Recap

Small-cell lung cancer (SCLC) occurs almost exclusively in cigarette smokers. Veterans are particularly vulnerable to SCLC because of their prevalent smoking history and exposures to carcinogens, including Agent Orange. 

SCLC is characterized by the early development of widespread metastases, including liver, bone, and brain. 

Unlike, non–-small cell lung cancer, which has seen great improvement in survival from the introduction of immunotherapy and targeted agents, there has been relatively little improvement in SCLC. 

Patients generally are classified into limited- and extensive-stage disease, but platinum-based chemotherapy is almost always the standard first-line treatment. Unfortunately, most patients relapse within a year. 

In this ReCAP, Dr Shadia Jalal, of Indiana University Melvin and Bren Simon Comprehensive Cancer Center, discusses second-line treatment options for SCLC patients who relapse after chemotherapy. She also discusses four subtypes of SCLC categorized on the basis of specific transcription regulators, which may offer the potential of targeted therapies for this patient population.  

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Shadia Jalal, MD, Associate Professor of Medicine, Physician, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana 

Shadia Jalal, MD, has disclosed no relevant financial relationships. 

Small-cell lung cancer (SCLC) occurs almost exclusively in cigarette smokers. Veterans are particularly vulnerable to SCLC because of their prevalent smoking history and exposures to carcinogens, including Agent Orange. 

SCLC is characterized by the early development of widespread metastases, including liver, bone, and brain. 

Unlike, non–-small cell lung cancer, which has seen great improvement in survival from the introduction of immunotherapy and targeted agents, there has been relatively little improvement in SCLC. 

Patients generally are classified into limited- and extensive-stage disease, but platinum-based chemotherapy is almost always the standard first-line treatment. Unfortunately, most patients relapse within a year. 

In this ReCAP, Dr Shadia Jalal, of Indiana University Melvin and Bren Simon Comprehensive Cancer Center, discusses second-line treatment options for SCLC patients who relapse after chemotherapy. She also discusses four subtypes of SCLC categorized on the basis of specific transcription regulators, which may offer the potential of targeted therapies for this patient population.  

--

Shadia Jalal, MD, Associate Professor of Medicine, Physician, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana 

Shadia Jalal, MD, has disclosed no relevant financial relationships. 

Small-cell lung cancer (SCLC) occurs almost exclusively in cigarette smokers. Veterans are particularly vulnerable to SCLC because of their prevalent smoking history and exposures to carcinogens, including Agent Orange. 

SCLC is characterized by the early development of widespread metastases, including liver, bone, and brain. 

Unlike, non–-small cell lung cancer, which has seen great improvement in survival from the introduction of immunotherapy and targeted agents, there has been relatively little improvement in SCLC. 

Patients generally are classified into limited- and extensive-stage disease, but platinum-based chemotherapy is almost always the standard first-line treatment. Unfortunately, most patients relapse within a year. 

In this ReCAP, Dr Shadia Jalal, of Indiana University Melvin and Bren Simon Comprehensive Cancer Center, discusses second-line treatment options for SCLC patients who relapse after chemotherapy. She also discusses four subtypes of SCLC categorized on the basis of specific transcription regulators, which may offer the potential of targeted therapies for this patient population.  

--

Shadia Jalal, MD, Associate Professor of Medicine, Physician, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana 

Shadia Jalal, MD, has disclosed no relevant financial relationships. 

Upadacitinib in the management of Crohn's disease and novel data challenging standard clinical practice are some of the inflammatory bowel disease (IBD) highlights from Digestive Disease Week (DDW) 2023, as reported by Dr Joseph Feuerstein, from Harvard Medical School, Boston, Massachusetts.

Dr Feuerstein begins by discussing two studies of upadacitinib induction and maintenance in Crohn's disease. Both studies showed that the drug achieved higher fistula closure and remission rates than did placebo, regardless of prior biologic therapy exposure.

The third study chosen by Dr Feuerstein asks whether early resection of ileocecal Crohn's disease might achieve better outcomes than would standard anti–tumor necrosis factor therapy. The study results suggested that early resection could postpone the need for medication for longer than previously thought.

More potentially practice-changing data comes from the SuPREMe-CD study, which showed that using Kono-S anastomosis reduced endoscopic recurrence of Crohn's disease compared with traditional side-to-side anastomosis.

Dr Feuerstein next discusses an analysis of the SAPPHIRE Registry, which found that IBD treatments were not linked to cancer risk. In closing, he reports on a study that showed longer withdrawal time during colonoscopy, meaning longer time spent examining the colon, is associated with improved detection of polypoid dysplasia.

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Joseph D. Feuerstein, MD, Associate Professor of Medicine, Department of Gastroenterology, Harvard Medical School; Attending in Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Joseph D. Feuerstein, MD, has disclosed no relevant financial relationships.

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Upadacitinib in the management of Crohn's disease and novel data challenging standard clinical practice are some of the inflammatory bowel disease (IBD) highlights from Digestive Disease Week (DDW) 2023, as reported by Dr Joseph Feuerstein, from Harvard Medical School, Boston, Massachusetts.

Dr Feuerstein begins by discussing two studies of upadacitinib induction and maintenance in Crohn's disease. Both studies showed that the drug achieved higher fistula closure and remission rates than did placebo, regardless of prior biologic therapy exposure.

The third study chosen by Dr Feuerstein asks whether early resection of ileocecal Crohn's disease might achieve better outcomes than would standard anti–tumor necrosis factor therapy. The study results suggested that early resection could postpone the need for medication for longer than previously thought.

More potentially practice-changing data comes from the SuPREMe-CD study, which showed that using Kono-S anastomosis reduced endoscopic recurrence of Crohn's disease compared with traditional side-to-side anastomosis.

Dr Feuerstein next discusses an analysis of the SAPPHIRE Registry, which found that IBD treatments were not linked to cancer risk. In closing, he reports on a study that showed longer withdrawal time during colonoscopy, meaning longer time spent examining the colon, is associated with improved detection of polypoid dysplasia.

--

Joseph D. Feuerstein, MD, Associate Professor of Medicine, Department of Gastroenterology, Harvard Medical School; Attending in Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Joseph D. Feuerstein, MD, has disclosed no relevant financial relationships.

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Upadacitinib in the management of Crohn's disease and novel data challenging standard clinical practice are some of the inflammatory bowel disease (IBD) highlights from Digestive Disease Week (DDW) 2023, as reported by Dr Joseph Feuerstein, from Harvard Medical School, Boston, Massachusetts.

Dr Feuerstein begins by discussing two studies of upadacitinib induction and maintenance in Crohn's disease. Both studies showed that the drug achieved higher fistula closure and remission rates than did placebo, regardless of prior biologic therapy exposure.

The third study chosen by Dr Feuerstein asks whether early resection of ileocecal Crohn's disease might achieve better outcomes than would standard anti–tumor necrosis factor therapy. The study results suggested that early resection could postpone the need for medication for longer than previously thought.

More potentially practice-changing data comes from the SuPREMe-CD study, which showed that using Kono-S anastomosis reduced endoscopic recurrence of Crohn's disease compared with traditional side-to-side anastomosis.

Dr Feuerstein next discusses an analysis of the SAPPHIRE Registry, which found that IBD treatments were not linked to cancer risk. In closing, he reports on a study that showed longer withdrawal time during colonoscopy, meaning longer time spent examining the colon, is associated with improved detection of polypoid dysplasia.

--

Joseph D. Feuerstein, MD, Associate Professor of Medicine, Department of Gastroenterology, Harvard Medical School; Attending in Gastroenterology, Center for Inflammatory Bowel Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Joseph D. Feuerstein, MD, has disclosed no relevant financial relationships.

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Study results of microbiotic therapeutics for Clostridioides difficile infection (CDI) and a microbial dietary score that points to increased cancer risk are the microbiome advances from Digestive Disease Week 2023, as selected by Dr Purna Kashyap, from the Mayo Clinic in Rochester, Minnesota. 

Dr Kashyap starts with four studies examining microbiotic therapeutics for patients with CDI; the first two looked at RBX2660, which was recently approved by the US Food and Drug Administration (FDA). 

The first study showed that clonal engraftment of RBX2660 microbiota was associated with clinical response to the treatment, while the second indicated that the therapy is safe and effective in immunocompromised patients. 

Next, Dr Kashyap discusses a study of SER-109, also recently approved by the FDA. ESOSPOR IV revealed that the oral microbiome therapeutic achieved durable responses, even in patients with two or more CDI recurrences.  

After discussing a final CDI study that may provide a mechanism for the effectiveness of the live biotherapeutic VE303, he moves on to colon cancer. 

Dr Kashyap explains that a microbial dietary score was found to be associated not only with low-quality diets but also with an increased risk for colorectal cancer. 

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Purna C. Kashyap, MBBS, Professor of Medicine and Physiology; Consultant, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 

Purna C. Kashyap, MBBS, has disclosed no relevant financial relationships. 

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Study results of microbiotic therapeutics for Clostridioides difficile infection (CDI) and a microbial dietary score that points to increased cancer risk are the microbiome advances from Digestive Disease Week 2023, as selected by Dr Purna Kashyap, from the Mayo Clinic in Rochester, Minnesota. 

Dr Kashyap starts with four studies examining microbiotic therapeutics for patients with CDI; the first two looked at RBX2660, which was recently approved by the US Food and Drug Administration (FDA). 

The first study showed that clonal engraftment of RBX2660 microbiota was associated with clinical response to the treatment, while the second indicated that the therapy is safe and effective in immunocompromised patients. 

Next, Dr Kashyap discusses a study of SER-109, also recently approved by the FDA. ESOSPOR IV revealed that the oral microbiome therapeutic achieved durable responses, even in patients with two or more CDI recurrences.  

After discussing a final CDI study that may provide a mechanism for the effectiveness of the live biotherapeutic VE303, he moves on to colon cancer. 

Dr Kashyap explains that a microbial dietary score was found to be associated not only with low-quality diets but also with an increased risk for colorectal cancer. 

--

Purna C. Kashyap, MBBS, Professor of Medicine and Physiology; Consultant, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 

Purna C. Kashyap, MBBS, has disclosed no relevant financial relationships. 

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Study results of microbiotic therapeutics for Clostridioides difficile infection (CDI) and a microbial dietary score that points to increased cancer risk are the microbiome advances from Digestive Disease Week 2023, as selected by Dr Purna Kashyap, from the Mayo Clinic in Rochester, Minnesota. 

Dr Kashyap starts with four studies examining microbiotic therapeutics for patients with CDI; the first two looked at RBX2660, which was recently approved by the US Food and Drug Administration (FDA). 

The first study showed that clonal engraftment of RBX2660 microbiota was associated with clinical response to the treatment, while the second indicated that the therapy is safe and effective in immunocompromised patients. 

Next, Dr Kashyap discusses a study of SER-109, also recently approved by the FDA. ESOSPOR IV revealed that the oral microbiome therapeutic achieved durable responses, even in patients with two or more CDI recurrences.  

After discussing a final CDI study that may provide a mechanism for the effectiveness of the live biotherapeutic VE303, he moves on to colon cancer. 

Dr Kashyap explains that a microbial dietary score was found to be associated not only with low-quality diets but also with an increased risk for colorectal cancer. 

--

Purna C. Kashyap, MBBS, Professor of Medicine and Physiology; Consultant, Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 

Purna C. Kashyap, MBBS, has disclosed no relevant financial relationships. 

Digestive Disease Week® was sponsored by the American Gastroenterological Association, the American Association for the Study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

The treatment of type 2 diabetes (T2D) has traditionally followed a stepwise approach, beginning with metformin and continuing with the addition of other agents to achieve target glycemic control. 

In this ReCAP, Dr Chika Anekwe, of the Massachusetts General Hospital Weight Center in Boston, Massachusetts, discusses categories for antidiabetic therapies, when to combine medications that have differing mechanisms, and the clinical benefits of combination therapy, such as a stronger response in the reduction of hemoglobin A1c as well as loss of body weight. 

She also discusses tirzepatide, a dual therapy combining glucagon-like peptide-1 agonist and glucose-dependent insulinotropic polypeptide (GIP) agonist, which has shown clinically meaningful results for both blood sugar reduction and body weight reduction for patients with T2D. 

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Chika V. Anekwe, MD, MPH, Obesity Medicine Physician, Massachusetts General Hospital Weight Center, Boston, Massachusetts 

Chika V. Anekwe, MD, MPH, has disclosed no relevant financial relationships. 

The treatment of type 2 diabetes (T2D) has traditionally followed a stepwise approach, beginning with metformin and continuing with the addition of other agents to achieve target glycemic control. 

In this ReCAP, Dr Chika Anekwe, of the Massachusetts General Hospital Weight Center in Boston, Massachusetts, discusses categories for antidiabetic therapies, when to combine medications that have differing mechanisms, and the clinical benefits of combination therapy, such as a stronger response in the reduction of hemoglobin A1c as well as loss of body weight. 

She also discusses tirzepatide, a dual therapy combining glucagon-like peptide-1 agonist and glucose-dependent insulinotropic polypeptide (GIP) agonist, which has shown clinically meaningful results for both blood sugar reduction and body weight reduction for patients with T2D. 

--

Chika V. Anekwe, MD, MPH, Obesity Medicine Physician, Massachusetts General Hospital Weight Center, Boston, Massachusetts 

Chika V. Anekwe, MD, MPH, has disclosed no relevant financial relationships. 

The treatment of type 2 diabetes (T2D) has traditionally followed a stepwise approach, beginning with metformin and continuing with the addition of other agents to achieve target glycemic control. 

In this ReCAP, Dr Chika Anekwe, of the Massachusetts General Hospital Weight Center in Boston, Massachusetts, discusses categories for antidiabetic therapies, when to combine medications that have differing mechanisms, and the clinical benefits of combination therapy, such as a stronger response in the reduction of hemoglobin A1c as well as loss of body weight. 

She also discusses tirzepatide, a dual therapy combining glucagon-like peptide-1 agonist and glucose-dependent insulinotropic polypeptide (GIP) agonist, which has shown clinically meaningful results for both blood sugar reduction and body weight reduction for patients with T2D. 

--

Chika V. Anekwe, MD, MPH, Obesity Medicine Physician, Massachusetts General Hospital Weight Center, Boston, Massachusetts 

Chika V. Anekwe, MD, MPH, has disclosed no relevant financial relationships. 

Endocrine therapy (ET) has long been the therapeutic mainstay for first-line treatment of HR+/HER2- breast cancer. Yet, approximately one third of patients exhibit primary or acquired ET resistance, and some patients progress within 2 years after adjuvant ET. Resistance to endocrine therapy is a major challenge for a significant number of patients who go on to develop metastatic breast cancer.

Dr Jennifer Litton from The University of Texas MD Anderson Cancer Center in Houston, Texas, reports on current treatment recommendations and supporting research on the use of endocrine therapy and CDK4/6 inhibitors in both the metastatic and, more recently, the high-risk, early HR+/HER2- breast cancer settings.

Dr Litton also reviews key drivers of endocrine resistance, including somatic mutations such as ESR1. She emphasizes the need for next-generation testing in patients with metastatic HR+/HER2- disease to look for evidence of resistance, which may have implications for the next line of therapy.

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Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Jennifer K. Litton, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: The University of Texas MD Anderson Cancer Center

Serve(d) as a speaker or a member of a speakers bureau for: Clinical Care Options; Med Learning Group; Medpage; Medscape; PRIME; Physicians Education Resource; UpToDate

Endocrine therapy (ET) has long been the therapeutic mainstay for first-line treatment of HR+/HER2- breast cancer. Yet, approximately one third of patients exhibit primary or acquired ET resistance, and some patients progress within 2 years after adjuvant ET. Resistance to endocrine therapy is a major challenge for a significant number of patients who go on to develop metastatic breast cancer.

Dr Jennifer Litton from The University of Texas MD Anderson Cancer Center in Houston, Texas, reports on current treatment recommendations and supporting research on the use of endocrine therapy and CDK4/6 inhibitors in both the metastatic and, more recently, the high-risk, early HR+/HER2- breast cancer settings.

Dr Litton also reviews key drivers of endocrine resistance, including somatic mutations such as ESR1. She emphasizes the need for next-generation testing in patients with metastatic HR+/HER2- disease to look for evidence of resistance, which may have implications for the next line of therapy.

--

Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Jennifer K. Litton, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: The University of Texas MD Anderson Cancer Center

Serve(d) as a speaker or a member of a speakers bureau for: Clinical Care Options; Med Learning Group; Medpage; Medscape; PRIME; Physicians Education Resource; UpToDate

Endocrine therapy (ET) has long been the therapeutic mainstay for first-line treatment of HR+/HER2- breast cancer. Yet, approximately one third of patients exhibit primary or acquired ET resistance, and some patients progress within 2 years after adjuvant ET. Resistance to endocrine therapy is a major challenge for a significant number of patients who go on to develop metastatic breast cancer.

Dr Jennifer Litton from The University of Texas MD Anderson Cancer Center in Houston, Texas, reports on current treatment recommendations and supporting research on the use of endocrine therapy and CDK4/6 inhibitors in both the metastatic and, more recently, the high-risk, early HR+/HER2- breast cancer settings.

Dr Litton also reviews key drivers of endocrine resistance, including somatic mutations such as ESR1. She emphasizes the need for next-generation testing in patients with metastatic HR+/HER2- disease to look for evidence of resistance, which may have implications for the next line of therapy.

--

Professor, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas

Jennifer K. Litton, MD, has disclosed the following relevant financial relationships:

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: The University of Texas MD Anderson Cancer Center

Serve(d) as a speaker or a member of a speakers bureau for: Clinical Care Options; Med Learning Group; Medpage; Medscape; PRIME; Physicians Education Resource; UpToDate

People with type 2 diabetes are more likely than the general population to have a comorbid mental health disorder such as anxiety, depression, or eating disorders. Yet, only about one third receive treatment for these conditions.  

Untreated mental health disorders undermine quality of life and put this population at increased risk for poor self-care behaviors and suboptimal glycemic control.  

In this ReCAP, Mark Heyman, PhD, founder and director of the Center for Diabetes & Mental Health in San Diego, explains how diabetes burnout and distress undermine physical health for patients with type 2 diabetes. He emphasizes the importance of psychological support, and outlines screening tools to assess mental health in these patients. 

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Mark Heyman, PhD, Psychologist, Center for Diabetes & Mental Health, San Diego, California 

Mark Heyman, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Dexcom 

Received income in an amount equal to or greater than $250 from: Vertex; MannKind; Insulet 

People with type 2 diabetes are more likely than the general population to have a comorbid mental health disorder such as anxiety, depression, or eating disorders. Yet, only about one third receive treatment for these conditions.  

Untreated mental health disorders undermine quality of life and put this population at increased risk for poor self-care behaviors and suboptimal glycemic control.  

In this ReCAP, Mark Heyman, PhD, founder and director of the Center for Diabetes & Mental Health in San Diego, explains how diabetes burnout and distress undermine physical health for patients with type 2 diabetes. He emphasizes the importance of psychological support, and outlines screening tools to assess mental health in these patients. 

--

Mark Heyman, PhD, Psychologist, Center for Diabetes & Mental Health, San Diego, California 

Mark Heyman, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Dexcom 

Received income in an amount equal to or greater than $250 from: Vertex; MannKind; Insulet 

People with type 2 diabetes are more likely than the general population to have a comorbid mental health disorder such as anxiety, depression, or eating disorders. Yet, only about one third receive treatment for these conditions.  

Untreated mental health disorders undermine quality of life and put this population at increased risk for poor self-care behaviors and suboptimal glycemic control.  

In this ReCAP, Mark Heyman, PhD, founder and director of the Center for Diabetes & Mental Health in San Diego, explains how diabetes burnout and distress undermine physical health for patients with type 2 diabetes. He emphasizes the importance of psychological support, and outlines screening tools to assess mental health in these patients. 

--

Mark Heyman, PhD, Psychologist, Center for Diabetes & Mental Health, San Diego, California 

Mark Heyman, PhD, has disclosed the following relevant financial relationships: 

Serve(d) as a speaker or a member of a speakers bureau for: Dexcom 

Received income in an amount equal to or greater than $250 from: Vertex; MannKind; Insulet 

Type 2 diabetes (T2D) is associated with obesity and is increasing at an alarming rate in youth. Pediatric T2D disease progresses more rapidly than adult T2D and is harder to treat. 

Dr Maria Redondo, a pediatric endocrinologist at Baylor College of Medicine in Houston, Texas, explains that insulin resistance is the major trigger of T2D, and beta-cell dysfunction is key to its development. In children, beta-cell dysfunction occurs more rapidly compared with adults. Children also have higher rates of complications and associated conditions, such as renal disease, cardiovascular disease, and nonalcoholic fatty liver disease. 

Dr Redondo references evidence from the TODAY study, which indicates that treatment failure with first-line metformin is common in the pediatric population and affords minimal weight loss.  

She then discusses GLP-1 receptor agonists as second-line therapy for children aged 10 years or older. There are currently two FDA-approved options: once-daily liraglutide and once-weekly exenatide. Both are given subcutaneously. 

Finally, Dr Redondo highlights DPP-4 inhibitors, such as linagliptin, saxagliptin, and sitagliptin, as well as SGLT-2 inhibitors, such as dapagliflozin and canagliflozin, as emerging therapies currently in clinical trials.  

--

Maria J. Redondo, MD, PhD, MPH, Professor, Department of Pediatrics, Baylor College of Medicine; Staff Physician, Texas Children's Hospital, Houston, Texas 

Maria J. Redondo, MD, PhD, MPH, has disclosed the following relevant financial relationships: 

Received research grant from: NIH; NIDDK 

Type 2 diabetes (T2D) is associated with obesity and is increasing at an alarming rate in youth. Pediatric T2D disease progresses more rapidly than adult T2D and is harder to treat. 

Dr Maria Redondo, a pediatric endocrinologist at Baylor College of Medicine in Houston, Texas, explains that insulin resistance is the major trigger of T2D, and beta-cell dysfunction is key to its development. In children, beta-cell dysfunction occurs more rapidly compared with adults. Children also have higher rates of complications and associated conditions, such as renal disease, cardiovascular disease, and nonalcoholic fatty liver disease. 

Dr Redondo references evidence from the TODAY study, which indicates that treatment failure with first-line metformin is common in the pediatric population and affords minimal weight loss.  

She then discusses GLP-1 receptor agonists as second-line therapy for children aged 10 years or older. There are currently two FDA-approved options: once-daily liraglutide and once-weekly exenatide. Both are given subcutaneously. 

Finally, Dr Redondo highlights DPP-4 inhibitors, such as linagliptin, saxagliptin, and sitagliptin, as well as SGLT-2 inhibitors, such as dapagliflozin and canagliflozin, as emerging therapies currently in clinical trials.  

--

Maria J. Redondo, MD, PhD, MPH, Professor, Department of Pediatrics, Baylor College of Medicine; Staff Physician, Texas Children's Hospital, Houston, Texas 

Maria J. Redondo, MD, PhD, MPH, has disclosed the following relevant financial relationships: 

Received research grant from: NIH; NIDDK 

Type 2 diabetes (T2D) is associated with obesity and is increasing at an alarming rate in youth. Pediatric T2D disease progresses more rapidly than adult T2D and is harder to treat. 

Dr Maria Redondo, a pediatric endocrinologist at Baylor College of Medicine in Houston, Texas, explains that insulin resistance is the major trigger of T2D, and beta-cell dysfunction is key to its development. In children, beta-cell dysfunction occurs more rapidly compared with adults. Children also have higher rates of complications and associated conditions, such as renal disease, cardiovascular disease, and nonalcoholic fatty liver disease. 

Dr Redondo references evidence from the TODAY study, which indicates that treatment failure with first-line metformin is common in the pediatric population and affords minimal weight loss.  

She then discusses GLP-1 receptor agonists as second-line therapy for children aged 10 years or older. There are currently two FDA-approved options: once-daily liraglutide and once-weekly exenatide. Both are given subcutaneously. 

Finally, Dr Redondo highlights DPP-4 inhibitors, such as linagliptin, saxagliptin, and sitagliptin, as well as SGLT-2 inhibitors, such as dapagliflozin and canagliflozin, as emerging therapies currently in clinical trials.  

--

Maria J. Redondo, MD, PhD, MPH, Professor, Department of Pediatrics, Baylor College of Medicine; Staff Physician, Texas Children's Hospital, Houston, Texas 

Maria J. Redondo, MD, PhD, MPH, has disclosed the following relevant financial relationships: 

Received research grant from: NIH; NIDDK 

As Parkinson's disease progresses, dopamine and dopamine agonists that control tremor and stiffness can wear off too early or cause dyskinesia when they peak in the bloodstream.  

In this ReCAP, Dr Michael Okun, professor and chair of neurology at the University of Florida, explains that adjustments to dose, timing, or delivery mode of these medications can smooth out some fluctuations. He reports that catechol-O-methyltransferase inhibitors, such as opicapone, tolcapone, and entacapone, can extend the effect of dopamine and the addition of amantadine or istradefylline can suppress dyskinesia. 

He points out that for other patients, surgical options, such as deep brain stimulation or focused ultrasound, can alter how the brain controls disordered movement or implanted pumps can better regulate the delivery of medication either subcutaneously or directly into the gut. 

--

Michael S. Okun, MD, Chair of Neurology, College of Medicine; Director Norman Fixel Institute, University of Florida, Gainesville, Florida 

Michael S. Okun, MD, has disclosed no relevant financial relationships

As Parkinson's disease progresses, dopamine and dopamine agonists that control tremor and stiffness can wear off too early or cause dyskinesia when they peak in the bloodstream.  

In this ReCAP, Dr Michael Okun, professor and chair of neurology at the University of Florida, explains that adjustments to dose, timing, or delivery mode of these medications can smooth out some fluctuations. He reports that catechol-O-methyltransferase inhibitors, such as opicapone, tolcapone, and entacapone, can extend the effect of dopamine and the addition of amantadine or istradefylline can suppress dyskinesia. 

He points out that for other patients, surgical options, such as deep brain stimulation or focused ultrasound, can alter how the brain controls disordered movement or implanted pumps can better regulate the delivery of medication either subcutaneously or directly into the gut. 

--

Michael S. Okun, MD, Chair of Neurology, College of Medicine; Director Norman Fixel Institute, University of Florida, Gainesville, Florida 

Michael S. Okun, MD, has disclosed no relevant financial relationships

As Parkinson's disease progresses, dopamine and dopamine agonists that control tremor and stiffness can wear off too early or cause dyskinesia when they peak in the bloodstream.  

In this ReCAP, Dr Michael Okun, professor and chair of neurology at the University of Florida, explains that adjustments to dose, timing, or delivery mode of these medications can smooth out some fluctuations. He reports that catechol-O-methyltransferase inhibitors, such as opicapone, tolcapone, and entacapone, can extend the effect of dopamine and the addition of amantadine or istradefylline can suppress dyskinesia. 

He points out that for other patients, surgical options, such as deep brain stimulation or focused ultrasound, can alter how the brain controls disordered movement or implanted pumps can better regulate the delivery of medication either subcutaneously or directly into the gut. 

--

Michael S. Okun, MD, Chair of Neurology, College of Medicine; Director Norman Fixel Institute, University of Florida, Gainesville, Florida 

Michael S. Okun, MD, has disclosed no relevant financial relationships

Bipolar disorder  is a multifaceted condition associated with an increased risk for hospitalization and suicide as well as high costs to society and family. 

In this ReCAP, Dr Martha Sajatovic, of the University Hospitals of Cleveland, discusses evidence of the short- and long-term consequences of bipolar disorder, including progressive neurologic impact such as changes in brain structure.  

She discusses two FDA-approved long-acting injectables  for bipolar disorder and considerations for their use, including their potential for first-line maintenance treatment and benefits for medication adherence.  

Finally, she considers challenges in the clinical use of the long-acting injectables, including insufficient caregiver involvement and lack of awareness of the drugs' availability. 

--

Martha Sajatovic, MD, Director, Neurological and Behavioral Outcomes Center, University Hospitals of Cleveland, Cleveland, Ohio 

Martha Sajatovic, MD, has disclosed the following relevant financial relationships: 

Received research grant from: Otsuka; International Society for Bipolar Disorders; National Institutes of Health 

Received income in an amount equal to or greater than $250 from: Otsuka; Janssen; Lundbeck; Teva; Neurelis 

Received royalties from: Springer Press; Johns Hopkins University Press 

Bipolar disorder  is a multifaceted condition associated with an increased risk for hospitalization and suicide as well as high costs to society and family. 

In this ReCAP, Dr Martha Sajatovic, of the University Hospitals of Cleveland, discusses evidence of the short- and long-term consequences of bipolar disorder, including progressive neurologic impact such as changes in brain structure.  

She discusses two FDA-approved long-acting injectables  for bipolar disorder and considerations for their use, including their potential for first-line maintenance treatment and benefits for medication adherence.  

Finally, she considers challenges in the clinical use of the long-acting injectables, including insufficient caregiver involvement and lack of awareness of the drugs' availability. 

--

Martha Sajatovic, MD, Director, Neurological and Behavioral Outcomes Center, University Hospitals of Cleveland, Cleveland, Ohio 

Martha Sajatovic, MD, has disclosed the following relevant financial relationships: 

Received research grant from: Otsuka; International Society for Bipolar Disorders; National Institutes of Health 

Received income in an amount equal to or greater than $250 from: Otsuka; Janssen; Lundbeck; Teva; Neurelis 

Received royalties from: Springer Press; Johns Hopkins University Press 

Bipolar disorder  is a multifaceted condition associated with an increased risk for hospitalization and suicide as well as high costs to society and family. 

In this ReCAP, Dr Martha Sajatovic, of the University Hospitals of Cleveland, discusses evidence of the short- and long-term consequences of bipolar disorder, including progressive neurologic impact such as changes in brain structure.  

She discusses two FDA-approved long-acting injectables  for bipolar disorder and considerations for their use, including their potential for first-line maintenance treatment and benefits for medication adherence.  

Finally, she considers challenges in the clinical use of the long-acting injectables, including insufficient caregiver involvement and lack of awareness of the drugs' availability. 

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Martha Sajatovic, MD, Director, Neurological and Behavioral Outcomes Center, University Hospitals of Cleveland, Cleveland, Ohio 

Martha Sajatovic, MD, has disclosed the following relevant financial relationships: 

Received research grant from: Otsuka; International Society for Bipolar Disorders; National Institutes of Health 

Received income in an amount equal to or greater than $250 from: Otsuka; Janssen; Lundbeck; Teva; Neurelis 

Received royalties from: Springer Press; Johns Hopkins University Press 

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have become integral to the treatment of HR+/HER2- breast cancer. Approved in 2015 for use in the metastatic setting and most recently in the adjuvant setting, CDK4/6 inhibitors have revolutionized treatment in both endocrine-sensitive and endocrine-resistant settings and in pre- and postmenopausal women. 

But many questions remain regarding the optimal use of these medications in clinical practice. 

In this ReCAP, Dr Virginia Kaklamani from the University of Texas Health Sciences Center in San Antonio, Texas, and Dr Harold Burstein from Dana-Farber Cancer Institute, Boston, Massachusetts, begin their discussion by examining the potential role of adjuvant CDK4/6 inhibitor therapy in early, high-risk breast cancer.  

They discuss the three main studies that looked at the role of adjuvant CDK4/6 inhibitors, including the PALLAS and PENELOPE-B trials, in which palbociclib showed no benefit in invasive disease-free survival. In contrast, in the monarchE trial, abemaciclib showed a robust benefit in preventing recurrence, which was sustained after longer follow-up, as reported at the San Antonio Breast Cancer Symposium 2022. 

Turning to the metastatic setting, the panelists discuss the varied side effect profiles of the three approved CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. They also discuss current research into the continuation of these agents beyond progression and whether sequencing of CDK4/6 inhibitors may provide benefit. 

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Virginia Kaklamani, MD, Professor of Medicine, Division of Hematology/Oncology, University of Texas Health Sciences Center; Leader, Breast Oncology Program, University of Texas Health MD Anderson Cancer Center, San Antonio, Texas 

Virginia Kaklamani, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Gilead; Menarini; Pfizer; Novartis; Lilly; AstraZeneca; Genentech; Daichii; Seagen 

Harold J. Burstein, MD, PhD, Professor, Department of Medicine, Harvard Medical School; Medical Oncologist, Dana-Farber Cancer Institute, Boston, Massachusetts 

Harold J. Burstein, MD, PhD, has disclosed no relevant financial relationships. 

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have become integral to the treatment of HR+/HER2- breast cancer. Approved in 2015 for use in the metastatic setting and most recently in the adjuvant setting, CDK4/6 inhibitors have revolutionized treatment in both endocrine-sensitive and endocrine-resistant settings and in pre- and postmenopausal women. 

But many questions remain regarding the optimal use of these medications in clinical practice. 

In this ReCAP, Dr Virginia Kaklamani from the University of Texas Health Sciences Center in San Antonio, Texas, and Dr Harold Burstein from Dana-Farber Cancer Institute, Boston, Massachusetts, begin their discussion by examining the potential role of adjuvant CDK4/6 inhibitor therapy in early, high-risk breast cancer.  

They discuss the three main studies that looked at the role of adjuvant CDK4/6 inhibitors, including the PALLAS and PENELOPE-B trials, in which palbociclib showed no benefit in invasive disease-free survival. In contrast, in the monarchE trial, abemaciclib showed a robust benefit in preventing recurrence, which was sustained after longer follow-up, as reported at the San Antonio Breast Cancer Symposium 2022. 

Turning to the metastatic setting, the panelists discuss the varied side effect profiles of the three approved CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. They also discuss current research into the continuation of these agents beyond progression and whether sequencing of CDK4/6 inhibitors may provide benefit. 

--

Virginia Kaklamani, MD, Professor of Medicine, Division of Hematology/Oncology, University of Texas Health Sciences Center; Leader, Breast Oncology Program, University of Texas Health MD Anderson Cancer Center, San Antonio, Texas 

Virginia Kaklamani, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Gilead; Menarini; Pfizer; Novartis; Lilly; AstraZeneca; Genentech; Daichii; Seagen 

Harold J. Burstein, MD, PhD, Professor, Department of Medicine, Harvard Medical School; Medical Oncologist, Dana-Farber Cancer Institute, Boston, Massachusetts 

Harold J. Burstein, MD, PhD, has disclosed no relevant financial relationships. 

Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have become integral to the treatment of HR+/HER2- breast cancer. Approved in 2015 for use in the metastatic setting and most recently in the adjuvant setting, CDK4/6 inhibitors have revolutionized treatment in both endocrine-sensitive and endocrine-resistant settings and in pre- and postmenopausal women. 

But many questions remain regarding the optimal use of these medications in clinical practice. 

In this ReCAP, Dr Virginia Kaklamani from the University of Texas Health Sciences Center in San Antonio, Texas, and Dr Harold Burstein from Dana-Farber Cancer Institute, Boston, Massachusetts, begin their discussion by examining the potential role of adjuvant CDK4/6 inhibitor therapy in early, high-risk breast cancer.  

They discuss the three main studies that looked at the role of adjuvant CDK4/6 inhibitors, including the PALLAS and PENELOPE-B trials, in which palbociclib showed no benefit in invasive disease-free survival. In contrast, in the monarchE trial, abemaciclib showed a robust benefit in preventing recurrence, which was sustained after longer follow-up, as reported at the San Antonio Breast Cancer Symposium 2022. 

Turning to the metastatic setting, the panelists discuss the varied side effect profiles of the three approved CDK4/6 inhibitors, palbociclib, ribociclib, and abemaciclib. They also discuss current research into the continuation of these agents beyond progression and whether sequencing of CDK4/6 inhibitors may provide benefit. 

--

Virginia Kaklamani, MD, Professor of Medicine, Division of Hematology/Oncology, University of Texas Health Sciences Center; Leader, Breast Oncology Program, University of Texas Health MD Anderson Cancer Center, San Antonio, Texas 

Virginia Kaklamani, MD, has disclosed the following relevant financial relationships: 

Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Gilead; Menarini; Pfizer; Novartis; Lilly; AstraZeneca; Genentech; Daichii; Seagen 

Harold J. Burstein, MD, PhD, Professor, Department of Medicine, Harvard Medical School; Medical Oncologist, Dana-Farber Cancer Institute, Boston, Massachusetts 

Harold J. Burstein, MD, PhD, has disclosed no relevant financial relationships.