we take a multidisciplinary approach to treating sarcoma, integrating expertise across specialties to optimize patient outcomes. Our strategy includes a combination of surgery, radiation therapy, chemotherapy, and access to leading clinical trials.

By convening the best minds in orthopaedic oncology research and treatment throughout AHNCI and across the country, we develop a holistic care strategy through the exchange of ideas and expertise.

Serving as the foundation of our care philosophy,our biweekly internal sarcoma conference assembles AHN bone and soft tissue specialists from areas such as oncology, radiology, and pathology. In these discussions, we strategize for the most complex cases and share updates to ensure synergized, informed treatment plans.

We collaborate with other renowned cancer centers across the U.S. — including West Virginia University Hospital and Marshall University Medical Center — to exchange insights and enhance patient care.

AHNCI is at the forefront of sarcoma research, with recent contributions presented at the 2024 Musculoskeletal Tumor Society annual meeting by Lisa B. Ercolano, MD, Chief of AHN Orthopaedic Oncology.

According to Dr. Ercolano, findings indicate the potential for ctDNA to improve diagnosis, treatment monitoring, and recurrence detection — offering a non-invasive alternative to biopsy.

A pilot study assessing perioperative supplementation in sarcoma patients is informing a larger AHN trial on its role in surgical recovery.

Our research on how patients prefer to receive biopsy results underscores the need for individualized communication approaches.

In addition to extensive research, AHN uses the latest science, technology, and techniques to provide several treatment options to care for each unique patient and case.

A multidisciplinary surgical team — including oncologic, orthopaedic, thoracic, and plastic surgeons — tailors each procedure to the patient's needs.

As the only radiation oncology network in western Pennsylvania accredited by both the American Society for Radiation Oncology and the American College of Radiology, AHNCI uses advanced computer software and imaging to target the radiation beams directly at the tumor, minimizing exposure to healthy tissue.

We provide chemotherapy, targeted therapy, and immunotherapy as standalone treatments or in combination with surgery and radiation.

Our integrated team of pain management specialists, infection control specialists, physical therapists, and psychologists supports patients through both treatment and recovery.

AHN is committed to delivering leading-edge sarcoma care. To refer your patient to AHN Cancer Institute, call the Hope Line at (

AHN Orthopaedic Institute employs a multidisciplinary approach to sarcoma treatment, integrating surgery, radiation, chemotherapy, and clinical trials. Biweekly sarcoma conferences and multi-institutional collaborations enhance patient care through shared expertise. AHNCI leads sarcoma research, with studies on circulating tumor DNA and perioperative immunonutrition. The institute emphasizes individualized patient communication and offers advanced treatment options, including surgery, radiation, and medical oncology. Rehabilitation support is provided by a comprehensive team. AHN is dedicated to delivering cutting-edge sarcoma care, with a referral system in place for patient access.

AHNCI is at the forefront of sarcoma research, with recent contributions presented at the 2024 Musculoskeletal Tumor Society annual meeting.

Synergy and Science: AHN’s Multidisciplinary Approach to Sarcoma Treatment

Allegheny Health Network

Dermatological experts discuss challenges that are associated with the use of standard and emerging treatments in special patient population.

Patient Subgroups and Educational Opportunities in Rare Dermatological Disorders

Boni Elewski, MD

Dr Keegan, what are some patient-specific characteristics that you consider when you’re choosing an agent or a regimen for atopic dermatitis?

One of the first criteria one would want to think about is what’s the age of the patient? How severe is their condition? What have they tried before, etc.? Things like that are all important criteria, and they can range from it’s the first time a patient’s ever come in and they just need some education about what things can be helpful, and what things they should be staying away from to here are topical medicines to try, if this is just going to be intermittent, and let me know how things go to I’ve already failed this and I failed that before to the I come with a grocery bag full of tubes and creams that have a variety of prescriptions that are inside of them and a whole litany of over-the-counter medicines. Then putting the bottles in my face, “Is this one OK? Is this one OK?” Me just trying to be able to move through the conversation with them in order to get down to the nuts and bolts of what’s going on. There’s definitely a range of patients and a range of patient ages.

Then you just mentioned, we were just discussing the concept of killing 2 birds with 1 stone. So what other concurrent medical conditions do they have that they might potentially benefit from? They make a decision, back again, Dupixent [dupilumab], and someone who has asthma and atopic dermatitis, can they benefit from 1 medicine that will treat both things? Both from the simplicity for the patient, cost for the insurance company, and the mitigation of risk from the perspective of prescribing the medicines vs maybe 2 medicines where we don’t always know what the risk is when we’re combining those 2 medicines together. We just have theoretical concepts of how it might work, so that may be criteria. And then, as I mentioned before, sometimes one of the biggest challenges that patients have is they say they want something, but they really want to get better, and they may sidestep us and say that they want something else or, “I’d like just this type of a medicine because my friend told me this cream is really great.” You look at it and you’re like, “But you’ve got 3 tubes of it already in that grocery bag there that you’ve given me, and that’s really not going to make a lot of progress for you.” So sometimes what buy-in can you get from patients?

I don’t want to say that I always let them make the decision about what they’re going to give, but I’ve had plenty of patients that come in and say, “My sister takes this and she’s doing great. My aunt is on this medicine and doing great,” and if I have 3 or 4 medicines in my mind that are potentials, and they lock in on 1 of them and have a positive experience before they’ve even come in the door to me, that might be enough to try, for me to help them get over the hump of getting started on a medicine, whether it’s topic or systemic. Whatever it can take to help them get onto that next step and get better would be something that I would latch on to and use to my advantage as well too. So those are a couple of them. I’m sure Dr Cameron has a few more strategies or thoughts.

I thought that was really well said. I think that clearly a patient’s perception before they come in the office is huge. There’s a reason why…

What commercial did you see on TV last night?

There’s a reason why direct-to-consumer advertising plays such an important role still. And so clearly, if there are a couple of good options, patient satisfaction is always a priority for me as well as building trust. If they come in and they want to try therapy, if I let them try that therapy, if it doesn’t work, they trust me even more, and so it’s all about just building that physician-patient relationship. In terms of your thinking about which treatments, I completely agree. I think that a lot of times we have several good options now, which is great.

Jumping back on that direct-to-consumer advertising, I think one of the things that we should all recognize is that all these medicines that we’ve talked about today are made-up words. Opzelura [ruxolitinib], Dupixent, dupilumab, these are all made-up words, and we in healthcare are really used to using those made-up words and they make up our own language. We use a lot of made-up words all day long, and patients, when they hear those made-up words in the commercials, they can’t always differentiate them, so they may come to me sometimes with concern. 

“I want to put you on Dupixent,” and they’ll say, “I don’t want to go on that. I heard that I’m going to have a heart attack and get cancer.” And I love it when they tell me what they’re thinking because then I’m thinking, “Oh my gosh, that’s not actually anywhere in the package insert and nothing that we have to be concerned about.” But when they voice their concerns for maybe another commercial that they’ve heard and aren’t really sure of what that medicine is, we can help them to navigate that foreign language that is medicine.

Drs Keegan and Cameron discuss patient-specific considerations for selecting optimal atopic dermatitis treatment strategies.

Patient-Specific Characteristics Driving AD Treatment Regimen

Brian Keegan, MD, PhD

Patient Case No. 2

Patient No. 2 has stage 3 CKD and uncontrolled hypertension. They have a moderate reduction in their estimated glomerular filtration rate, confirming stage 3 CKD. Their hypertension is likely contributing to CKD progression.

Difficult-to-treat hypertension is a condition where blood pressure remains uncontrolled despite the use of three or more antihypertensive medications, including a diuretic. This condition is distinct from resistant hypertension, which is more common and involves blood pressure that is not controlled with three medications but may not include a diuretic. Difficult-to-treat hypertension is less frequent, affecting a smaller subset of patients with high blood pressure. It often requires a more comprehensive approach, including lifestyle modifications and potential secondary causes evaluation, to achieve optimal management.

Panelists discuss how chronic kidney disease (CKD) and uncontrolled hypertension create a damaging cycle, in which hypertension accelerates kidney damage while declining kidney function makes blood pressure harder to control.

C. Michael Gibson, MD, MS

 You mentioned clinical data. Reggie, are you familiar with the published data, especially from the ICONIC trial, which allowed the FDA approval of these drugs for children with Alagille syndrome?

 I have some knowledge. I love the name of the trial. ICONIC sounds iconic. Interestingly, it’s one of what I call backward placebo-controlled trials. It’s a medication withdrawal trial—that’s the fancy name—where everybody up front received the drug openly, indifferent to the usual trial where half the patients get the drug up front and half don’t. In this one, everybody got it up front. Supposedly, this improves or diminishes the subjective bias of itching.

Patients received maralixibat 380 µg/kg once a day for 18 weeks. Half the patients were continued on therapy, and in the other half, the medicine was removed. No one knew who was in which group. That was done for 4 weeks. Then everybody got back on open label for an extended period of time, up to 48 weeks. That’s where the ICONIC trial stopped. There’s an ongoing long-term arm of this trial, but ICONIC stopped at 48 weeks.

The take-home message was that in the first 18 weeks of open label, their ItchRO [Itch Reported Outcome] score dropped by almost 2 points. One point is considered clinically important in validation of the ItchRO, so a drop in 2 points is quite significant. As you might have imagined, during the 2 to 4 weeks where the drug was withdrawn, the effect remained in those who continued on drug. But in those where the drug was withdrawn, their itch scores rose back to baseline, clearly suggesting that this medicine was helping the itch.

Furthermore, after everybody gets on open label again, even the patients on placebo get back on the drug, and their ItchRO scores improve. The differences in improvement during the open labels and placebo are pretty dramatic. If you look at these patients at a year out, about 80% of the patients experienced a greater than or equal to 20% reduction in serum bile acids. Serum bile acid reduction was correlated to improved pruritus.

The medicine showed not only improvement in itch but also improvement in the serum bile acids, which may be getting a little off topic or to the next topic. There’s a conversation about serum bile acids being a biomarker of liver outcome. If you lower your serum bile acids, you might get more bang for your buck. You might get rid of the pruritus, but you might also be able to improve or prevent progression of the liver disease, although that might be a question for another one of these conversations. That’s a summary of the efficacy data of ICONIC.

Of course, you have to talk about adverse events, which did happen. As you might imagine, the most common were GI [gastrointestinal] related. Vomiting, abdominal pain, and diarrhea occurred in 50%-plus of the patients on treatment. Fortunately, these adverse events rarely led to drug discontinuation. They were quite tolerable, so the vast majority of patients were able to complete the trial. In the ongoing long-term arm, that seems to be the norm.

 Reggie, thank you for very nicely summarizing it. The drug, of course, was maralixibat.

Regino Gonzalez-Peralta, MD, reviews clinical implications from the phase 2 ICONIC trial evaluating the use of maralixibat for the management of Alagille syndrome in pediatric patients.

Using Maralixibat for the Management of Pediatric ALGS

Jennifer M. Vittorio, MD

Justin Mark, MD, is an internal medicine resident at the University of Miami Miller School of Medicine and Holy Cross Health. 

New data from an analysis of the FIGHT trial presented at the 

American College of Cardiology (ACC) 2025 Annual Scientific Sessions

 details significant disparities in heart failure outcomes among patients with 

 with reduced left ventricular ejection fraction (LVEF) following hospitalization.

A phase 2, double-blind, placebo-controlled randomized clinical trial of patients with established heart failure and reduced LVEF who were recently hospitalized, the FIGHT trial was published in 2016 and concluded use of liraglutide did not lead to greater posthospitalization clinical stability, which was the trial’s primary endpoint.

The ACC.25 data presented by Justin Mark, MD, of the University of Miami Miller School of Medicine and Holy Cross Health, was a secondary analysis of the FIGHT trial examining racial and ethnic disparities in heart failure outcomes from the trial, regardless of treatment assignment. Of the original 300 participants enrolled in the FIGHT trial, Mark and colleagues included 289 participants in the current analysis.

Results suggested non-White patients were significantly younger at baseline (55 vs. 64 years, 

 <.001) but had more severe disease, as evidenced by lower LVEF (21% vs. 25%, 

 = .04) and shorter 6-minute walk distances (190 vs. 251 m, 

 = .01). At 180 days, mortality rates were similar between racial and ethnic groups in both adjusted and unadjusted analyses. However, non-White patients had a higher rate of HF readmission (45% vs. 33%, 

 = .03) and greater increases in NT-proBNP levels (253 vs 196 pg/mL, 

 = .003), suggesting more significant worsening of HF status over time.

For more on this study, check out our interview with Mark from the conference floor at ACC.25.

Racial, Ethnic Differences in Heart Failure Outcomes in Type 2 Diabetes, with Justin Mark, MD

Mark has no relevant disclosures to report.

Mark J, Lopez J, Tracy. Racial Differences in Advanced Heart Failure Patients: Insights from the FIGHT Trial. 

Margulies KB, Hernandez AF, Redfield MM, et al. Effects of Liraglutide on Clinical Stability Among Patients With Advanced Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial. 

Justin Mark, MD, discusses an analysis of the FIGHT trial looking at racial and ethnic differences in heart failure outcomes. 

Racial, Ethnic Differences in Heart Failure Outcomes, with Justin Mark, MD

Justin Mark, MD

Ryan T. Fischer, MD

This has been a great program. I’ve learned a lot. We covered lots of ground about antithrombotic therapy, coronary artery disease [CAD], and peripheral artery disease [PAD] in general. Let me turn to our distinguished panel for some closing thoughts. I’ll start with you, Manesh. Any final points [that] you want to make for the audience?

Deepak, it’s been fun and exciting. It’s fun to talk to people about evidence for the things we see. We’ve learned over the last decade is that vascular disease unfortunately is still the leading cause of cardiovascular mobility issues and mortality. As we have more options, which is a good thing, we have to get the right dose for the right patient at the right time. Some of that is understanding the risk and the risk benefits that we’ve talked about. Concerning patients with polyvascular disease, patients with broad thrombotic risk, it’s important to understand how you can make them have better outcomes. We’ve talked about that today. Hopefully it’s something that people will take home.

 I agree. It’s been a wonderful panel. I’m thrilled to be part of this. My take-home message would be to focus on identifying these polyvascular patients. Because they’re such high-risk patients, it’s important not to be focused on the coronary artery disease. But if patients have coronary artery disease and vascular disease in another territory, then that’s the pinnacle of our risk. Diabetes on top of that is going to be at that highest cardiovascular risk, so we need to talk with our patients about the fact that they’re at a higher risk and how that guides our recommendations for changing medications. Oftentimes patients can be resistant, understandably, to wanting to add another medication. But part of patient-centered decision-making is educating them that this is why that goes a long way.

We need to educate the medical community about those risks that identify polyvascular disease, diabetes is a real risk amplifier. Great points. Eric, any closing thoughts?

 This was a fantastic discussion. For everyone watching this, it’s important for us to not be fearful of making a change in our practice. We’ve been set in our ways for a long time, but we’ve had these accumulating data. It’s time for us to be open-minded about making changes that benefit our patients. We’ve heard today that there are many agents that can optimize long-term cardiovascular and limb-related risk outcomes and improve the care for our patients, so it was a great discussion.

Absolutely agree and Sahil, any final thoughts?

 That’s really important. What Eric just said is that we’ve been in this mode of using dual-antiplatelet therapy for extended amounts of time with very little evidence, particularly in the PAD population, which is the predominant part of my practice. It’s great that we have strong evidence to support the use of dual-pathway inhibition. We need to get the message out to our referring doctors and our patients that this is the way forward to optimize the risk.

Terrific. Marc, you’ll get the final word.

 It’s been an honor to be part of this panel. We’ve learned that we have a gap in terms of the evidence and how we treat our patients. Part of that is that we have a lot of patients to see. We’re all very busy clinicians. Everyone wants to do their best. But understanding who the highest-risk patient is and what the best evidence is needs to be at the top of your mind as you see your clinic patients, and polyvascular disease resonates. I learned that term from you, Deepak, many years ago. It has been shown in every study to be such a potent marker of risk and beneficial for some of these strategies and other things like diabetes. We need to take that into the clinic and start treating our patients better.

I couldn’t agree more. Hopefully the audience found this exchange of ideas informative, interesting, and educational. Hopefully these are things you can take this into your practices. As I mentioned, I learned a lot. A final point I’ll make is that when you’re thinking about coronary artery disease, think about the whole patient. For that patient you’re seeing for 1 specific condition, that might be the issue in the office for that day. But they may have other risk factors. They may have plaque in other arterial territories. We talked a lot in this session about polyvascular disease, but keep in mind that CAD, PAD, and cerebrovascular disease can coexist. Even though the patient might be seeing you for angina in that office visit or hospital encounter, think about all those associated risks. If you identify those associated risks, you realize that it’s a very high-risk patient, the sort of patient for whom we want to do everything possible to reduce their risk, including intense lifestyle modification. Beyond that, in many cases pharmacotherapy, polypharmacy with wisdom and caution, and in some cases procedural care are all complementary approaches, not competitive approaches.

Thanks to all of you on our panel and to our audience for this rich and informative discussion. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming 

 and other great content right in your in-box.

A panel of expert cardiologists share their concluding thoughts on management of polyvascular disease in clinical practice.  

Concluding Thoughts

Sahil Parikh, MD

Associate Professor of Medicine at Johns Hopkins Medicine

Chaturvedi discussed findings from the NeST study at ASH 2024, including an increased risk of stroke in those with silent cerebral infarction progression.

Highlighting the Danger of SCI Progression during iTTP Remission, with Shruti Chaturvedi, MBSS, MS

Silent cerebral infarctions (SCI) are progressive even during remission in immune thrombotic thrombocytopenic purpura (iTTP) without acute episodes. SCI progression should be prevented in these patients to reduce stroke risk and may be a suitable endpoint in intervention trials aiming to mitigate adverse neurovascular outcomes in iTTP.

These findings are from the prospective NeST study, data from which were presented at the

 66th American Society of Hematology (ASH) Annual Meeting and Exposition

, held December 7-10, 2024, in San Diego, California, by Shruti Chaturvedi, MBBS, MS, Associate Professor of Medicine at Johns Hopkins Medicine.

“These ischemic lesions, or vascular disease, in the brain is progressing during remission. So, we should treat all of our TTP patients as the kind of patients that you would consider high risk for stroke. So intensive risk factor modification. If they have high blood pressure, we need to control it. We need to make sure that their cholesterol is under control. If they have diabetes, if they're smoking, all of that needs to be addressed until we have more targeted interventions for this population,” Chaturvedi advised clinicians during a conversation with 

Chaturvedi and colleagues found that of 26 participants with repeat imaging, new or progressive lesions were seen in 38.5% (n = 10) The median Age-Related White Matter Changes score also significantly increased from 2 to 2.5 (

 = .002) on the follow up MRI. Notably, the rate of stroke was significantly higher in those with progressive SCI than those without progressive SCI (30% vs. 0%, 

“This data actually highlights that SCI and its progression, which you can monitor for even as short as 1 year, might be a reasonable end point for these trials, thereby reducing the cost and duration of trials in an ultra-rare disease,” Chaturvedi said.

Chaturvedi S, Brown J, Yu J, Gerber GF, Lin D. Silent Cerebral Infarction Is Progressive during Clinical Remission and Associated with Stroke in Immune TTP Survivors. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 144

Shruti Chaturvedi, MBBS, MS

Thank you to all 3 of you for participating in this rich discussion. I’d like to give you one last opportunity for any pearl that you might have that you want to share with your colleagues about taking care of patients with atopic dermatitis now, and then what we are going to be doing over the next year or two, as we learn more and continue to add to our therapeutic options. Do you have anything you would like to add?

My advice to my colleagues is for those who aren’t participating locally in journal clubs and meetings, do it because by doing so, you’ll meet incredible providers who share the same passion you do by improving the lives of patients. You’ll find other providers who speak your same language who you get along with and you’ll enjoy collaborating with on care for patients. The second thing is for patients to hang in there. We’re in this together. This is a journey. This isn’t a 1-gene condition. This is complicated, but we’re in it together, and we’re going to find the answers and stick with it until we find the answer that will make our patients become their best selves. I joke that my patients are my Prozac all day long because they give me such a high when they come in and they’re happy. You can see when they’re not happy, but it’s so empowering on my side and it’s a real honor to be in a position to ask them questions that nobody else can ask and to walk side by side with our patients in this journey.

Susan, do you have any words to your colleagues or to your patients or their families?

 It is a partnership, laying out the options treatment wise and weighing the risks and benefits, and all the other extraneous things, costs, and other things that influence the family. It’s also being the empathetic providers that we all are and that the patient knows you’re listening. That’s a huge aspect of any chronic disease, that patients need to feel heard and they need to know that you are listening and that it matters what they’re going through. We know statistically and scientifically all of the things about the diseases, but everybody’s different and not everyone fits into that mold. We need to be able to pull those idiosyncrasies out from the patient, knowing what has failed and helped, and you are there as their provider to get success for their disease and their quality of life and to be able to move forward.

If you have a patient who is not doing well on what we have available, you might want to go to clinicaltrials.gov and look at sites all over the country where children, adolescents, and adults with different types or different levels of atopic dermatitis might be able to participate in a clinical trial to help get the data needed to move forward. 

 The National Eczema Association [NEA] may have information about clinical trials across the country, so they may be a good resource for that as well.

 I encourage my patients to start their own local chapter of the NEA. Patients need to collaborate with each other and relate so they can help each other by sharing stories and know they’re not the only one. It’s insane to me how I’ll go in and see a patient, and they’ll feel so alone, but there are so many people out there suffering from this. They should never feel alone.

They’re going to seek answers through social media or through other online sources. They’re going to be seeking answers, and you can either direct them and give them the proper information, or they’re going to find it on their own, so we have to realize that and try to direct them to places that matter. Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchange segments and other great content right in your inbox. Thanks to all 3 of you, and we’ll see you again soon.

Clinical pearls regarding the management of patients with atopic dermatitis with newer treatment approaches as the field continues to evolve. 

Authors