Articles related to Internal Medicine

A randomized phase II trial has found that consolidation therapy with nivolumab (Opdivo) plus ipilimumab (Yervoy) after chemoradiotherapy did not lead to better survival outcomes for patients with small cell lung cancer (SCLC). The study enrolled 222 patients with stage I-IIIB histologically or cytologically confirmed limited-disease SCLC, and adequate hematologic, renal, lung, and pulmonary function. The combination regimen yielded no improvement in overall survival, and grade 3 adverse events were approximately 2.5 times more common in the dual therapy group.

“MB” is a frail, wheelchair-ridden, nearly blind, and mostly deaf woman living with early dementia and neglected lung cancer. What this oncologist thought MB wanted and needed was a lot different than what MB actually wanted and needed after discussing various options with her and talking to her family on numerous occasions. A humbling, honest view of an oncologist’s biases.

DLBCL is increasingly being recognized as a heterogeneous disease with distinct molecular subtypes. This has challenged the rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) treatment paradigm in recent years, as several DLBCL subtypes have inferior survival after standard R-CHOP therapy. So how do you choose? In this review the authors conclude with proposed clinical management scenarios in which DA-R-EPOCH may be preferred, including some for patient populations in which the use of R-CHOP vs. DA-R-EPOCH is controversial.

For patients being prescribed isotretinoin, there used to be three risk categories: women of reproductive potential, women not of reproductive potential, and males. The new risk classifications are two: those who can become pregnant and those who cannot. This change was based on stakeholder feedback that gender-specific language can be a barrier to access for patients who do not identify with the previous gender-specific patient categories.

A study published in Morbidity & Mortality Weekly Report (MMWR) argues that immunosuppressed patients and people with compromised immune systems need more than two vaccine doses to achieve adequate protection against COVID-19. After two vaccine doses, immunocompromised patients saw 77% vaccine effectiveness against hospitalization, versus 90% for immunocompetent individuals.

Only 8 of 35 studies could be included in the meta-analysis. Combined, these indicate a 25% risk reduction for physical distancing, 53% for mask-wearing, and 53% for hand washing. The accompanying BMJ editorial explores the possible reasons for the findings and the oddity that so little quality research is available on such an important topic.