Expanding Health Professional Education in the Rio Grande Valley during the COVID-19 Pandemic

Purpose: The COVID-19 Pandemic has prompted innovation in health professional education, such that learners are able to recognize and mitigate healthcare disparities in the outcomes of vulnerable populations. The objective of our project was to increase education on preventing, preparing for, and responding to COVID-19 and other locally prevalent infectious diseases that disproportionately affect RGV communities. Description: This project had 3 goals: (1) provide learners with virtual patient-interaction simulations (2) provide interactive training modules on the identification, prevention, and treatment of infectious diseases affecting South TX and strategies to increase child vaccinations, and (3) provide learners an opportunity to coordinate community health promotion via PPE and COVID-19 information distribution. Partners: Collaborative stakeholders included the AHEC Scholars Program and the Department of Pediatrics at UTRGV SOM. Both functioned as sponsoring bodies overseeing this operation. Mursion and Nearpod were consulted regarding how the use of their technologies could advance Goals 1 & 2. UT Health RGV patients and RGV colonia populations were the rationale for completion of Goal 3 and the project as a whole, as we sought to aid in improving their overall health. Looking Ahead: Our approach integrated content learning and practice with regard to identifying, preventing, and addressing regionally prevalent infectious/non-infectious diseases and sensitive health topics affecting all age groups. The multifaceted nature of the project helped to solidify the knowledge gleaned and revealed possible avenues for health professional curriculum that can further learning in areas that are difficult to address in a traditional standardized manner, from pediatric patient encounters to community health interventions

Neratinib + fulvestrant + trastuzumab for HR-positive, HER2-negative, HER2-mutant metastatic breast cancer: Outcomes and biomarker analysis from the SUMMIT trial

BACKGROUND: HER2 mutations are targetable alterations in patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). In the SUMMIT basket study, patients with HER2-mutant MBC received neratinib monotherapy, neratinib + fulvestrant, or neratinib + fulvestrant + trastuzumab (N + F + T). We report results from 71 patients with HR+, HER2-mutant MBC, including 21 (seven in each arm) from a randomized substudy of fulvestrant versus fulvestrant + trastuzumab (F + T) versus N + F + T. PATIENTS AND METHODS: Patients with HR+ HER2-negative MBC with activating HER2 mutation(s) and prior cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy received N + F + T (oral neratinib 240 mg/day with loperamide prophylaxis, intramuscular fulvestrant 500 mg on days 1, 15, and 29 of cycle 1 then q4w, intravenous trastuzumab 8 mg/kg then 6 mg/kg q3w) or F + T or fulvestrant alone. Those whose disease progressed on F + T or fulvestrant could cross-over to N + F + T. Efficacy endpoints included investigator-assessed objective response rate (ORR), clinical benefit rate (RECIST v1.1), duration of response, and progression-free survival (PFS). Plasma and/or formalin-fixed paraffin-embedded tissue samples were collected at baseline; plasma was collected during and at end of treatment. Extracted DNA was analyzed by next-generation sequencing. RESULTS: ORR for 57 N + F + T-treated patients was 39% [95% confidence interval (CI) 26% to 52%); median PFS was 8.3 months (95% CI 6.0-15.1 months). No responses occurred in fulvestrant- or F + T-treated patients; responses in patients crossing over to N + F + T supported the requirement for neratinib in the triplet. Responses were observed in patients with ductal and lobular histology, 1 or ≥1 HER2 mutations, and co-occurring HER3 mutations. Longitudinal circulating tumor DNA sequencing revealed acquisition of additional HER2 alterations, and mutations in genes including PIK3CA, enabling further precision targeting and possible re-response. CONCLUSIONS: The benefit of N + F + T for HR+ HER2-mutant MBC after progression on CDK4/6is is clinically meaningful and, based on this study, N + F + T has been included in the National Comprehensive Cancer Network treatment guidelines. SUMMIT has improved our understanding of the translational implications of targeting HER2 mutations with neratinib-based therapy

Evaluating Hepatitis B Seroprotection and Revaccination for Children with Inflammatory Bowel Disease

To the Editor: We read with interest the article entitled "Serologic Status of Routine Childhood Vaccines, Cytomegalovirus, and Epstein-Barr Virus in Children With Inflammatory Bowel Disease" by deBruyn et al., particularly the section on hepatitis B (HBV) seroprotection. We conducted a similar study in our US tertiary care center, analyzing HBV seroprotection in 159 children with inflammatory bowel disease (IBD) age 0-22 who received the three-dose HBV primary series and had been exposed to a biologic agent