Cleveland Clinic journal of medicine
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Surveillance of left ventricular function, part of current US Food and Drug Administration recommendations for anti-human epidermal growth factor receptor 2 (anti-HER2) chemotherapy, is based on historical data involving patients who received concomitant anthracycline therapy, a key enhancer of cardiac risk. More recent anti-HER2 treatment data suggest that cardiotoxicity detected by screening is rare and usually benign for patients who do not have cardiovascular risk factors and are not taking an anthracycline. Because of the burden of repetitive echocardiography required for surveillance and the risk of false-positive results, potentially leading to discontinuing lifesaving treatment, we advocate for a more focused cardiac surveillance strategy.
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Peanut and tree-nut allergies have increased dramatically in prevalence, especially in children. Historically, children with food allergies have been treated through strict avoidance of the allergen. Recently, an oral preparation of peanut allergen (Palforzia) was approved for immunotherapy (ie, desensitization) in children 4 to 17 years old. This article reviews oral immunotherapy and its role in children with peanut allergies.
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Recent developments in precision oncology have increased the complexity of diagnostic and therapeutic decisions. Here, we broadly review the field of precision oncology and discuss common mutational drivers in non-small cell lung cancer (NSCLC) that directly relate to the diagnosis, evaluation, and treatment of patients with metastatic disease.
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The 2019 guideline from the Anticoagulation Forum provides clear instructions on how to use 2 agents for reversing the effects of direct oral anticoagulants (DOACs): idarucizumab for dabigatran-associated bleeding and andexanet alfa for bleeding associated with rivaroxaban and apixaban. The guideline also discusses off-label use of andexanet alfa for bleeding associated with edoxaban and betrixaban and the use of hemostatic agents such as activated prothrombin complex concentrate and 4-factor prothrombin complex concentrate. Lastly, it offers approaches for building and managing stewardship programs at the health system level.