Latest Conference Articles

As the immuno-oncology landscape intensifies, a second player in the game, Merck's PD-1 inhibitor pembrolizumab (Keytruda), was recently approved for the treatment of advanced, unresectable melanoma.

A late afternoon talk on the third day at The Liver Meeting 2014, evaluated the influence of some of the newer antiviral agents on "brain fog," a phenomenon quite commonly observed in hepatitis C virus-infected patients, especially among those with mild disease.

The efficacy of oral antivirals for hepatitis C infection is a moot point. The prevailing discussion now delves into the best combinations that can target different viral genotypes, access to these combination regimens, and the subsequent dent in the budget of the patient, the health plan, or the care provider-as the case may be.

Medicare costs, Department of Veterans Affairs budgetary costs, and the economic impact on the developing world-these were some of the topics discussed at the evening session, Health Economics and Cost-Effectiveness, on the third day at The Liver Meeting 2014, held in Boston, Massachusetts, November 7 to 11, 2014.

Amidst discussions on liver care, transplants, and infections was a session on Value-Based Medicine in Hepatology, on the third day at The Liver Meeting 2014, an annual event by the American Association for the Study of Liver Disease, held in Boston, Massachusetts, from November 7 to 11, 2014. Presenters saw a huge turnout for the session, a sign of increased interest in value-based care.

A pattern is emerging in the hepatitis C virus treatment realm-of the newly approved agents, the sofosbuvir- and simeprevir-based regimens are gaining traction. A poster session on approved therapeutic agents on November 9, 2014, at the annual meeting of the American Association for the Study of Liver Disease, proved this again.

Bashar A. Aqel, MD, Mayo Clinic, Phoenix, Arizona, presented results from phase 2 of the COSMOS (Combination Of SiMeprevir and sOfosbuvir in hepatitis C virus genotype 1 infected patients) trial.

While the cost of hepatitis C treatment continues to be a major topic of debate-with the approval of simeprevir (Olysio), sofosbuvir (Sovaldi), and now the combination, sofosbuvir and ledipasvir (Harvoni)-those in favor of the treatment provide a strong research-based argument. The cost-debate is global, as shown by this cost-effectiveness study conducted in Italy.

While the cost of novel hepatitis C drugs has been rigorously debated, real-world data on the safety and efficacy of these drugs has now started showing up. A white paper released by CVS Health Research Institute in September of this year reported that in addition to the downward trend in utilization of sofosbuvir, which has cure rates of more than 95%, high discontinuation rates are being observed.

The era of accountable care and pay for performance is here, and physicians will have to embrace these novel reimbursement models. In a plenary session, Rubin Cohen, MD, FCCP, a member of the American College of Chest Physician's quality improvement committee, discussed the relationship between quality improvement and outcomes.

During a plenary session at the American College of Chest Physicians' CHEST meeting in Austin, Texas, Edgar Jimenez, MD, FCCM, vice president of critical care integration at Baylor Scott and White Health in Central Texas, discussed how to prepare for Ebola in the Intensive Care Unit (ICU) setting. Dr Jimenez began by introducing the session as a way to answer questions and to provide hospital ICU staff with key considerations for Ebola preparation in the United States.

A symposium on idiopathic pulmonary fibrosis (IPF), which was presented on behalf of InterMune, Inc, highlighted clinical data supporting the use of pirfenidone in patients with IPF. Leading the panel discussion was Steven Nathan, MD, FCCP, a principal investigator involved in studies of pirfenidone. Dr Nathan was joined by IPF experts Lisa Lancaster, MD, of Vanderbilt University Medical Center and Marilyn Glassberg, MD, of the University of Miami Health System.

The categorization of lung allograft dysfunction is changing, David Nunley, MD, clinical director of lung transplant at the University of Louisville Health Care Outpatient Center, said at the 2014 CHEST meeting in Austin, Texas.

Fear is the biggest barrier preventing providers from using social media to its fullest potential, according to Christopher Carroll, MD, social media editor at CHEST and research director for the Division of Critical Care at the Connecticut Children's Medical Center.

Dan Heath, a senior fellow at the Center for Advancement of Social Entrepreneurship at Duke University, outlined strategies for implementing change within an organization, including looking for solutions that are already present within an organization, as a solution to a large problem may already have been implemented on a small scale.

During a panel discussion, Darren Taichman, MD, PhD, executive deputy editor of the Annals of Internal Medicine and adjunct associate professor of medicine, Perelman School of Medicine, University of Pennsylvania, presented updates to pulmonary hypertension treatment guidelines, and Daniel Oulette, MD, FCCP, leader of the American College of Chest Physicians guideline oversight committee, discussed the move toward evidence-based guidelines that allow for continuous updates.

The molecular heterogeneity of idiopathic pulmonary fibrosis (IPF) may be important when selecting treatment strategies, including 2 new medications for delaying the progression of IPF-pirfenidone and nintedanib. In a featured lecture, Steven K. Huang, MD, an expert in IPF and an assistant professor of internal medicine at the University of Michigan, discussed characterization of the disease from the perspective of genetics.

The big news at the 2014 CHEST meeting in Austin, TX, was that 2 new drugs - pirfenidone and nintedanib - were approved to treat idiopathic pulmonary fibrosis, according to Steven Nathan, MD, medical director of the Lung Transplant Program at Inova Fairfax Hospital in Falls Church, VA.

Guidelines for the treatment of healthcare-associated pneumonia recommend the use of broad-spectrum therapy. But based on current evidence, use of broad-spectrum therapy may not be warranted, according to Marcos I. Restrepo, MD, MSc, of the University of Texas Health Science Center at San Antonio.

In this session, Gerard A. Silvestri MD, MS, a professor at the Medical University of South Carolina, discussed the evolution of therapy for non-small cell lung cancer (NSCLC). The use of targeted therapies has led to a dramatic improvement in survival for a certain subset of patients with NSCLC whose cancers have specific driver mutations.

Lung cancer is a good candidate for broad, population-based screening because it is a common disease with a high mortality rate that is often more successfully treated when a diagnosis is established early in the disease process. In an educational session, Gerard A. Silvestri, MD, MS, a professor at the Medical University of South Carolina, discussed the state of the art in lung cancer screening.

Treating bipolar depression with standard antidepressants has long been controversial, because some patients do not respond and it is believed that the drugs trigger manic episodes. Two physicians outline data on an antipsychotic initially approved for schizophrenia that received an additional indication for bipolar depression.

Treating psychiatric disorders in children and teenagers offers benefits that far outweigh risks, according to Craig Donnelly, MD, of Geisel School of Medicine at Dartmouth. If mental health problems go untreated, the teenager runs the risk of developing a more serious disorder as an adult.

Patients with serious mental illness die 15 to 20 years earlier than those with similar cardiovascular conditions. According to Joseph P. McEvoy, MD, of the Medical College of Georgia, "There's no mystery here." Cognitive deficits, issues, and lack of access can make it hard for these patients to get primary care, and to stick with the instructions they do receive. To help this group, Dr McEvoy believes psychiatrists can gain competency to treat hypertension, diabetes, obesity and to help these patients quit smoking.

The better-known symptoms of schizophrenia are devastating enough: hallucinations, delusions, agitated body movements, the inability to experience pleasure. Yet even when these facets are controlled with antipsychotic drugs, cognitive deficits that make it hard to maintain relationships or hold a job can still consign patients to a life in the shadows, with few friends or little contact with family.

Steven D. Hickman, PsyD, associate clinical professor at the University of California, San Diego, invited a roomful of conference attendees to put down the notes, close their eyes, set an intention, and breathe, gaining an "awareness of the breath." His session, "Mindfulness-Based Stress Reduction for Patients with Chronic or Life-Threatening Illness," highlighted techniques based on 2000-year-old Eastern philosophy that can help patients learn to respond to pain, not react to it.

Evidence of who gets post-traumatic stress disorder, how genetics plays a role, and how to treat it is growing, but much work remains to help the estimated 3.5% of the population who suffer its effects in any given year, according to Murray B. Stein, MD, MPH, professor of Psychiatry and Family and Preventive Medicine, and vice chair for Clinical Research in Psychiatry at the University of California, San Diego.

For more than 70 years, standard care for those addicted to alcohol or drugs has called for the afflicted person to abstain from the substance completely, and to become immersed in a community of fellow sufferers for support. This is particularly true in the early months, when the "phenomenon of craving" remains acute.