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CancerNetwork® collaborated with CURE® to speak with Samantha Shenoy, NP, MSN, a nurse practitioner at the Cancer Immunotherapy Clinic of University of California San Francisco (UCSF) Health, about the role she plays when treating patients with multiple myeloma who are receiving talquetamab-tgvs (Talvey). Of note, emphasis was placed on managing treatment-emergent adverse effects (TRAEs) and toxicities that may impact quality of life.

Shenoy foregrounded the discussion by outlining the role of nurses in facilitating the management of toxicities and providing education to patients in both an inpatient and outpatient capacity. She subsequently discussed common skin, oral, and dermatologic toxicities, as well as how they impact patient quality of life.

Furthermore, she touched upon taking an aggressive approach to addressing early-grade cytokine release syndrome (CRS), placing an emphasis on close adherence to UCSF clinical guidelines for treating it. Additionally, Shenoy acknowledged the possibility of neurological effects occurring as a result of treatment with talquetamab, although she stated she has not observed any in her experiences with using the bispecific.

Shenoy disclosed talquetamab-related monitoring parameters, indicating that taste changes and weight loss were notable risks. Particularly for weight loss, she mentioned that she regularly checks in with patients about their eating habits and weight. Furthermore, methods for living with taste changes were discussed, which included recommendations for prophylactics, dietary modifications, and dry mouth remedies.

Shenoy continued by suggesting that the efficacy seen with talquetamab, particularly as part of a combination therapy, makes it an impactful agent. Citing her experience as part of the phase 1 TRIMM-2 trial (NCT04108195), where talquetamab was assessed in combination with daratumumab (Darzalex) in relapsed or refractory multiple myeloma, she claimed that combination therapies for bispecifics would become the new standard in this patient population.

She concluded by expressing her passion for educating patients about management strategies for multiple myeloma. Additionally, she further illustrated the sentiment through her experience witnessing patients continue treatment for several years while overcoming toxicities associated with talquetamab.

“I feel passionately about the fact that we can educate patients who are struggling at the beginning [to] hang in there. It is not going to last forever,” Shenoy stated. “I can imagine how frustrating it is [when you are not] able to taste, your mouth is dry, and your hands are peeling. Just know that it is not forever.”

Dholaria, BR, Weisel K, Mateos MV, et al. Talquetamab (tal) + daratumumab (dara) in patients (pts) with relapsed/refractory multiple myeloma (RRMM): updated TRIMM-2 results. 

 2023;41(suppl 16). doi:10.1200/JCO.2023.41.16_suppl.8003

Samantha Shenoy, NP, MSN, discusses how her role plays a vital part in patient care for those receiving talquetamab for multiple myeloma.

Mitigating AEs and Protecting QOL Following Talquetamab in Multiple Myeloma

 spoke with James R. Berenson, MD, about the potential role that JAK inhibitors may play in the treatment of patients with multiple myeloma. The conversation focused on the rationale for researching this drug class as well as ongoing initiatives to assess the utility of agents like ruxolitinib (Jakafi) for this patient population.

Berenson, founder, medical and scientific director, and president and chief executive officer of the Institute for Myeloma and Bone Cancer Research and private practitioner in West Hollywood, California, described the factors associated with the overexpression of JAK in the bone marrow, which may constitute a prime survival factor for multiple myeloma. This overexpression may affect the checkpoint inhibitor proteins in the body, resulting in resistance to standard anti-myeloma therapies such as immunomodulatory drugs.

Additionally, he mentioned a patient case that had involved a scenario in which 

mutated multiple myeloma progressed following prior treatment with lenalidomide (Revlimid). According to Berenson, the disease’s resistance to lenalidomide was primarily associated with proteins driven by JAK; subsequent treatment involving JAK inhibition proved successful in restoring the efficacy of lenalidomide.

Based on a rationale to target JAK overactivity in the bone marrow and results from this patient case, Berenson and colleagues have focused on researching ruxolitinib as a therapeutic candidate for potentially improving outcomes in multiple myeloma via JAK inhibition. Findings from a phase 1 trial (NCT03110822), for example, have demonstrated that the efficacy and tolerability of ruxolitinib plus methylprednisolone can be extended with lenalidomide in those with multiple myeloma. Additionally, other ongoing trials aim to combine ruxolitinib with agents such as selinexor (Xpovio).

“The question is, where will ruxolitinib sit in the sequencing of treatment of [patients with] multiple myeloma? Where will selinexor be?” Berenson stated. “At this point, there's certainly been low use of these drugs, especially ruxolitinib in multiple myeloma. We hope, with a more positive signal, these drugs will move further up in the algorithm of how you treat multiple myeloma.”

Berenson JR, Limon A, Rice S, et al. A phase I trial evaluating the addition of lenalidomide to patients with relapsed/refractory multiple myeloma progressing on ruxolitinib and methylprednisolone. 

. 2024;19(3):343-357. doi:10.1007/s11523-024-01049-w

James R. Berenson, MD, describes ongoing efforts to evaluate treatment with JAK inhibitors like ruxolitinib among patients with multiple myeloma.

Exploring the Potential Role of JAK Inhibitors in Multiple Myeloma

 spoke with multiple registered nurses about research they presented on safely administering treatment options such as CAR T-cell therapy and bispecific T-cell engager (BiTE) therapy in patients with multiple myeloma and other malignancies.

 a registered nurse at the University of Rochester Medical Center, highlighted the management of adverse effects including peripheral neuropathy in patients with multiple myeloma undergoing treatment with ciltacabtagene autoleucel (cilta-cel; Carvykti). He discussed these treatment strategies in the context of a presentation he gave on findings from the 

 in which investigators assessed treatment with cilta-cel in those who were refractory to lenalidomide (Revlimid).

According to Applewhite, cilta-cel may offer “another path” aside from standard treatment options such as chemotherapy and give “more time” to patients with multiple myeloma.

 a nurse coordinator at Stanford Healthcare, highlighted the importance of identifying and mitigating cranial nerve palsy (CNP) in patients with multiple myeloma who are treated with cilta-cel. At the conference, 

Bennett presented data on CNP outcomes across various studies,

 which included the phase 1/2 CARTITUDE-1 trial (NCT03548207), phase 2 CARTITUDE-2 trial (NCT04133636), and phase 3 CARTITUDE-4 trial (NCT04181827).

According to findings from this presentation, patients had CNP onset at a median of approximately 3 weeks after beginning treatment with cilta-cel. Most cases of CNP tended to occur in male patients.

clinical program director at Johns Hopkins Hospital and Johns Hopkins Health System, spoke about a study designed to evaluate the feasibility and safety of using BiTE therapy to treat those with cancer in an outpatient setting.

 Mooney emphasized multidisciplinary collaboration among nurses, pharmacy providers, and social workers as part of monitoring patients for toxicity as they undergo treatment with BiTE agents.

Applewhite I, Elfrink G, Esselmann J, Lonardi C, Florendo E, Sidiqi MH. Efficacy and adverse events after ciltacabtagene autoleucel treatment in the CARTITUDE-4 as-treated population consisting of patients with lenalidomide-refractory multiple myeloma who received 1-3 prior lines of therapy. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

Bennett L, Kruyswijk S, Sidana S, et al. Incidence and management of cranial nerve impairments in patients with multiple myeloma treated with ciltacabtagene autoleucel in CARTITUDE studies. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

Mooney K, Allen N, Anderson K, Zukas A. Taking a BiTE out of hospital admission days using a team approach to managing patients at risk for treatment related toxicities. Presented at: 2024 Oncology Nursing Society Congress; April 24-28, 2024; Washington, DC.

Oncology Nursing Society’s Annual Meeting (ONS)

Registered nurses discuss research related to agents like ciltacabtagene autoleucel presented at the 2024 Oncology Nursing Society Congress.

Administering CAR T-Cell Therapy and Bispecific Agents in Nursing Practice

 Frontline Forum program, Joselle Cook, MBBS; Matthew James Pianko, MD; Luciano Costa, MD, PhD; and Timothy Schmidt, MD, reviewed key data updates and real-world practice findings in newly diagnosed multiple myeloma (NDMM), and how they may impact patient subgroups including those with transplant-ineligible NDMM.

Cook, a hematologist specializing in the management of patients with multiple myeloma at the Mayo Clinic in Rochester, Minnesota; and Pianko, a hematologist in the Division of Hematology and Oncology at The University of Michigan-Ann Arbor, led one part of the discussion. They discussed efficacy results from studies including the phase 3 MAIA study (NCT02252172), which assessed daratumumab (Darzalex) plus lenalidomide (Revlimid) and dexamethasone vs lenalidomide plus dexamethasone in previously untreated multiple myeloma. They also spoke about the selection of patients with transplant ineligible multiple myeloma for triplet vs doublet induction therapy regimens and potential disparities in care for patients of racial and ethnic minorities.

“We need trials to accommodate patients who are working [and patients] who are unpartnered, [and] we need to do more to understand the biologic drivers [of multiple myeloma] in Black patients,” Cook said. “Even though we have this explosion of [new] therapies onto the scene, we still have so much to do to make access to these novel treatments accessible and more equitable for everyone.”

Costa, a professor of Medicine and director of the Multiple Myeloma Program at The University of Alabama at Birmingham, and Schmidt, assistant professor in the Division of Hematology, Medical Oncology, and Palliative Care within the Division of Medicine at The University of Wisconsin, also discussed updates in the multiple myeloma space, which included a review of findings from the phase 2 GRIFFIN trial (NCT02874742). In this trial, investigators assessed daratumumab plus lenalidomide, bortezomib (Velcade), and dexamethasone as a treatment for patients with transplant-ineligible NDMM. Costa and Schmidt also spoke about approaching consolidation and maintenance therapy for patients with transplant-ineligible NDMM.

“As we’re trying to move treatments into earlier lines of therapy—particularly things like bispecifics and CAR T—improving access is [something] that we as a field and as a community need to address,” Schmidt said.

Don’t forget to subscribe to the “Oncology On-The-Go” podcast on 

Transforming Transplant-Ineligible Newly Diagnosed Multiple Myeloma: From Real-World Evidence to Clinical Practice

Experts discuss key data updates in real-world newly diagnosed multiple myeloma practices, and how these findings may change the treatment paradigm.

Frontline Forum: Real-World Practice in Newly Diagnosed Multiple Myeloma

In a Twitter Spaces edition of the Oncology-On-The-Go podcast, Rafael Fonseca, MD and Krina Patel, MD, MSc spoke with CancerNetwork

 about how key findings from multiple myeloma trials presented at the 

2023 American Society of Clinical Oncology (ASCO) Annual Meeting

Fonseca, director of Innovation and Transformation Relationships at the Mayo Clinic in Phoenix, Arizona and Patel, an associate professor in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, detailed results from the 

) assessing teclistamab-cqyv (Tecvayli) plus talquetamab in those with relapsed/refractory multiple myeloma.

In the RedirectTT-1 trial, investigators reported an objective response rate (ORR) of 86.6% across all dose levels and 96.3% at the recommended phase 2 dose.

 Additionally, the combined complete response (CR) or stringent CR rate was 40.2% and 40.7% at each respective dose level.

Another trial of interest that Fonseca and Patel discussed included 

the phase 2 LINKER-MM1 trial (NCT03761108)

 evaluating linvoseltamab (REGN5458) in relapsed/refractory multiple myeloma. In the study, the agent elicited an ORR of 71% at the 200 mg dose level.

 Moreover, the CR rate was 14%, the very good partial response (PR) rate was 29%, and the PR rate was 12%. The estimated 6-month progression-free survival (PFS) rate among patients receiving the regimen was 72.7%.

Fonseca and Patel also discussed results from the 

 comparing ciltacabtagene autoleucel (cilta-cel; Carvykti) with standard of care in lenalidomide (Revlimid)-refractory multiple myeloma. In patients receiving cilta-cel, the median PFS was not reached (NR, 95% CI, 22.8 months-not estimable [NE]) vs 11.8 months (95% CI, 9.7-13.8) among those receiving standard of care.

 The 12-month PFS rate in each respective arm was 76% vs 49%.

Cohen YC, Morillo D, Gatt ME, et al. First results from the RedirecTT-1 study with teclistamab (tec) + talquetamab (tal) simultaneously targeting BCMA and GPRC5D in patients (pts) with relapsed/refractory multiple myeloma (RRMM). 

. 2023;41 (suppl 16):8002. doi:10.1200/JCO.2023.41.16_suppl.8002

Lee HC, Bumma N, Richter JR, et al. LINKER-MM1 study: Linvoseltamab (REGN5458) in patients with relapsed/refractory multiple myeloma. 

. 2023;41(suppl 16):8006. doi:10.1200/JCO.2023.41.16_suppl.8006

Dhakal B, Yong K, Harrison SJ, et al. First phase 3 results from CARTITUDE-4: Cilta-cel versus standard of care (PVd or DPd) in lenalidomide-refractory multiple myeloma. 

 2023;41(suppl 17):LBA106. doi:10.1200/JCO.2023.41.17_suppl.LBA106

San-Miguel J, Dhakal B, Yong K, et al. Cilta-cel or standard care in lenalidomide-refractory multiple myeloma. 

. Published online June 5, 2023. doi:10.1056/NEJMoa2303379

ASCO Annual Meeting: Hematology

Experts from Mayo Clinic and The University of Texas MD Anderson Cancer Center discuss results from multiple myeloma trials presented at the 2023 American Society of Clinical Oncology Annual Meeting and how they may apply to clinical practice.

Relapsed/Refractory Multiple Myeloma Trial Updates From ASCO 2023

 during March’s Myeloma Awareness Month, Krina Patel, MD, MSc, spoke about disparities in outcomes and clinical trial access for patients with multiple myeloma.

Patel, associate professor in the Department of Lymphoma/Myeloma in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discussed previous research focusing on how factors including gender, race, and ethnicity correlated with treatment outcomes with autologous hemopoietic stem cell transplantation and CAR T-cell therapy.

She also detailed ongoing efforts from organizations such as the FDA and the International Myeloma Foundation on increasing enrollment of underserved patient groups on clinical trials as well as financial initiatives that may help to reduce barriers to treatment including transportation. 

Contemporary Concepts in Hematologic Oncology

Krina Patel, MD, MSc, discusses research and initiatives that may help to mitigate disparities in patients with multiple myeloma including factors such as gender, race, and ethnicity.

Oncology On-The-Go Podcast: Multiple Myeloma Outcome Disparities, Trial Access

As part of its Between the Lines™ video series, CancerNetwork® spoke with Paul G. Richardson, MD, clinical program leader and director of Clinical Research for the Jerome Lipper Multiple Myeloma Center at Dana-Farber Cancer Institute in Boston, Massachusetts, and Christina Gasparetto, MD, professor of medicine at Duke University Medical School in Durham, North Carolina, about recent updates in the use of proteasome inhibitors for patients with multiple myeloma.

In the video series, Richardson and Gasparetto discussed the following:

Overview of proteasome inhibitor therapy in multiple myeloma

Real-world data with proteasome inhibitors

The phase 3 TOURMALINE-MM1 trial (NCT01564537) of ixazomib therapy in relapsed/refractory multiple myeloma

Ixazomib plus pomalidomide and dexamethasone in patients with relapsed or refractory multiple myeloma

Be sure to tune in to other videos in the 

CancerNetwork® Between the Lines™ series

Updates in Use of Proteasome Inhibitors for Relapsed/Refractory Multiple Myeloma 

Paul G. Richardson, MD, and Christina Gasparetto, MD, offer insights into the use of proteasome inhibitors in relapsed or refractory multiple myeloma.

Between the Lines™ Podcast: Updates in Use of Proteasome Inhibitors for Relapsed/Refractory Multiple Myeloma

The feature article for this episode comes from the April issue of the journal

Treatment Considerations for Transplant-Ineligible Multiple Myeloma

.” Sarah A. Holstein, MD, PhD, an associate professor of internal medicine in the Division of Oncology & Hematology at University of Nebraska Medical Center in Omaha, spoke about the need for further research into treatment options for the older and frailer patient population of multiple myeloma.

Holstein also explained the importance of understanding results from multiple myeloma clinical trials through the lens of how they apply to this specific transplant-ineligible population.

Don’t forget to subscribe to the "Oncology Peer Review On-The-Go" podcast on Apple Podcasts, Spotify, or anywhere podcasts are available.

CancerNetwork®’s podcast dives into an article focused on treatment options for older, transplant-ineligible patients with multiple myeloma.

Oncology Peer Review On-The-Go: Treatment Considerations for Transplant-Ineligible Multiple Myeloma

As part of our coverage of the American Society of Hematology (ASH) Annual Meeting & Exposition, being held December 9–12 in Atlanta, we are speaking with Faith Davies, MD, about molecular remission in multiple myeloma. Dr. Davies is a professor of medicine and deputy director of the Myeloma Institute at the University of Arkansas for Medical Sciences in Little Rock. She is giving a talk titled, “Is Molecular Remission the Goal of Multiple Myeloma Therapy?” during an education session at the conference.

First, Dr. Davies, can you provide a brief overview of the types of therapies that are used to treat multiple myeloma?

We actually have an array of therapies and in some ways, multiple myeloma is a hematologic malignancy that has had the most expansion in the number of therapies over the last few years. We have a number of different groups of therapies. There are the immune-modulatory drugs such as lenalidomide, thalidomide, and pomalidomide; and we have the proteasome inhibitors such as bortezomib, carfilzomib, and ixazomib. We still use the traditional chemotherapy drugs such as cyclophosphamide and melphalan, and we now have some antibodies that are also used such as daratumumab and elotuzumab.

Essentially the recent studies have shown that, as a general rule, three drugs tend to be better than two, and ideally we want to pick drugs from those different groups as combinations. It is quite common as an induction therapy to use an immune-modulatory drug with a proteasome inhibitor and a steroid, for example. In the relapse setting it is probably more common to use an antibody such as daratumumab or elotuzumab with either with one of the immunologic drugs or a proteasome inhibitor. This has given us the ability to mix and match drugs and really trying to aim to ensure that we are able to give a patient a drug that is not only effective for them but has a safety profile attached to it.

What is the role of transplant for patients with multiple myeloma, where does that modality come in during the course of treatment and for which patients?

We are still using transplants an awful lot. It is most appropriate for patients who are younger and fitter and have a relatively good performance status. In the majority of the time, the transplant is conditioned with melphalan, and we tend to use an autologous transplant rather than an allogeneic transplant. There was a large study from a French group, which I talked about at last year’s ASH meeting, where patients still seemed to benefit from an autologous transplant in the first treatment course compared to just using some of the newer agents we’ve been talking about.

In this interview we discuss the goals of therapy in multiple myeloma, treatment combinations and transplantation, and how markers such as minimal residual disease are used.

Multiple Myeloma

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