Podcast 301: Monkeypox — what to look for, how to treat

08/19/22 • 17 min

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

This time, we look to New York for guidance on recognizing and treating monkeypox.

Dr. Eric Meyerowitz of Montefiore and Dr. Stephen Baum of Einstein will lead you through the monkeypox thicket in a 17-minute chat.

Included below is information for patients as well as links to some key articles of interest to clinicians.

LINKS:

For patients: Dr. Barry Zingman’s “Monkeypox — What you need to know”

For clinicians:

The post Podcast 301: Monkeypox — what to look for, how to treat first appeared on Clinical Conversations.

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

This time, we look to New York for guidance on recognizing and treating monkeypox.

Dr. Eric Meyerowitz of Montefiore and Dr. Stephen Baum of Einstein will lead you through the monkeypox thicket in a 17-minute chat.

Included below is information for patients as well as links to some key articles of interest to clinicians.

LINKS:

For patients: Dr. Barry Zingman’s “Monkeypox — What you need to know”

For clinicians:

The post Podcast 301: Monkeypox — what to look for, how to treat first appeared on Clinical Conversations.

Previous Episode

Podcast 300: NADIM II trial offers “quite exciting” results in lung cancer

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE.

We’re back with another interview from this year’s IASLC conference.

This time, Christine Sadlowski and Dr. Julia Rotow interview Dr. Mariano Provencio about the survival outcomes from the NADIM II trial. In that trial, patients with resectable stage III AB non-small cell lung cancer received nivolumab plus chemotherapy versus chemotherapy alone.

Overall survival at 5 years in these patients has been roughly 30%, according to Provencio. With the addition of chemo-immunotherapy, patients who showed a complete pathological response were all alive at the 3-year mark. These results, according to Rotow, are “really quite exciting.”

INTERVIEW TRANSCRIPT

Christine Sadlowski:

This is part of the NEJM Group coverage of the IASLC’s 2022 World Conference on Lung Cancer. I’m Christine Sadlowski, and with me Dr. Julia Rotow, a clinical oncologist at Dana-Farber Cancer Institute in Boston. We’re here to interview Dr. Mariano Provencio, Chair of Medical Oncology at the Hospital Universitario Puerta de Hierro Majadahonda in Madrid in Spain. He is the lead author on NADIM II, a phase 2 trial of neoadjuvant nivolumab added to chemotherapy for resectable stage III AB non-small cell lung cancer. Welcome.

Dr. Mariano Provencio:

Thank you.

Christine Sadlowski:

So first, I’d like to ask you about the history of this research because these findings come after several previous studies, including NADIM nivolumab in this clinical setting. Can you refresh us briefly on what is known so far?

Dr. Mariano Provencio:

We studied the combination with nivolumab plus chemotherapy in NADIM I. It was a clinical trial focused on stage IIIA according to the 7^th edition. It was a phase two trial. We obtained very exciting results: in overall survival, three times the historical series; in DFS [disease-free survival] around 77 percent at two years — almost double the historical series — and also early results in PCR, pathological complete response, almost 60 percent.

Then following that was the second clinical trial comparing nivolumab plus chemotherapy versus chemotherapy, and this is NADIM II.

Dr. Julia Rotow:

Thank you, Dr. Provencio. So, when you think about what we knew already in the field, could you take us through some of the key findings from the NADIM II study and what these might add to our current understanding of nivolumab in this setting?

Dr. Mariano Provencio:

In NADIM II, the primary objective was complete pathological response, and we obtained higher complete pathological response in the experimental arm. Nivo plus chemo versus chemo: Odds Ratio 7.88; p = 0.0068. We presented at the last lung cancer congress (IASLC) more progress, in PFS longer with hazard ratio of 0.48 and more overall survival hazard ratio of 0.40. And this is quite amazing results, in my opinion, comparing with chemotherapy arm.

Christine Sadlowski:

Can I go back a little bit and say in this particular presentation you’re showing primarily secondary outcomes, is that correct?

Dr. Mariano Provencio:

We presented the primary end point was a complete pathological response. It was positive and then we presented in this congress the secondary outcomes, survival outcomes, yes.

Christine Sadlowski:

And they were at 12 and 24 months, correct?

Dr. Mariano Provencio:

Correct.

Christine Sadlowski:

I was struck by the finding on overall survival. That’s obviously improved with adjuvant therapy.

Dr. Mariano Provencio:

We use adjuvant nivolumab therapy for six months. We think so, this is the first clinical trials who reported an increase in overall survival in this setting using immunotherapy plus chemotherapy and adjuvant.

Dr. Julia Rotow:

I was struck by these results. They were quite impressive. Are there any caveats we should take away from your status as secondary versus primary outcomes on the study?

Dr. Mariano Provencio:

In the first clinical trial, in NADIM I, the primary endpoint was progression-free survival. We saw pathological complete response was quite robust endpoint. I think these results are very significant in survival outcomes are very, very significant.

Christine Sadlowski:

So, what does that mean for clinical practice? I don’t actually know how nivolumab is currently used. I understand it’s approved for other cancers, not this one, but is it currently used?

Dr. Mariano Prov...

Next Episode

Podcast 298: COPD exacerbations — 7 days of antibiotics versus 2

A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE AT THIS LINK.

In treating most exacerbations of chronic obstructive pulmonary disease (COPD) the usual regimen consists of prednisone plus 5- to 7-days of antibiotics. But what if a shorter course of antibiotic therapy would do? That would be both convenient for patients and less likely to promote antibiotic resistance.

A recent paper in Therapeutic Advances in Respiratory Disease describes just such a strategy: patients received prednisone plus either 2 or 7 days of levofloxacin. There was no substantive difference in clinical results between the groups. Summarized in NEJM Journal Watch General Medicine as “practice changing,” this research seems worth a closer look.

To that end we’ve invited two of the researchers and the Journal Watch editor who wrote the summary to discuss the issues raised.

Have a listen to this 14-minute Clinical Conversation.

(A note of no great consequence: We’ve called this “Podcast 298” because, while numbering the titles, your host negligently skipped from 297 to 299 in his haste to achieve 300 episodes.)

Therapeutic Advances in Respiratory Disease paper

Journal Watch summary

TRANSCRIPT

Joe Elia:

A recent summary in NEJM Journal Watch Journal General Medicine labeled a study about treating acute exacerbations of chronic obstructive pulmonary disease — or COPD — as practice changing, so it seems important to spread the news.

To do that, we’ve got Dr. Daniel Dressler, the summarizer of the study, Dr. Salma Messous, the study’s first author, and Dr. Semir Nouira, a senior author, to discuss it with us.

Dr. Dressler is a professor of medicine at Emory University in Atlanta. He is also deputy editor of NEJM Journal Watch General Medicine. Dr. Messous and Dr. Nouira are in the Emergency Department and the Department of Laboratory Research at Monastir University in Tunisia. Welcome to you both.

Dr. Semir Nouira:

Thank you very much. Welcome.

Dr. Salma Messous:

Thank you very much.

Dr. Daniel Dressler:

Thank you so much, Joe. Welcome, again, to Dr. Messous and Dr. Nouira.

I’ll just jump in and ask you if you would agree with this thumbnail description of your work: You randomized approximately 300 patients with acute exacerbation of COPD to one of two antibiotic regimens, either a two-day course of levofloxacin — or a seven-day course, which is the usual care, so I’ll ask you if that’s correct and if you can tell us briefly why you undertook this study, and essentially what you found.

Dr. Semir Nouira:

Thank you, Dan, for your choice of our study. I’m very proud to be here and to be with you to explain the background of our study and the results of our study.

Our study is probably the first that compares a short course of antibiotic — as short as two days — compared to seven days’ conventional duration. We found that there are similar results, and that the two-day is as effective as seven days.

You know, actually the objective of the study is not to show or to demonstrate the similarity between short course and conventional course of antibiotics, this was clearly shown many years ago — I can say at least since 2008, since the publication of the first analyses comparing the efficacy between short and a conventional course. So years ago it was shown, this evidence.

This was not our question, and as you can expect, this is very important as a result to know, it’s very important, it’s very relevant because this would lead to less consumption of antibiotics, less antibacterial resistance, less adverse effects, and perhaps more compliance.

So this was demonstrated many years ago, but the question of the present study is the following: What is the shortest course of antibiotics that we can accept for our patient, COPD patients with exacerbation. This is the main question of the study, and you know that according to a recent recommendation of the GOLD, it is recommended that antibiotic therapy should not exceed five days, and some studies demonstrate that even with three days, we can have similar results as conventional duration. So for us, the question is, could we decrease the duration to less than three days? And that’s why we performed this study because according to in vitro and animal studies, antibiotic therapy has its maximum effect during the first hours, so why not reduce antibiotic therapy to the least duration?

This was the background of...