Lehigh Valley Hospital (also known as Lehigh Valley Hospital-Cedar Crest) is a hospital in Allentown, Pennsylvania, United States.Lehigh Valley Hospital is the largest hospital in the Lehigh Valley metropolitan region and the third largest hospital in Pennsylvania with 877 licensed beds and the third most operating rooms of any Pennsylvania hospital (46). Lehigh Valley Reilly Children's Hospital is also located on the hospital's Cedar Crest campus in Allentown.Lehigh Valley Hospital is the flagship hospital of Lehigh Valley Health Network (LVHN), a multi-campus healthcare network in eastern Pennsylvania that also includes seven smaller full-service hospitals in the region:LVHN also has community health centers, primary care and specialty physician practices, pharmacies, imaging, home health, hospice, laboratory services and other health services in eight Pennsylvania counties: Berks, Bucks, Carbon, Lehigh, Luzerne, Monroe, Northampton, and Schuylkill.
Background Standard adjuvant chemotherapy for stage III colon cancer consists of a fluoropyrimidine-plus-oxaliplatin regimen. Whether the addition of atezolizumab (an anti-programmed death ligand 1 agent) to a modified FOLFOX6 regimen (fluorouracil, oxaliplatin, and leucovorin; called mFOLFOX6) would improve outcomes in patients with stage III colon cancer with mismatch repair-deficient (dMMR) status is unclear. Methods In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients with resected stage III dMMR tumors to receive either adjuvant atezolizumab plus mFOLFOX6 for 6 months, with atezolizumab continued as monotherapy (for a total of 12 months of therapy), or mFOLFOX6 alone for 6 months. The primary end point was disease-free survival. Secondary end points were overall survival and the adverse-event profile. Results A total of 355 patients were assigned to receive atezolizumab plus mFOLFOX6 and 357 to receive mFOLFOX6 alone. The median age of the patients was 64 years, 55.1% were women, and 53.9% had tumors that were T4, N2, or both (indicating high risk). At a median follow-up of 40.9 months, the 3-year disease-free survival was 86.3% (95% confidence interval [CI], 81.8 to 89.8) in the atezolizumab-mFOLFOX6 group, as compared with 76.2% (95% CI, 70.9 to 80.6) in the mFOLFOX6 group (hazard ratio for disease recurrence or death, 0.50; 95% CI, 0.35 to 0.73; P<0.001). Adverse events of grade 3 or 4 occurred in 84.1% of the patients who received atezolizumab plus mFOLFOX6 and in 71.9% of those who received mFOLFOX6 alone. Conclusions The addition of atezolizumab to mFOLFOX6 significantly improved disease-free survival among patients with stage III dMMR colon cancer. (Funded by the National Cancer Institute of the National Institutes of Health and Genentech; ATOMIC ClinicalTrials.gov number, NCT02912559.)
TPS5632 Background: Concurrent chemoradiation therapy (CCRT) is the standard of care for locally advanced cervical cancer (LACC); however, outcomes remain suboptimal in patients with high-risk disease. Recent studies suggest that integration of immunotherapy (IO) with definitive chemoradiation, or induction chemotherapy prior to CCRT improves outcomes. Whether treatment intensification with induction systemic therapy and IO prior to CCRT and IO further improves disease control remains unknown. Induction chemotherapy may reduce tumor burden, eradicate micrometastatic disease, and improve tumor immunogenicity prior to definitive CCRT. Preclinical and clinical data support synergy between systemic therapy or radiotherapy and immune checkpoint blockade, providing the rationale for evaluating an induction strategy incorporating chemotherapy and immunotherapy before standard CCRT with immunotherapy, followed by maintenance immunotherapy. Optional tumor tissue and blood samples will be collected for exploratory correlative analyses, including immune and molecular biomarkers associated with response, resistance, and patterns of failure. Methods: NRG-GY037 is a prospective, multi-institutional phase III randomized trial conducted through NRG Oncology. A total of 336 patients will be enrolled (168 per arm). Patients will be stratified by FIGO stage (III vs. IVA) and presence or absence of para-aortic lymph nodes (N2). The primary endpoint is progression free survival (PFS). The study has 90% power to detect PFS hazard ratio of 0.65 in the experimental arm. Treatment: Patients with previously untreated, high-risk LACC are randomized to receive either induction chemotherapy with pembrolizumab for 6 weeks followed by CCRT with pembrolizumab and pembrolizumab maintenance, or standard CCRT with pembrolizumab followed by pembrolizumab maintenance. Major Eligibility Criteria: Eligible patients have histologically confirmed cervical carcinoma (squamous, adenocarcinoma, or adenosquamous), TNM T3 and T4 disease, N0-2, ECOG performance status 0–1, and no prior definitive therapy for cervical cancer. Current Enrollment Status: The trial is actively accruing patients. No efficacy or safety data are available at the time of submission. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT07061977. Clinical trial information: NCT07061977 .
This letter challenges the prevailing assumption that residual shunt following patent foramen ovale (PFO) closure is a primary driver of recurrent stroke risk. While residual shunt has been associated with higher rates of neurologic events in observational studies, the author argues that this relationship is not supported by randomized data and may be confounded by diagnostic ambiguity, particularly the inclusion of transient ischemic attack alongside stroke outcomes. The complex pathophysiology of PFO-related stroke, requiring thrombus formation, transient right-to-left shunting, and specific anatomic factors, is often substantially mitigated by the closure procedure itself. Emerging evidence suggests that device-related factors, including incomplete endothelialization and altered atrial hemodynamics, may independently contribute to thromboembolic risk after closure, irrespective of residual shunting. The letter proposes that residual shunt may be an inadequate surrogate endpoint and that clinical focus should instead remain on true stroke recurrence. It further cautions against routine re-intervention to eliminate residual shunt, advocating instead for consideration of prolonged antithrombotic therapy and alternative closure strategies, such as suture-based approaches, which may avoid device-related complications. Overall, this perspective calls for a reassessment of current paradigms in post-PFO closure management and outcome evaluation.
Background and objective Lung cancer continues to be the most common cause of cancer-related death in the United States. While low-dose CT (LDCT) screening has been shown to reduce mortality among high-risk individuals, screening uptake at the national level remains low. Resident-run clinics, particularly those serving as Federally Qualified Health Centers (FQHCs), face unique barriers to implementation, including clinical time constraints and fragmented identification of eligible patients. The objective of the study is to improve lung cancer screening (LCS) rates in high-risk patients in an outpatient resident-run FQHC-Look-Alike through a sequential implementation of targeted patient outreach and electronic health record (EHR) care gap optimization as a quality improvement project. Methods This quality improvement project was conducted at an urban residency clinic. A department-built EHR report identified patients aged 50-77 years with a ≥20 pack-year smoking history. Two interventions were implemented: Phase I: secure EHR messaging to eligible patients, encouraging screening discussions; and Phase II: manual entry of LCS health maintenance modifiers ("care gaps") to trigger point-of-care reminders during active encounters. Data were analyzed using a segmented regression model to assess level and trend changes in monthly screening completion. Results Of the 310 patients identified by the EHR report, 158 (51%) met clinical inclusion criteria and successfully completed LDCT screening during the study period. Following the initiation of interventions, the mean monthly screening completion rate increased from 1.2 to 12.3 scans per month. Segmented regression analysis confirmed a statistically significant level change (coefficient: 11.2; p < 0.001) following the optimization of EHR care gaps, reflecting a sustained improvement in preventive care delivery. Conclusions A dual-modality intervention combining direct patient outreach with provider-facing EHR prompts significantly improves LCS rates in a resident-led safety-net setting. By standardizing the identification of high-risk cohorts and utilizing existing EHR infrastructure for point-of-care alerts, outpatient practices can overcome common implementation barriers. This low-resource, pragmatic approach provides a scalable blueprint for other graduate medical education programs to optimize preventive oncology outcomes.
Abstract Primary pulmonary meningiomas are exceedingly rare with only 67 cases reported in the English language medical literature. They are often benign and treated with conservative surgical excision. Primary is a designation that has been assigned when there is no evidence of intracranial meningioma, otherwise this would be assigned as ectopic. The proposed mechanism for the development of meningiomas outside of the CNS is from multipotent neural crest cells. We present a rare case of pulmonary meningioma found on pulmonary nodule biopsy. This is a 79-year-old male with medical history of atrial fibrillation with previous ablation who initially presented to the hospital for complaints of dizziness and found to be symptomatic from bradycardia. During his workup in the ED, he had a CT Chest performed and was incidentally found to have a nodule in the right upper lobe measuring 2.0cm x 2.4cm. The nodule itself was contiguous with the pleura. He underwent ion navigational bronchoscopy with fine needle aspiration of lesion as well as cryobiopsy with pathology results revealing Grade 1 meningioma. This patient was discussed at our multidisciplinary thoracic conference, and the consensus opinion was surgical excision. To establish a diagnosis of primary pulmonary meningioma, transbronchial biopsy is frequently used. MRI intracranial imaging is recommended to rule out dissemination from an intracranial source. If there is evidence of intracranial meningioma as well, this would be an example of malignant pulmonary meningiomas. Although for our patient, the histologic features suggest grade 1 meningioma. The prognosis of benign PPM is good and in a review of the literature of 35 benign cases, at follow up there were no documented instances of relapse or metastatic lesions. This is an important case as it is exceedingly rare in the literature, and we are yet to fully understand the implications of this disease. Although surgical excision is typically first line, we do not fully understand the implications of monitoring these lesions. This abstract is funded by: None
