COR2ED Medical Education

Dr. Jaume Capdevila, a Medical Oncologist at Vall d’Hebron University Hospital in Barcelona, Spain, and Dr. Rachel van Leeuwaarde, an Endocrinologist from the University Medical Center of Utrecht in The Netherlands discuss the use of multi-kinase inhibitors (MKIs), in particular VEGFR-TKIs in patients with radioactive iodine refractory differentiated thyroid cancer (DTC).

In this podcast, the two experts discuss key trials (SELECT, DECISION and COSMIC-311) and efficacy parameters of the current VEGFR-TKIs (lenvatinib, sorafenib and cabozantinib), how to manage toxicity whilst trying to optimise treatment outcomes and preserving always patients’ quality of life. They also discuss treatment strategies, when to start systemic treatment, which drug should be used first and how to sequence therapies. To close the podcast they take a look at ongoing clinical trials with other treatments in development for DTC.

In this third episode of the podcast series Women and Girls Bleed Too, Advanced Nurse Practitioner Debra Pollard (Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital, London, UK) is joined by Haematologist Dr. Michelle Lavin (RCSI and National Coagulation Centre, St James’ Hospital, Dublin, Ireland). They talk about the impact a bleeding disorder can have on the lives on women and girls and how these patients can and should be supported in first- and second-line care.

When thinking about management, many healthcare providers will first consider medical treatment. Dr. Lavin gives a brief overview of the first-line treatment options for women and girls with bleeding symptoms. However, the speakers stress that the management of these patients goes beyond medical treatment options alone. They provide practical tips and recommendations for first-line healthcare professionals when they treat a patient with a bleeding disorder. As many bleeding disorders are hereditary diseases, a diagnosis not only has impact on the patient, but on their family as well. A bleeding disorder also impacts family planning, pregnancy, and quality of life. Medical and psychological support is essential throughout life.

Finally, Michelle Lavin and Debra Pollard discuss some important topics for first-line healthcare providers to be aware of when they have a woman with a bleeding disorder in their practice, including the impact of a bleeding disorder on any medical invention, such as surgery, dental procedures or infertility treatment, but also on the use of pain medication.

In this second episode of the podcast series Women and Girls Bleed Too, Haematologist Dr. Roseline d’Oiron (Reference Centre for Haemophilia and RBD, Bicêtre Hospital AP-HP and University of Paris-Saclay in France) and Obstetrician/Gynaecologist Prof. Rezan Abdul-Kadir (The Royal Free Foundation Hospital in London, UK) discuss how to identify women and girls who are likely to have a bleeding disorder.

Prof. Abdul-Kadir addresses the steps she takes when she suspects a potential bleeding disorder in one of her patients. Dr. d’Oiron confirms it is key to get a clear understanding of the personal bleeding history and family history. There are several screening tools available to help assess the patient’s signs and symptoms. The experts discuss when a patient should be referred to a Haematologist, it is important to know that Haematologists are easily accessible for referral when in doubt.

Finally, Dr. d’Oiron and Prof. Abdul-Kadir address the types of testing that should and should not be done in first line. It turns out there are many misconceptions about laboratory testing for bleeding disorders. For example, contrary to common belief a normal aPTT and PT does not exclude a bleeding disorder. Furthermore, referring to a Haematologist for testing does not mean the patient should remain untreated. Starting basic treatment is crucial to limit the bleeding and address any iron deficiency as quickly as possible.

In this first episode of the podcast series Bleeding Disorders in Women and Girls: Women & Girls Bleed Too, Dr. Michelle Lavin (Haematologist at the National Coagulation Centre, St James’ Hospital, Dublin, Ireland) and Dr. Sarah O’Brien (Paediatric Haematologist at the Nationwide Children’s Hospital, Columbus, OH, USA) discuss how bleeding disorders occur in women and girls: Women & Girls Bleed Too. In clinical practice, sometimes girls can be forgotten about as bleeding disorders are more associated with males.

Dr. Lavin and Dr. O’Brien discuss the signs and symptoms of bleeding disorders and their impact on the quality of life of young girls, adolescents and adult women. Furthermore, they address how diagnosis may be easier in adults than in children, given the longer history of bleeding challenges. The experts also explore potential taboos in discussing these signs and symptoms with patients, considering intercultural differences and gender taboos, and the importance of normalising the conversation amongst healthcare professionals.

Finally, Dr. Lavin and Dr. O’Brien provide guidance on the next steps first-line healthcare providers should take when they see a patient with abnormal bleeding, including treatment initiation to limit the bleeding and address iron deficiency and referral to a haematologist for further assessment.

In this episode, Dr Choo discusses some key abstracts presented during the virtual ASCO and WCGIC congresses in 2021.

Dr Choo comments that despite the promising and positive data with hepatic arterial infusion chemotherapy (HAIC) in two different Phase 3 trials settings, the impact on clinical practice is still questionable.

Dr Choo reviews some updated data from IMbrave150 which is the study that validated atezolizumab+bevacizumab combination as the new standard of care in 1L setting for aHCC patients. In addition, real-world data from OPTIMIS and GIDEON studies, confirmed that sorafenib has still a role to play in 1L specifically in Child-Pugh B patients.

Dr Choo emphasises that biomarkers are urgently needed in HCC and summarises several studies investigating potential biomarkers that would require further investigation prior to clinical practice validation.

Finally, Dr Choo completes the overview by presenting a Japanese study that provides support for radio frequency ablation as an option, apart from surgery for patients with small HCC.

Dr. Tanya Dorff (City of Hope Comprehensive Cancer Center, Los Angeles, USA) and Dr. Phillip Koo (Banner MD Anderson Cancer Center, Arizona, USA) discuss the latest developments in the field of radiopharmaceuticals and their use in Prostate Cancer.

This second episode focuses on PSMA-targeted radiopharmaceuticals and how PSMA can be a target for imaging as well as for therapies. Efficacy and safety data from the phase 2 TheraP study are discussed which investigated lutetium-PSMA versus cabazitaxel in patients with mCRPC who had progressed on docetaxel. The experts also discuss the ongoing VISION trial and what the results may mean for clinical practice as well as other ongoing trials looking at lutetium-PSMA in combination with other prostate cancer therapies such as PARP inhibitors, immunotherapies, hormonal therapies and chemotherapy. Treatment sequencing is also considered in terms of where lutetium-PSMA fits into clinical practice for mCRPC patients and how the treatment compares to Radium-223.

Dr. Tanya Dorff (City of Hope Comprehensive Cancer Center, Los Angeles, USA) and Dr. Phillip Koo (Banner MD Anderson Cancer Center, Arizona, USA) discuss the latest developments in the field of radiopharmaceuticals and their use in Prostate Cancer. They are also joined by guest speaker Dr. Neal Shore (Carolina Urologic Research Center, North Carolina, USA).

In this first episode, the experts focus on the alpha emitter, Radium-223 which received regulatory approval on the basis of the phase 3 ALSYMPCA trial in patients with metastatic castration resistant prostate cancer (mCRPC) and symptomatic bone metastases. They consider mechanism of action and discuss key results from the trial and the safety profile.

The experts also review the ERA-223 and PEACE-III randomised trials which investigated the use of Radium-223 in combination with next generation androgen receptor inhibitors (ARIs). A number of real-world evidence studies are also reviewed as the experts consider where radium-223 fits into the overall treatment sequence for mCRPC patients. Radiation safety and general considerations for delivering therapy with radiopharmaceuticals are also discussed.