILE IS AVAILABLE BELOW

Steven Cummings has co-written a take-no-prisoners editorial in the New England Journal of Medicine. The topic? Vitamin D supplements. The conclusion? “...providers should stop screening for 25-hydroxyvitamin D levels or recommending vitamin D supplements, and people should stop taking vitamin D supplements to prevent major diseases or extend life.”

Dr. Cummings was commenting on research findings from the VITAL trial, also published in the journal, showing no fracture-lowering benefits of the supplements.

Allan Brett interviews Cummings to get the details on his pronouncement, and it takes just 13 minutes to dismiss vitamin D (which, by the way, is not a vitamin at all).

NEJM presentation of VITAL results

Cummings and Rosen editorial

The post Podcast 297: Forget about all that vitamin D testing!! first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

THE USUAL AUDIO FILE IS AVAILABLE BELOW

Dr. Cummings was commenting on research findings from the VITAL trial, also published in the journal, showing no fracture-lowering benefits of the supplements.

Allan Brett interviews Cummings to get the details on his pronouncement, and it takes just 13 minutes to dismiss vitamin D (which, by the way, is not a vitamin at all).

NEJM presentation of VITAL results

Cummings and Rosen editorial

The post Podcast 297: Forget about all that vitamin D testing!! first appeared on Clinical Conversations.

Previous Episode

Podcast 296: A roundtable on the question, Why are young internists flocking to the hospitalist practice style?

A VIDEO RECORDING OF THIS ROUNDTABLE IS AVAILABLE CLICK HERE.

THE USUAL AUDIO FILE IS AVAILABLE BELOW

Your host is old enough to remember when hospital corridors featured physicians with little black bags, scurrying around to see their patients.

That’s no longer true, of course. Most of the physicians seen in those corridors these days are white-coated employees.

The Annals of Internal Medicine reported a few months ago that “By 2018, 71% of newly certified general internists practiced as hospitalists, compared with only 8% practicing as outpatient-only physicians.” In addition, between 2008 and 2018 mixed-practice physicians — those black-bag-carrying types — declined by over 50%.

To investigate this shift, we gathered five young internists for a roundtable discussion on the attractions of the hospitalist specialty.

Running time: 30 minutes

Annals of Internal Medicine article

The post Podcast 296: A roundtable on the question, Why are young internists flocking to the hospitalist practice style? first appeared on Clinical Conversations.

Next Episode

Podcast 299: Lung cancer and atezolizumab — results from the IMpower010 trial

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

Interim results on overall survival in phase 3 of the IMpower010 trial were presented at this year’s meeting of the International Assosciation for the Study of Lung Cancer (IASLC). As part of the NEJM Group’s coverage of the conference, Christine Sadlowski interviewed the presenter, Dr. Enriqueta Felip. In a 15-minute interview, she discusses the implications for different patient groups and the past, present, and future of the IMpower trial, which tests adjuvant atezolizumab following platinum-based chemotherapy in patients with resected early-stage non–small-cell lung cancer.

INTERVIEW TRANSCRIPT:

Christine Sadlowski:

This is coverage of the IASLC’s 2022 World Conference on Lung Cancer. I’m Christine Sadlowski of the NEJM Group. With me today is Dr. Enriqueta Felip, who is head of the thoracic cancer unit at the Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology in Barcelona, Spain. She is the presenting author for the overall survival interim analysis of IMpower010, which tested atezolizumab in patients with resected early stage non-small cell lung cancer following platinum-based chemotherapy.

Dr. Felip, thank you very much for joining me.

Dr. Enriqueta Felip:

Thank you. It’s a pleasure.

Christine Sadlowski:

So, last year I interviewed your colleague, Dr. Heather Wakelee, about the interim findings on progression-free survival from this same study. Can you briefly remind us what those findings were?

Dr. Enriqueta Felip:

So, IMpower010 is a randomized trial in patients with completely resected stage IB with a tumor size greater than four centimeters, II-IIIA according to the Seven TNM Classification, and patients received adjuvants, platinum-based chemotherapy, and then 1,000 patients were randomized to receive one year of atezolizumab or best supportive care. The primary endpoint in this trial was the disease-free survival, and the primary endpoint was presented by Dr. Wakelee during the ASCO last year and also published in Lancet.

So, in this trial, for those patients with stage II-IIIA and PD-L1-positive tumors, atezolizumab improved disease-free survival with a hazard ratio of 0.66. For those patients with stage II-IIIA, irrespective of PDL-1, disease-free survival was improved with a hazard ratio of 0.79, and in the whole group of patients, patients with a stage IB-IIIA, the hazard ratio for disease-free survival was 0.81, and the statistical significance boundary for disease-free survival was not met in this population.

So here, during the IASLC conference, we present the first prespecified interim analysis of overall survival and a safety analysis with a median follow-up of 45 months and with a clinical cutoff in April 2022. So, at this analysis with an event to patient ratio of 25% in the intention-to-treat population, the overall survival is not mature.

So, in this analysis, we presented the results of overall survival in this interim analysis for patients with stage II-IIIA and PD-L1-positive tumors. Overall, there is a trend towards an improvement in overall survival for those patients receiving atezolizumab. The median overall survival was not reached in either of the treatment arms. The hazard ratio was 0.71 with a 95% confidence interval between 0.49 to 1.03. So, at 60 months there is 76.8% of the patients alive in the atezolizumab arm, 67.5% of the patients in the control arm.

At this overall survival interim analysis, we observe no differences in overall survival when we analyze all randomized stage II-IIIA population, irrespective of PD-L1, with a hazard ratio of 0.95, and also no differences in overall survival was observed in an intention-to-treat population, including patients with a stage IB disease, with a hazard ratio of 0.995.

And also, we analyzed the overall survival in patients with stage II-IIIA based on PD-L1. So, as I mentioned, for those patients with PD-L1-positive tumors, there is a nonsignificant trend in favor of atezolizumab with a hazard ratio of 0.71. For those patients with PD-L1-negative tumors, the hazard ratio is 1.36, and for those patients with PD-L1 50% or higher, the hazard ratio for overall survival is 0.43. We analyzed also the hazard ratio for those patients with PD-L1 between 1-49%, that is 0.95. So, it’s important that for those patients with PD-L1 50% or higher, when we exclude those patients with EGFR and ALK, the hazard ratio for overall survival is 0.42, the median overall survival was not reached in both treatment arms, and at five years, there are 84% of the patients in the atezolizumab <...