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Journal Spotlight

Lymphoma
Issues in Oncology

Possible Impact of Nurse Navigation Program in Achieving Equitable Care and Outcomes in Minority vs White Patients

Matthew Stenger  /  November 25, 2021

In a single-institution study reported in Cancer, Bei Hu, MD, of the Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute/Atrium Health in Charlotte, and colleagues found that use of a dedicated nurse navigation program contributed to redressing the recognized inequities i...

Multiple Myeloma
Immunotherapy

Maintenance Daratumumab Prolongs Progression-Free Survival in Newly Diagnosed Multiple Myeloma

Matthew Stenger  /  November 25, 2021

As reported in The Lancet Oncology by Philippe Moreau, MD, of the University Hospital Hôtel-Dieu, Nantes, and colleagues, an interim analysis of part 2 of the phase III CASSIOPEIA trial has showed significantly prolonged progression-free survival with maintenance daratumumab vs observation following...

Breast Cancer

No Disease-Free Survival Difference With Longer Anastrozole Treatment After Endocrine Therapy in HR-Positive Breast Cancer

Matthew Stenger  /  November 25, 2021

In an Austrian Breast and Colorectal Cancer Study Group phase III trial (ABCSG-16/SALSA) reported in The New England Journal of Medicine, Michael Gnant, MD, of the Comprehensive Cancer Center, Medical University of Vienna, and colleagues found no difference in disease-free survival with 2 vs 5 years...

Kidney Cancer
Immunotherapy

KEYNOTE-564 Trial: Adjuvant Pembrolizumab Improves Disease-Free Survival in High-Risk Renal Cell Carcinoma

Matthew Stenger  /  November 25, 2021

As reported in The New England Journal of Medicine by Toni K. Choueiri, MD, of Dana-Farber Cancer Institute, and colleagues, an interim analysis of the phase III KEYNOTE-564 trial has showed improved disease-free survival with adjuvant pembrolizumab vs placebo after nephrectomy in high-risk patients...

Prostate Cancer

Addition of Ipatasertib to Abiraterone Plus Prednisolone Improves Radiographic Progression–Free Survival in Metastatic Castration-Resistant Prostate Cancer With PTEN Loss

Matthew Stenger  /  November 25, 2021

In a phase III trial (IPATential150) reported in The Lancet, Christopher Sweeney, MD, of Dana-Farber Cancer Institute, and colleagues, found that the addition of the AKT inhibitor ipatasertib to abiraterone and prednisolone produced a significant improvement in radiographic progression-free survival...

Leukemia

Noninferior Progression-Free Survival and Reduced Cardiovascular Toxicity With Acalabrutinib vs Ibrutinib in Previously Treated CLL

Matthew Stenger  /  October 25, 2021

As reported in the Journal of Clinical Oncology by John C. Byrd, MD, of The Ohio State University Comprehensive Cancer Center, and colleagues, the phase III ELEVATE-RR trial has shown noninferior progression-free survival with the more-selective Bruton’s tyrosine kinase (BTK) inhibitor acalabrutinib...

Breast Cancer

Sacituzumab Govitecan-hziy Improves Survival vs Single-Agent Chemotherapy in Metastatic Triple-Negative Breast Cancer

The ASCO Post Staff  /  October 10, 2021 - Supplement: Breast Cancer Almanac

As reported in The New England Journal of Medicine by Aditya Bardia, MD, of the Division of Medical Oncology, Massachusetts General Hospital Cancer Center, and colleagues, the phase III ASCENT trial has shown prolonged progression-free and overall survival with the Trop-2–directed antibody-drug conj...

Breast Cancer

Margetuximab-cmkb Plus Chemotherapy Prolongs Progression-Free Survival in Heavily Pretreated HER2 Positive Breast Cancer

The ASCO Post Staff  /  October 10, 2021 - Supplement: Breast Cancer Almanac

As reported in JAMA Oncology by Hope S. Rugo, MD, of the University of California San Francisco Helen Diller Family Comprehensive Cancer Center, and colleagues, the phase III SOPHIA trial has shown significantly prolonged progression-free survival with margetuximab-cmkb plus chemotherapy vs trastuzu...

Breast Cancer

Reduction in Ipsilateral Recurrence Risk With Radiotherapy vs Observation After Lumpectomy for Good-Risk DCIS

Matthew Stenger  /  October 10, 2021

In an analysis of long-term outcomes from the phase III NRG/RTOG 9804 trial reported in the Journal of Clinical Oncology, Beryl McCormick, MD, of Memorial Sloan Kettering Cancer Center, and colleagues found that whole-breast irradiation vs observation was associated with a reduced risk of all and in...

Thyroid Cancer

Cabozantinib Prolongs Progression-Free Survival in Previously Treated Radioiodine-Refractory Differentiated Thyroid Cancer

Matthew Stenger  /  October 10, 2021

As reported in The Lancet Oncology by Marcia S. Brose, MD, Abramson Cancer Center, University of Pennsylvania, and colleagues, the phase III COSMIC-311 trial has shown that cabozantinib produced a numerically higher objective response rate and significantly prolonged progression-free survival vs pla...

COVID-19

Resurgence of COVID-19 Infection in a Large Highly Vaccinated U.S. Health System Workforce

Matthew Stenger  /  October 10, 2021

In a letter to the editor in The New England Journal of Medicine, Jocelyn Keehner, MD, of the University of California San Diego Health (UCSDH), and colleagues describe a marked resurgence of COVID-19 infections among fully vaccinated workers in the UCSDH workforce in July 2021.1 The resurgence appe...

Multiple Myeloma
Immunotherapy

Subcutaneous Daratumumab Added to Pomalidomide Plus Dexamethasone Improves Progression-Free Survival in Multiple Myeloma

Matthew Stenger  /  September 10, 2021

As reported in The Lancet Oncology by Meletios A. Dimopoulos, MD, of the National and Kapodistrian University of Athens, and colleagues, the phase III APOLLO trial has shown significantly improved progression-free survival with the addition of subcutaneous (SC) daratumumab to oral pomalidomide/dexam...

Multiple Myeloma
Immunotherapy

Treatment of Relapsed Myeloma: Options Include New Drugs, Novel Combinations

Shaji K. Kumar, MD  /  September 10, 2021

The treatment paradigm for multiple myeloma continues to evolve at a rapid pace with the introduction of new drugs and the development of drug combinations, particularly the initial approach to the treatment of newly diagnosed multiple myeloma.1 One major shift in the treatment of newly diagnosed mu...

Gastroesophageal Cancer

Adding First-Line Nivolumab to Chemotherapy Improves Survival in Gastric, Gastroesophageal Junction, and Esophageal Adenocarcinomas

Matthew Stenger  /  September 25, 2021

As reported in The Lancet by Yelena Y. Janjigian, MD, of the Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, and colleagues, the phase III CheckMate 649 trial has shown that the addition of first-line nivolumab to chemotherapy resulted in improved overall and progression-f...

Gynecologic Cancers

Study Shows Sentinel Lymph Node Biopsy to Be ‘Viable Option’ for Surgical Staging of Endometrial Cancer

The ASCO Post Staff  /  September 25, 2021 - Supplement: Gynecologic Cancers Almanac

Sentinel lymph node biopsy “had similar diagnostic accuracy and prognostic ability as lymphadenectomy in patients with high-grade endometrial cancer at greatest risk for nodal metastases,” according to the SENTOR trial, a prospective cohort study of 156 patients with clinical stage I disease. Using ...

Gynecologic Cancers

IMagyn050 Trial: Addition of Atezolizumab to Bevacizumab and Chemotherapy for Newly Diagnosed Stage III or IV Ovarian Cancer

The ASCO Post Staff  /  September 25, 2021 - Supplement: Gynecologic Cancers Almanac

As reported in the Journal of Clinical Oncology by Kathleen N. Moore, MD, and colleagues,1 the phase III IMagyn050/GOG 3015/ENGOT-OV39 trial has shown that the addition of atezolizumab to bevacizumab and chemotherapy did not significantly improve progression-free survival in patients with newly diag...

Gynecologic Cancers

Overall Survival With Olaparib vs Placebo Maintenance in Patients With Platinum-Sensitive Relapsed Ovarian Cancer and BRCA1/2 Mutation

The ASCO Post Staff  /  September 25, 2021 - Supplement: Gynecologic Cancers Almanac

As reported in The Lancet Oncology by Andrés Poveda, MD, and colleagues, the phase III SOLO2/ENGOT-Ov21 trial has shown a large numeric but statistically nonsignificant improvement in the secondary endpoint of overall survival with olaparib tablet maintenance therapy vs placebo in patients with plat...

Prostate Cancer

TITAN Confirms Survival Benefit of Apalutamide Plus ADT in Metastatic Prostate Cancer: Now, Move Therapy Forward

Neal D. Shore, MD, FACS  /  September 10, 2021

As reported in the Journal of Clinical Oncology by Chi et al1—and summarized in this issue of The ASCO Post—the prespecified final overall survival analysis of the phase III TITAN trial1-3 has confirmed a clear overall survival and radiographic progression-free survival benefit with the combination ...

Gynecologic Cancers
Genomics/Genetics

Prevalence of Germline BRCA Mutations in Indian Women With Ovarian Cancer

Jame Abraham, MD, FACP  /  September 10, 2021

Ovarian cancer is one of the most common gynecologic cancers, with 313,959 new cases and 207,252 deaths reported worldwide in 2020.1 Since there is no effective screening method, ovarian cancer in general is diagnosed in its late stage. The 5-year survival rate in women with ovarian cancer is less t...

Gynecologic Cancers
Genomics/Genetics

High Prevalence of Germline BRCA Mutations in Indian Women With Ovarian Cancer

Matthew Stenger  /  September 10, 2021

In a prospective cross-sectional study reported in JCO Global Oncology, Sudeep Gupta, MBBS, MD, DM, of Tata Memorial Centre, and colleagues found that Indian women with ovarian cancer not selected for study based on clinical factors had a high prevalence of germline pathogenic or likely pathogenic B...

Prostate Cancer

Lutetium-177–PSMA-617: A First-in-Class Radioligand Therapeutic in Metastatic Prostate Cancer

David R. Wise, MD, PhD  /  September 10, 2021

Based on the findings of the phase III VISION trial, reported by Sartor et al1 and summarized in this issue of The ASCO Post, lutetium-177–PSMA-617 (LuPSMA) is the first of the prostate-specific membrane antigen–targeted cancer theranostics to demonstrate a survival-prolonging benefit for men with m...

Prostate Cancer

Adding LuPSMA to Standard Care Improves Outcomes in Castration-Resistant Prostate Cancer

Matthew Stenger  /  September 10, 2021

As reported in The New England Journal of Medicine by Oliver Sartor, MD, of the School of Medicine, Tulane University, and colleagues, the phase III VISION trial has shown prolonged progression-free and overall survival with lutetium-177–PSMA-617 (LuPSMA) radioligand therapy plus standard care vs st...

Prostate Cancer

Maintained Benefit of Apalutamide Plus Androgen-Deprivation Therapy Shown in Metastatic Castration-Sensitive Prostate Cancer

Matthew Stenger  /  September 10, 2021

As reported in the Journal of Clinical Oncology by Kim N. Chi, MD, of BC Cancer and Vancouver Prostate Centre, and colleagues, the final overall survival analysis of the phase III TITAN trial showed significant benefit of apalutamide plus androgen-deprivation therapy vs placebo plus androgen-depriva...

Skin Cancer
Immunotherapy

Adjuvant Pembrolizumab Improves Distant Metastasis–Free Survival in Resected High-Risk Stage III Melanoma

Matthew Stenger  /  July 25, 2021

As reported in The Lancet Oncology by Alexander M.M. Eggermont, MD, of Princess Máxima Center, Utrecht, the Netherlands, and colleagues, the pivotal phase III EORTC 1325/KEYNOTE-054 trial has shown significant improvement in the secondary endpoint of distant metastasis–free survival, as well as cont...

Lung Cancer

High Prevalence of Previously Undiagnosed Emphysema Among Individuals Undergoing Low-Dose CT Screening for Lung Cancer

Matthew Stenger  /  August 25, 2021

In a prospective cohort study reported in Clinical Imaging, David Steiger, MD, of the Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, in New York, and colleagues in the International Early Lung Cancer Action Program (I-ELCAP) identified emphysema in ...

Immunotherapy
Solid Tumors

NCI-MATCH Subprotocol Finds Nivolumab Active in Mismatch Repair–Deficient Cancers Other Than Colorectal Cancer

Matthew Stenger  /  April 25, 2020

In a study (NCI-MATCH trial subprotocol, arm Z1D) reported in the Journal of Clinical Oncology, Nilofer S. Azad, MD, of Johns Hopkins Medicine Sidney Kimmel Comprehensive Cancer, and colleagues found that nivolumab was active in mismatch repair (MMR)-deficient noncolorectal cancers.1 As...

Head and Neck Cancer
Immunotherapy

No Progression-Free Survival Benefit With First-Line Avelumab Plus Chemoradiotherapy in Squamous Cell Carcinoma of the Head and Neck

Matthew Stenger  /  August 10, 2021

As reported in The Lancet Oncology by Nancy Y. Lee, MD, of Memorial Sloan Kettering Cancer Center, and colleagues, the phase III JAVELIN Head and Neck 100 trial has shown no improvement in progression-free survival with the addition of the PD-L1 inhibitor avelumab to chemoradiotherapy in patients wi...

Breast Cancer
Immunotherapy

Sacituzumab Govitecan-hziy Improves Survival vs Single-Agent Chemotherapy in Metastatic Triple-Negative Breast Cancer

Matthew Stenger  /  August 10, 2021

As reported in The New England Journal of Medicine by Aditya Bardia, MD, of the Division of Medical Oncology, Massachusetts General Hospital Cancer Center, and colleagues, the phase III ASCENT trial has shown prolonged progression-free and overall survival with the Trop-2–directed antibody-drug conj...

Prostate Cancer

Mortality Risk With Adjuvant vs Early Salvage Radiotherapy in Men With Adverse Pathology at Radical Prostatectomy for Prostate Cancer

Matthew Stenger  /  August 10, 2021

In a retrospective cohort study reported in the Journal of Clinical Oncology, Derya Tilki, MD, of Martini-Klinik Prostate Cancer Center, University Hospital-Hamburg-Eppendorf, Hamburg, and colleagues found that adjuvant radiotherapy was associated with reduced risk for all-cause mortality vs early s...

Immunotherapy
Bladder Cancer

Adjuvant Nivolumab Improves Disease-Free Survival in High-Risk Muscle-Invasive Urothelial Carcinoma

Matthew Stenger  /  August 10, 2021

As reported inThe New England Journal of Medicine by Dean F. Bajorin, MD, of the Department of Medicine, Memorial Sloan Kettering Cancer Center, and colleagues, an interim analysis of the phase III CheckMate 274 trial has shown improved disease-free survival with adjuvant nivolumab vs placebo amon...

Solid Tumors
Immunotherapy
Colorectal Cancer

Is Tumor Mutational Burden Predictive of Survival Outcomes in Solid Tumors Treated With Immune Checkpoint Inhibitors?

Matthew Stenger  /  June 10, 2021

In a letter to the editor in The New England Journal of Medicine, Benoit Rousseau, MD, PhD, and Michael B. Foote, MD, of Memorial Sloan Kettering Cancer Center (MSK), and colleagues presented evidence that a high tumor mutational burden (TMB) threshold of 10 alone may not be sufficient to predict im...

Lymphoma

Dual PI3Kδ/CK1ε Inhibitor Umbralisib in Relapsed or Refractory Indolent Non-Hodgkin Lymphoma

Matthew Stenger  /  July 25, 2021

As reported in the Journal of Clinical Oncology by Nathan H. Fowler, MD, of The University of Texas MD Anderson Cancer Center, and colleagues, a phase IIb trial (UNITY-NHL) has shown that the dual PI3Kδ/casein kinase (CK)1ε inhibitor umbralisib produced durable responses in patients with relapsed or...

Gynecologic Cancers

Addition of Adavosertib to Gemcitabine Improves Outcomes in High-Grade Serous Ovarian Cancer

Matthew Stenger  /  July 25, 2021

In a phase II trial reported in The Lancet, Stephanie Lheureux, MD, of Princess Margaret Cancer Centre, Toronto, and colleagues, found that the addition of the oral Wee1 inhibitor adavosertib to gemcitabine significantly improved progression-free and overall survival in platinum-resistant/refractory...

Lymphoma

Pembrolizumab Improves Progression-Free Survival vs Brentuximab Vedotin in Relapsed or Refractory Classic Hodgkin Lymphoma

Matthew Stenger  /  May 25, 2021

As reported in The Lancet Oncology by John Kuruvilla, MD, of Princess Margaret Cancer Centre, Toronto, and colleagues, an interim analysis of the phase III KEYNOTE-204 trial has shown significantly improved progression-free survival with pembrolizumab vs brentuximab vedotin in patients with relapsed...

Leukemia

Lessons From Pneumococcal Vaccine Responses in Patients With CLL in an Evolving Vaccine Landscape

Raamis Khwaja, MD; Philip A. Thompson, MBBS (Hons); and Nitin Jain, MD  /  June 25, 2021

The role of vaccines in mitigating the significant morbidity and mortality associated with infections in chronic lymphocytic leukemia (CLL) is a developing field of study, punctuated by the advent of novel therapeutic agents and pressing questions regarding the global SARS–CoV-2 vaccination efforts....

Bladder Cancer

Sacituzumab Govitecan-hziy in Urothelial Carcinoma Progressing After Platinum-Based Chemotherapy and Checkpoint Inhibitor Therapy

Matthew Stenger  /  July 10, 2021

In a cohort of the phase II TROPHY-U-01 trial reported in the Journal of Clinical Oncology, Scott T. Tagawa, MD, MS, of Weill Cornell Medicine, New York, and colleagues, found that the antibody-drug conjugate sacituzumab govitecan-hziy produced durable responses in patients with metastatic urothel...

Issues in Oncology

ASCO Releases New Recommendations on Systemic Therapy Dosing for Adults With Obesity and Cancer

Jasenka Piljac Žegarac, PhD  /  July 10, 2021

ASCO has approved new recommendations for the appropriate dosing of systemic anticancer agents in adults with obesity and cancer.1 The guideline update was based on evidence collected from a systematic review of the literature published between November 1, 2010, and March 27, 2020, regarding dosing ...

Bladder Cancer

EV-301 Trial: Enfortumab Vedotin-ejfv Improves Overall Survival vs Chemotherapy in Previously Treated Advanced Urothelial Carcinoma

Matthew Stenger  /  July 10, 2021

As reported in The New England Journal of Medicine by Thomas Powles, MD, of Barts Cancer Centre, Queen Mary University of London, and colleagues, a prespecified interim analysis of the phase III EV-301 trial has shown improved overall survival with the antibody-drug conjugate enfortumab vedotin-ej...

Global Cancer Care

Postoperative Mortality and Complications After Cancer Surgery in High- vs Low- or Middle-Income Countries

Matthew Stenger  /  July 10, 2021

In a prospective cohort study reported in The Lancet, the GlobalSurg Collaborative found that 30-day mortality after surgery for colorectal and gastric cancers, but not breast cancer, was higher in low- or middle-income countries vs high-income countries.1 Among all patients, mortality rates followi...

Breast Cancer
Genomics/Genetics

Disease Risk Associated With Protein-Truncating and Rare Missense Variants in Breast Cancer Risk Genes

Matthew Stenger  /  July 10, 2021

In a study reported in TheNew England Journal of Medicine, Leila Dorling, PhD, of the Centre for Cancer Genetic Epidemiology, Departments of Public Health and Primary Care, University of Cambridge, United Kingdom, and colleagues in the international Breast Cancer Association Consortium (BCAC), ide...

Lymphoma

Addition of Copanlisib to Rituximab Improves Progression-Free Survival in Relapsed Indolent Non-Hodgkin Lymphoma

Matthew Stenger  /  June 25, 2021

As reported in The Lancet Oncology by Matthew J. Matasar, MD, of Memorial Sloan Kettering Cancer Center, and colleagues, the phase III CHRONOS-3 trial has shown that the addition of the pan-class I PI3K inhibitor copanlisib to rituximab significantly improved progression-free survival vs rituximab...

Lung Cancer
Immunotherapy

Dual Immune Checkpoint Blockade With Nivolumab and Ipilimumab for Treatment of Malignant Pleural Mesothelioma

Samuel Rosner, MD, and Patrick M. Forde, MBBCh  /  June 10, 2021

In recent years, immune checkpoint inhibitors in the treatment of mesothelioma have been a keen area of investigation for this immunogenic solid tumor. With recent publications, principally findings from CheckMate 743 by Baas et al1 (reviewed in this issue of The ASCO Post), combination immune check...

Leukemia

Oral Azacitidine Improves Overall Survival vs Placebo as Maintenance Therapy for AML in First Remission

Matthew Stenger  /  May 25, 2021

As reported in The New England Journal of Medicine by Andrew H. Wei, MB, BS, PhD, of the Australian Centre for Blood Diseases, Monash University, Melbourne, and colleagues, the phase III QUAZAR AML-001 trial has shown prolonged overall survival with oral azacitidine maintenance therapy vs placebo ...

Solid Tumors
Immunotherapy

Is High Tumor Mutational Burden Predictive of Immune Checkpoint Blockade Efficacy Across All Cancer Types?

Thierry André, MD, and Romain Cohen, MD, PhD  /  June 10, 2021

In a letter recently published in The New England Journal of Medicine and reviewed in this issue of The ASCO Post, Rousseau and colleagues reported data on the spectrum of benefit from immune checkpoint blockade in hypermutated tumors.1 Indeed, the U.S. Food and Drug Administration (FDA) recently ap...

Kidney Cancer
Immunotherapy

Cabozantinib With Nivolumab for Metastatic Renal Cell Carcinoma: A New Front-Line Standard

Neal S. Chawla, MD, and Sumanta K. Pal, MD, FASCO  /  June 10, 2021

The pace of clinical research in metastatic renal cell carcinoma is faster than ever. Over the past 5 years, we have seen data from six phase III clinical trials evaluating combination strategies with checkpoint inhibitors. The era began with data from CheckMate 214, evaluating nivolumab with ipili...

Gastroesophageal Cancer

Adjuvant Nivolumab Improves Disease-Free Survival vs Placebo in Resected Esophageal or Gastroesophageal Junction Cancer After Neoadjuvant Chemoradiotherapy

Matthew Stenger  /  June 10, 2021

As reported in The New England Journal of Medicine by Ronan J. Kelly, MB BCh, MBA, of The Charles A. -Sammons Cancer Center at Baylor University Medical Center, and colleagues, an interim analysis of the phase III CheckMate 577 trial has shown a significant improvement in disease-free survival wit...

Lung Cancer
Immunotherapy

Nivolumab/Ipilimumab Improves Overall Survival vs Chemotherapy in First-Line Treatment for Unresectable Malignant Pleural Mesothelioma

Matthew Stenger  /  June 10, 2021

As reported in The Lancet by Paul Baas, MD, of The Netherlands Cancer Institute, Amsterdam, and colleagues, a prespecified interim analysis in the phase III CheckMate 743 trial has shown improved overall survival with first-line nivolumab/ipilimumab vs platinum-based chemotherapy in unresectable mal...

Lung Cancer

First-Line Cemiplimab-rwlc Improves Outcomes vs Platinum-Doublet Chemotherapy in Advanced NSCLC With PD-L1 Expression ≥ 50%

Matthew Stenger  /  May 25, 2021

As reported in The Lancet by Ahmet Sezer, MD, of Başkent University, Adana, Turkey, and colleagues, the phase III EMPOWER-Lung 1 trial has shown improved overall and progression-free survival with cemiplimab-rwlc vs platinum doublet chemotherapy among patients with advanced non–small cell lung cance...

Kidney Cancer
Immunotherapy

First-Line Nivolumab Plus Cabozantinib Improves Progression-Free and Overall Survival vs Sunitinib in Advanced Renal Cell Carcinoma

Matthew Stenger  /  May 25, 2021

As reported in The New England Journal of Medicine by Toni K. Choueiri, MD, of Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, and colleagues, the phase III CheckMate 9ER trial has shown that the combination of nivolumab and cabozantinib improved progression-free survival and o...

Survivorship

Improving Prediction of Risk for 10-Year Left-Ventricular Systolic Dysfunction in Survivors of Childhood Cancer

Matthew Stenger  /  May 25, 2021

In a Dutch study reported in JACC: CardioOncology, Jan M. Leerink, PhD candidate, of Amsterdam UMC, University of Amsterdam Department of Clinical and Experimental Cardiology, and colleagues found that the addition of ejection fraction measurement at the time of first surveillance echocardiogram imp...

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