Medical Journal News

The advent of immunotherapy based on immune checkpoint inhibitors has improved the treatment of advanced hepatocellular carcinoma and is now the first-line standard of care for systemic therapy.1 In light of this progress, the introduction of immune checkpoint inhibitor-based therapy combinations for the treatment of earlier stages of disease seems a reasonable step.

TACE plus lenvatinib plus pembrolizumab showed significant, clinically meaningful improvement in progression-free survival in patients with unresectable, non-metastatic hepatocellular carcinoma compared with TACE plus placebo. The numerical improvement in overall survival is encouraging, but longer follow-up is necessary.

Durvalumab plus bevacizumab plus TACE has the potential to set a new standard of care. With additional follow-up of the EMERALD-1 study, future analyses, including the final overall survival data and patient-reported outcomes, will help to further characterise the potential clinical benefits of durvalumab plus bevacizumab plus TACE in hepatocellular carcinoma amenable to embolisation.

bmj;388/jan08_7/r11/FAF1faRuth White was a woman of many passions; from antique textiles to singing opera to Aston Villa Football Club she threw herself into everything she committed to. This also translated into her professional life.In 2000 the death of a trainee psychiatrist and her baby led to a huge amount of soul searching across the NHS—the report into the deaths1 highlighted a range of contributing factors, including the lack of specialist mental health services for pregnant women and new mothers.The case prompted White, a community psychiatrist in Worcester, to set up one of the first community perinatal mental health teams in the country, using her considerable passion and drive to cajole the powers that be to give her the money to do it.White was self-taught, seeking out the advice of experts in the field to learn about perinatal mental health and then training community nurses and midwives to identify women at...

Most of us have favourite questions that we like to ask when consulting with patients or that we’re fond of teaching to medical students and resident doctors. One popular question many GPs teach their registrars to ask is, “What made you come today, particularly?” This can sometimes lead patients to disclose a triggering event that was just as important as the long running symptom they first presented with.Personally, I put a different question at the top of my own list for teaching: “How is this conversation going for you so far?” I like this question for several reasons. It helps you to find if you’re on the right track or have missed something important that the patient tried to say and you didn’t fully register. You can then recalibrate your response straight away, rather than finding out too late that you’ve gone badly off track. It’s also a way of...

Just over 10 years ago I was diagnosed with Parkinson’s disease. I had suffered for several years from strange bouts of cramp, stiffness, and a very painful back. A badly torn rotator cuff only confused the issue as I put much of my discomfort down to my shoulder or back problems. Before major back surgery the surgeon expressed doubts and quietly suggested a neurological rather than a musculoskeletal issue. Raising the possibility of a life changing condition with such non-alarmist tact was helpful.A colleague along the corridor was more direct but equally careful. Not everybody would have appreciated this directness, but I was relieved. Knowing what I had gave me a better chance of dealing with it.Facing the figuresDisease progression has been mercifully slow since my diagnosis. However, the intrinsic uncertainty in the condition breeds anxiety: another Parkinson’s gift. A thoughtless remark could cause me to lose confidence, leading to...

This piece comes with a trigger warning. We used to avoid talking about cancer, menopause, periods, or other stigmatised topics—adding to feelings of shame and limiting our understanding. This remains true of suicide, especially among healthcare staff. The writer Adam Kay describes NHS staff suicides as being “brushed under the carpet.”1 But talking about suicide is important, as open conversation reduces its risk.2Some statistics stick in my head. One nurse dies by suicide each week in the UK.3 The suicide rate in women doctors is up to four times that of women in the general population.4 Unfortunately, most colleagues are oblivious to the pain experienced by a huge proportion of their co-workers. But each tragedy can cause guilt, shame, and higher rates of suicide in the loved ones and colleagues affected.4Clare Gerada35 started the NHS Practitioner Health service,6 and she and Ananta Dave have written3 about awareness and prevention of...

New England Journal of Medicine, Volume 392, Issue 2, Page 138-149, January 9, 2025.

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