The first of four Clinical Year in Review sessions was held on Sunday, May 15, and featured reviews of some of the most important and impactful papers published over the past year in pulmonary vascular disease, interstitial lung disease, lung cancer, and pneumonia and pulmonary infections.
Belinda Natalia Rivera-Lebron, MD, MS, of the University of Pittsburgh, opened the session with a review of three pulmonary vascular disease studies, including results from the Efficacy and Safety of Initial Triple Versus Initial Dual Oral Combination Therapy in Patients with Newly Diagnosed Pulmonary Arterial Hypertension, or TRITON.
“Randomized controlled trials have demonstrated that dual combination therapy in incident or treatment-naive patients with PAH alleviates symptoms and improves exercise tolerance and clinical outcomes such as disease progression, hospitalization, or death,” Dr. Rivera-Lebron said. “Therefore, major guidelines support the use of dual combination therapy up front in most patients who are newly diagnosed.”
In TRITON, 247 newly diagnosed treatment-naïve PAH patients were randomized to receive the triple combination of macitentan, tadalafil, and selexipag, or dual combination macitentan/tadalafil plus placebo.
Among the findings, Dr. Rivera-Lebron said that, despite no improvement in pulmonary vascular resistance, six-minute walk distance, or NT-proBNP, patients in the triple therapy cohort demonstrated decreased risk for disease progression and first clinical events.
“Limitations of the trial included a short duration of just 26 weeks, highlighting the need for additional studies on up-front triple therapy,” she said. “Triple therapy is not ready for prime time, so the recommendation remains that most newly diagnosed patients should receive dual combination therapy with close follow-up for possible sequential addition of a third drug.”
Rupal J. Shah, MD, MSCE, of the University of California, San Francisco, followed with a review of recent literature on interstitial lung disease, including a study that looked at the potential role of endobronchial optical coherence tomography for the microscopic diagnosis of usual interstitial pneumonia.
“The diagnosis of ILD is challenging. Current guidelines recommend multidisciplinary review, but when the CT is not diagnostic, we’re often left with either referring patients for surgical biopsy, or most recent guidelines offer transbronchial lung cryobiopsy,” Dr. Shah said. “Unfortunately, many of our patients come to us with disease that’s too advanced or they have significant comorbidities for which these diagnostic options are too risky. Therefore, they are left with a diagnosis of unclassified ILD, making clinical management more challenging.”
The investigators in this study reported that EB-OCT is safe, Dr. Shah reported, and that it is feasible to teach bronchoscopic technique and interpretation with high reproducibility in a single center.
“Additionally, EB-OCT had high sensitivity and specificity for detection of UIP pattern, particularly in mild-to-moderate disease,” she said.
While further studies are needed, Dr. Shah believes EB-OCT has the potential to change the diagnostic algorithm for ILD, including potential use to assess changes in disease over time.
In the next presentation, Neal Navani, MD, MSc, PhD, of University College London, reviewed some of the most important papers in lung cancer screening and treatment over the past year.
“One of the biggest changes to lung cancer care in the last year is the new U.S. Preventive Services Task Force recommendation for lung cancer screening in the United States,” Dr. Navani said. “The new recommendation suggests that lung cancer screening should be offered to adults aged 50 to 80 who have a 20 pack-year history of smoking, and they should either be current smokers or have quit within the past 15 years.”
This updated recommendation, he said, could potentially double the number of people eligible for lung cancer screening.
“Importantly, it will make more African American and female smokers eligible for lung cancer screening in the U.S.,” Dr. Navani said. “We have to recognize, however, that despite this change in guideline, there are still significant implementation barriers that remain.”
In the final presentation of the session, Francesco Amati, MD, of the University of Milan, reviewed recent literature on pneumonia and pulmonary infections, including a recently published study looking at whether a three-day antibiotic treatment regimen is adequate for patients with community-acquired pneumonia in non-critical care settings.
“Antibiotic therapy can be safely discontinued in patients who have moderate CAP with early clinical response to therapy, and a three-day treatment seems to be relevant for approximately 60 percent of immunocompetent patients with moderate CAP,” Dr. Amati said.
Chronic obstructive pulmonary disease and asthma will be the focus of the second part of the Clinical Year in Review on Monday, May 16, from 9:30–11 a.m. PT in Hall E (North Building, Exhibition Level), Moscone Center.
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