Cancer

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Which One is the Loneliest Number (9.27.2024)

Jack Cush, MD

Dr. Jack Cush reviews the regulatory approvals, announcements, guidelines and interesting journal articles from the past week on RheumNow.com. When not to use muscle relaxants, how frequent is loneliness in RA/PsA/SpA, and when to refer patients with Still's disease.

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Stratified Cancer Screening in Dermatomyositis

Jack Cush, MD

The International Myositis Assessment and Clinical Studies Group (IMACS) have published  evidence and consensus based cancer screening guidelines for patients with idiopathic inflammatory myopathies, including dermatomyositis. 

They proposed 18 final recommendations - 13 were

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Cancer presenting as Inflammatory low back pain? 34 Cases presenting as SpA over 10 yrs often w/ higher ESR/CRP/LDH levels. CA included myeloma, leukemia, lymphoma, CA of breast/lung/prostate & bone tumors. https://t.co/YYKYx39tbD https://t.co/m9uCbJBsnU

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Dr. John Cush @RheumNow( View Tweet )
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Systemic Sclerosis Insights (9.13.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles from this past week on RheumNow.com.

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CA-125 & PET/CT screening in 1432 myositis. 125 pts had CA-125 w/in 5yrs of onset - 3.1% false-positives (fibroids, endometriosis) & 14.3% false-negatives. 139 had PET done- 5.5% false-positives (LN, lung nodules), 28.6% false-negatives (missed melanoma, breast or prostate CA)… https://t.co/16KSDmp9Kz https://t.co/6QFl4jhDxp
Dr. John Cush @RheumNow( View Tweet )
Claims analysis of two datasets showed TNFi treatment in 1st two years after newly Dx breast cancer (n 2216) had no effect on overall survival (OS); but had signif better breast cancer survival (HR 0.28; 0.08–0.98) vs csDMARD Rx. Pts on GC worse OS (HR 2.18)… https://t.co/Kxk7Sy7ahi https://t.co/PtxRsTifi1
Dr. John Cush @RheumNow( View Tweet )
Points to Consider when Managing Inflammatory Arthritis with Cancer https://t.co/qLMPwDNMiy https://t.co/sL87mp0gd4

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Dr. John Cush @RheumNow( View Tweet )
Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease A matched cohort study from the Veterans Health Administration shows that RA patients have a >50% increased risk of lung cancer, a 3-fold higher risk of lung cancer in RA-ILD. https://t.co/J9FCdkId8H https://t.co/uJylDP3IIp

Links:

Dr. John Cush @RheumNow( View Tweet )
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Higher Cancer Rates (8.16.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal reports from the past week on RheumNow.com, noting his concerns about diet, cancer, ILD, death and dosing challenges.

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Lung Cancer in Rheumatoid Arthritis and Interstitial Lung Disease

Jack Cush, MD

A matched cohort study from the Veterans Health Administration shows that rheumatoid arthritis patients have a >50% increased risk of lung cancer, and a 3-fold higher risk of lung cancer in RA-interstitial lung disease (ILD).

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Breast CA (BC) & TNFi - study of 2 cohorts (Optum commercial * SEER/Medicare) found that 17% & 16% of BC pts received TNFi. 1 yr overall survival was no different +/- TNFi (HR= 0.77 & 0.84); but BC survival better on TNFi (HR 0.28; 0.08–0.98) vs csDMARDs. https://t.co/cGqT80rGTR https://t.co/n7i5VNFkVT

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Dr. John Cush @RheumNow( View Tweet )
2024 EULAR Points to consider when treating patients with cancer https://t.co/oXO8m8mrfJ https://t.co/v69zPteDr0

Links:

Dr. John Cush @RheumNow( View Tweet )
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Best Rheumatologists (7.19.2024)

Jack Cush, MD

This week on the RheumNow Podcast, Dr. Jack Cush reviews the news and journal reports of interesting, including irAE, pollution and Psoriasis, microwave therapy, scleroderma without scleroderma that only the best rheumatologists could discern.

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JAK inhibitors have been used as adjunctive therapy to reduce flammation arising with checkpoint inhibitor use in cancer (Hodgkins, Lung CA), using itacitinib w/ pembrolizumab or ruxolitinib & nivolumab improved trial outcomes https://t.co/eF6wO72D80 https://t.co/IFDYuI71X5

Links:

Dr. John Cush @RheumNow( View Tweet )
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Future Big BiTEs (6.28.2024)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and regulatory announcements from the past week on RheumNow.com.

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Lit. cohort analysis of >330K #AS shows higher risk of cancer (RR=1.16: 1.07–1.26); w/ higher risk in Asia, but not Europe. Increased CA risk for : bone (RR 3.41), thyroid(1.76), myeloma (1.74), leukemia (1.52), kidney (1.45), prostate (1.43), NHL (1.42) https://t.co/disRefur0l https://t.co/ffjED0Ftvc

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Dr. John Cush @RheumNow( View Tweet )
EULAR24,Roundup

EULAR 2024 Rheumatology Roundup (6.21.2024)

Jack Cush, MD

Drs. Artie Kavanaugh and Jack Cush discuss highlights from the EULAR 2024 meeting in Vienna

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EULAR 2024 – Day 4 Report

Jack Cush, MD

The final day of EULAR 2024 was rich in posters, Late-breaking oral presentations and EULAR updates and recommendations.  Below is a synopsis of the half-day's action.

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EULAR 2024 – Day 3 Report

Jack Cush, MD

EULAR treats its attendees to a wonderful lunch each day – Schnitzel, gnocchi, goulash at lunch after muffins and coffee in the morning. It's no wonder the meeting has been a lively one, well attended with a wealth of stimulating ideas, research and discussion. Here are a few of my favorite

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important session worth reading the full recommendations - TNF tick of approval @RheumNow #EULAR2024 https://t.co/ORDocVie11

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Peter Nash @drpnash( View Tweet )
Swedish/Danish cohort study in PsA 17000+ bionaïve 8000+ TNFi & 2000+ other MoA Overall non melanoma skin cancer rate 651 (505 BCC & 87 SCC) TNFi treated pts: HR 1.25 NMSC vs. bionaive (95CI 1.04 to 1.50) HR 1.19 NMSC vs. other MoA (ns) #EULAR2024 @RheumNow AbstOP0150 https://t.co/DVj8l7yFR6

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Aurelie Najm @AurelieRheumo( View Tweet )
Top 3 messages Re #JAKi #safety Shared decision w benefit/risk info Some #CV risks are more Impt than others- stratify your pt into risk categories #Smoking is a big risk for #MACE & #malignancy-So work on facilitating Smoking #cessation #EULAR2024 @eular_org @RheumNow

Janet Pope @Janetbirdope( View Tweet )

Medicare & Optum claims data study of 2851 #RA pts w/ breast cancer (BC). In 3 mos before BC 27028% received bDMARDs. W/in 1st 3 yrs post-BC Dx 24-26% were receiving bDMARDs. 70% of RA pts on steroids without change w/ time https://t.co/51NcXv0xyc https://t.co/461NZiFvDO

Links:

Dr. John Cush @RheumNow( View Tweet )
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Is Cannabis Safe? (6.7.2024)

Jack Cush, MD

Dr. Jack Cush reviews FDA approval, news and journal articles -- and it’s the week before EULAR 2024 in Vienna!!

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Chinese study of 552 pts w/ ANCA Assoc. Vasculitis - 23 had cancer prior to AAV Dx; 43 after Dx (w/in 4.3yrs)= SIR: 2.24. CA mostly lung CA (SIR: 5), followed by kidney, bladder, ureter, prostate. Higher risk if male (HR:2.8) and older (per year, HR:1.04) https://t.co/xhH3uU3GCj

Links:

Dr. John Cush @RheumNow( View Tweet )

Recent Blogs

Hard Conversations: DMARDs and Malignancy

Michael Putman, MD, MSCI
Risk Option Decision
Cancer is the most difficult DMARD risk to discuss with patients. Few warnings could scare people away from a drug faster than the words “may increase risk of cancer,” yet the risks (even when substantiated) have all been low and may be counterbalanced by the benefits of disease control. Read Post

A Brief History of Rheumatoid Arthritis Mimics

Robert Schoen, MD, MBA
books history
Imagine that 100 years from now, your great granddaughter, an eminent rheumatologist, reviews the history of rheumatoid arthritis mimics. Read Post

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