Expert Interviews

Panelists discuss how patients typically respond well to chimeric antigen receptor (CAR) T-cell therapy with manageable adverse effects (AEs), including expected cytokine release syndrome (CRS) presenting as fever, whereas rare neurotoxicity is closely monitored through frequent cognitive testing and treated with steroids and late immune system effects like urinary tract infections (UTIs), respiratory infections, and shingles occur in the first 6 months post treatment but resolve with appropriate medications and prophylactic treatments, with outcomes improving significantly when CAR T is used earlier in treatment lines rather than after patients have exhausted all other options.

Panelists discuss how patients with multiple myeloma can achieve excellent quality of life with bispecific therapies like talquetamab despite manageable adverse effects, with Karen sharing her advice to embrace treatment opportunities, accept a "new normal," and focus on the meaningful life experiences these innovative therapies enable, including her recent trip to Italy and time with 6 grandchildren she wouldn't have met without these advancing treatments.

Panelists discuss how nursing support for chimeric antigen receptor (CAR) T-cell therapy success involves providing comprehensive educational materials covering everything from collection to survivorship, conducting virtual CAR T classes, and adapting to new outpatient CAR T protocols where patients receive cells and go home with vital sign monitoring equipment for caregivers. The panelists also celebrate recent FDA regulatory changes that reduced required stay times from 4 weeks to 2 weeks and driving restrictions from 8 weeks to 2 weeks, making CAR T therapy more accessible by allowing patients to return to work and normal life sooner, with reduced financial burden on families.

Dordaviprone was recommended at a dose of 625 mg orally once weekly for adults, and the recommended dosage is based on body weight for pediatric patients.

Extended follow-up for individuals with H3K27M-mutated diffuse midline glioma may help explain the duration of response across patient subgroups.

An expert discusses that combining the bispecific antibodies teclistamab and talquetamab has shown promising efficacy and manageable toxicity in heavily pretreated multiple myeloma patients—including those with extramedullary disease—offering a compelling dual-targeted option for high-risk cases while allowing flexibility in sequencing for slower-progressing disease.

Geraldine O’Sullivan Coyne, MD, PhD, MRCPI, described the excitement of seeing novel molecules such as antibody-drug conjugates become more prominent.

Ronald Bleday, MD, credits a chronic pain clinic for consulting patients who may be at a greater risk for prolonged opioid use following surgery.

Panelists discuss how voracidinib shows superior brain penetration compared to other IDH inhibitors and explore exciting combination approaches with immunotherapy and vaccines that target the immunosuppressive effects of 2-HG in the tumor microenvironment.

The primary end points of the EPCORE FL-1 trial were met while assessing an epcoritamab-based combination for patients with R/R follicular lymphoma.

Panelists discuss how to implement hepatotoxicity monitoring protocols, counsel patients about avoiding hepatotoxic substances, and manage the infrequent but manageable liver enzyme elevations that typically occur within the first 6 months of treatment.

Panelists discuss how their key takeaways emphasize the importance of communication and collaboration between academic centers and community practices to ensure equitable access to bispecific therapies, highlighting that it’s an exciting time in myeloma treatment with patient-friendly options that can be administered closer to home, and concluding that virtually no patient should be denied exposure to bispecific therapy before discontinuing treatment, while anticipating that de-escalated Q4 weekly schedules and trispecific agents will transform current practice patterns in the coming years.

Oncology Decoded provides the current management of metastatic bladder cancer, recent advancements in systemic therapy, patient selection, and AE mitigation.

Ronald Bleday, MD, stated that before standardizing a stepwise approach to treating surgical pain, providers might have overtreated patients with opioids.

Panelists discuss how comprehensive supportive care strategies for GPRC5D bispecifics like talquetamab involve managing unique toxicities including taste and smell changes, skin and nail effects, and gastrointestinal issues, with one patient emphasizing her philosophy of addressing adverse effects as they arise rather than anticipating them, while highlighting the importance of continued research funding for innovative treatments that have extended her survival beyond initial prognosis.

Panelists discuss how shared clinical decision-making in chimeric antigen receptor (CAR) T-cell therapy involves seamless coordination between physicians and nurse coordinators who streamline the referral process for patients after first-line therapy failure, with coordinators managing logistics like condensing multiple appointments, arranging travel and lodging benefits through CAR T companies for out-of-state patients, providing clear communication in “nurse talk” rather than medical jargon, and emphasizing that the referral process is straightforward—encouraging oncologists not to wait but to send patients immediately after 1 line of therapy so the team can handle insurance approval and T-cell collection while patients return home during the 4- to 8-week manufacturing period.

Panelists discuss how patients with relapsed/refractory (R/R) multiple myeloma experience the challenging process of confirming disease recurrence through bone marrow biopsies and PET scans, often struggling with difficult treatment regimens like immunotherapy and daily lenalidomide (Revlimid) that cause severe illness, leading patients to advocate for themselves by researching alternative therapies like chimeric antigen receptor (CAR) T-cell therapy through educational materials and videos, ultimately seeking second-line treatments that offer the appeal of “one and done” therapy with less ongoing chemotherapy compared with traditional lifelong treatment approaches.

“It’s a treatment for those patients who don’t have any other effective treatments available,” said Muhammad Umair Mushtaq, MD, on lifileucel in melanoma.

Panelists discuss how the step-up dosing strategy for talquetamab involves graduated dose escalation from 0.01 to 0.06 mg/kg before reaching therapeutic levels to minimize severe cytokine release syndrome, with real-world data showing 85% to 86% of patients can safely receive outpatient step-up dosing, though one patient’s inpatient experience was chosen due to her drug allergies and travel distance considerations.

Conducting trials safely within a community setting lies at the heart of a successful collaboration between Northwell Health and START.

“There is margin to improve on these treatments, but this is a real hope for patients with melanoma,” said Mushtaq on TIL therapies.

Experts at the 2025 National ICE-T Conference discussed the need for improved management of toxicities in patients with leukemia.

The expertise of START's network may streamline the availability of clinical trial enrollment and novel treatment options among patients with cancer.

An expert explains that teclistamab has proven to be a highly effective and well-tolerated therapy for relapsed/refractory multiple myeloma in real-world settings, with outcomes mirroring clinical trials and improved infection management strategies enhancing its safety and accessibility for a broader range of patients.

“Every patient [with multiple myeloma] should be offered CAR T before they’re offered a bispecific, with some rare exceptions,” said Barry Paul, MD.

A new START center in New York may give patients with advanced malignancies an opportunity to access novel therapies in the community setting.

Barry Paul, MD, listed cilta-cel, anito-cel, and arlo-cel as 3 of the CAR T-cell therapies with the most promising efficacy in patients with multiple myeloma.

START is the largest early-phase oncology network in the community-based setting, according to Geraldine O’Sullivan Coyne, MD, PhD, MRCPI.

Jose Sandoval Sus, MD, discussed standard CAR T-cell therapies in patients across multiple high-risk lymphoma indications.

Panelists discuss evolving treatment strategies for metastatic melanoma with asymptomatic brain metastases, highlighting the superiority of PD-1 plus CTLA-4 combination therapy for durable intracranial responses, while noting that newer immunotherapy combinations like PD-1 plus LAG-3 show promise but require further evidence before altering current standards of care.