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Avelumab in combination with axitinib was found effective and safe as frontline treatment for advanced RCC in real-world findings.

Real-World Data Back First-Line Avelumab and Axitinib in Advanced RCC

Patient-reported outcomes were consistent between patients with RCC using tivozanib/nivolumab and tivozanib monotherapy according to study findings.

Person acute kidney injury Comprehensive image overview of kidneys showing sudden loss of function | Image Credit: © Premium Graphics - stock.adobe.com.

Tivozanib Combo Yields Similar PROs to Monotherapy in Advanced Clear Cell RCC

Katy Beckermann, MD, PhD, explained that oncology nurses and APPs should be ready to administer and explain dose modifications for patients with RCC.

Dose Reductions Possible for Tivozanib With and Without Nivolumab for RCC

According to Laurence Albiges, MD, PhD, treatment of RCC with cabozantinib, nivolumab, and ipilimumab can cause potentially serious toxicities that should be closely monitored.

Nivolumab Combo for RCC Necessitates AE Monitoring, Awareness

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Caroline Seymour joined MJH Life Sciences in 2018 and has expertise in video production and print/digital publication. Email: cseymour@onclive.com​

The NCCN updated its guidelines to clarify the role of ctDNA as a biomarker for recurrence risk in colon and rectal cancer and for disease monitoring in Merkel cell carcinoma.

NCCN Guideline Updates on ctDNA Stance in MCC and Colon, Rectal Cancer

Erica S. Doubleday, MS, FNP-C, BSN, RN, discussed taking advantage of available resources to provide comprehensive care for patients with breast cancer.

Utilizing Resources to Educate Oncology Nurses, APPs on Latest Advances in Breast Cancer

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Oncology rapid-access clinics should be essential to patient care standards across the oncology continuum.

Oncology Rapid Access Clinics: APPs Improve Outcomes for Acutely Ill Patients

While high-risk multiple myeloma can be difficult to treat with aggressive therapies, treatment considerations with the help of diagnostic tools may prove helpful when determining when to de-escalate treatment for certain patients.

At a recent Community Case Forum hosted by Oncology Nursing News, Mark Davis, PA-C, a physician assistant from Texas Oncology, Southwest Forth Worth Cancer Center, and colleagues discussed disease burden and diagnostic tools, as well as risk stratification and treatment approaches in high-risk multiple myeloma.

“In terms of risk stratification, we use the International Staging System [ISS], which is more or less the old way of doing it…” Davis explained during the event, adding that providers use the revised ISS with lactate dehydrogenase (LDH) levels and high-risk cytogenetics of chromosomal abnormalities. “So somebody who has a double-hit myeloma, that means they have 2 chromosomal abnormalities, and that is going to put them at a higher risk classification.”

Factors associated with high-risk disease or the progressive relapse setting include those with newly diagnosed myeloma who have a revised ISS of III, extramedullary disease, circulating plasma cells, and cytogenic abnormalities. For patients with newly diagnosed multiple myeloma, cytogenic abnormalities associated with high risk for disease progression or relapse include Del(1p32), t(4;14), t(14;16), t(14;20), Del(17p) or monosomy 

 mutation, 1q21 gain or amplification, and MYC translocation.

“As an [advanced practice provider (APP)] we can really help clinicians not only identify high-risk patients based on cytogenetics but also those who have a short course of remission and identify them as high risk as well,” Davis said in an interview with Oncology Nursing News. “And so patients who have disease progression within 2 years of their induction therapy, [that] automatically puts them in a subgroup of high-risk disease. And we are trying to tailor therapies differently in those patient populations that have more aggressive disease.”

Factors that may impact treatment for patients include their personal preferences, physical activity, work productivity, comorbidities, quality of life, disease symptoms and control, treatment-related toxicities that could lead to discontinuation, treatment convenience (oral vs intravenous), and financial toxicity.

With high-risk myeloma, it is a disease that can be difficult to treat. To further complicate management, many patients are unable to receive intense treatment because of comorbidities.

At the Community Case Forum, Davis presented a case of a 76-year-old female with ISS stage II myeloma, who is not eligible for a transplant and also presents with early-stage Parkinson’s disease that is currently controlled with treatment. At diagnosis, she presented with severe lower back and neck pain, has experienced increasing fatigue and mobility challenges, and reported with an ECOG performance status of 1.

The case, Davis noted, highlights certain patients’ inability–for example, older, frail, or transplant-ineligible patients–to receive aggressive therapy, whether considered high risk or not, and, in turn, the need for treatment de-escalation.

The attendees were polled on what regimen should be prescribed for the frontline treatment of this patient, including:

bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (VRd), which included CRd lite;

daratumumab (Darzalex) plus lenalidomide and dexamethasone (Dara-Rd);

ixazomib (Ninlaro) plus lenalidomide and dexamethasone (Ixa-Rd); or

a quadruplet regimen like Dara-VRd or Dara-VMP)

Results were evenly divided-50% of respondents said that they would consider VRd while the other half were in favor of Dara-Rd.

“Both of those responses are on par to what we would expect,” Davis said. “…Frail and elderly patients are technically considered high-risk patients because historically, they’re unable to go with more aggressive therapies that include transplants.”

He added that these patients will also often be offered, in the community setting, a doublet that has inferior results due to concerns of toxicity. “More recent data from the MAIA study [NCT02252172]

 showed similar tolerance in older patients who were treated with Dara-RD vs Rd. Hopefully, this data will encourage clinicians to move further away from doublets even in our frail patients.”

Similarly, he added, often patients who are elderly or frail would not be offered a quadruplet regimen either. “You're often going to have to de-escalate [treatment] in some form or fashion.”

To aid in predicting long-term remission, the use of minimal residual disease (MRD) is growing in the multiple myeloma landscape.

“There's now studies ongoing about de-escalating therapy based on MRD, but also just even outside of that, from a prognostic value, it's more accurate than our M spikes,” Davis explained. “…MRD is most valuable when patients are wanting to de-escalate, and this could be a leverage point.”

In the case study, the patient was treated with frontline Dara-Rd. Following 9 months of treatment, she presented with an ECOG performance score of 2, a complete remission that was followed by a partial response at month 1 and very good partial response at month 8, with stable chemistry labs. In addition, the patient experienced grade 3 neutropenia that lasted for 1 cycle of treatment and appeared refractory to a single dose of granulocyte colony-stimulating factor. Her imaging revealed no new findings.

At 12 months, the patient’s ECOG performance score was 1 and she is stable in CR, chemisty and hematology labs, and continuance of no new findings on her imaging. Of note, her Parkinson’s disease remained in control with daily functioning that was consistent with baseline findings.

“MRD negativity at 12 months alone has also been associated with overall survival improvement. So again, it just highlights, for us, the relevance of deepening responses and maintaining somebody in a state of undetectable disease,” he said, highlighting that MRD negativity led to a median progression-free survival of 63 months, compared 27 months among patients with CR achievement, based on data from a pooled analysis of 3 Pethema/GemDavis clinical trials.

NCCN. Clinical Practice Guidelines in Oncology. Multiple myeloma, version 1.2025. Accessed December 12, 2024. 

https://www.nccn.org/professionals/physician_gls/pdf/myeloma.pdf

Facon T, Kumar S, Plesner T, et al. Daratumumab plus Lenalidomide and Dexamethasone for Untreated Myeloma. 

. 2019;380:2104-2115. doi:10.1056/NEJMoa1817249.

Lahuerta JJ, Paiva B, Vidriales MB, et al. Depth of Response in Multiple Myeloma: A Pooled Analysis of Three PETHEMA/GEM Clinical Trials. 

. 2017;35(25):2900-2910. doi:10.1200/JCO.2016.69.2517.

“Treatment effectiveness can have different meanings to patients,” a physician assistant said when discussing therapy for high-risk myeloma. 

High-Risk Myeloma Treatment Is Not One-Size-Fits-All

Patient Education: Preparing Patients for Bispecific Treatment in R/R MM

Video content above is prompted by the following:

How do you approach patient education regarding potential adverse events associated with talquetamab and other bispecific therapies?

John’s Journey with R/R MM

68-year-old male, construction worked, diagnosed with multiple myeloma 10 years ago

Initial treatment: bortezomib, lenalidomide, and dexamethasone, daratumumab, pomalidomide, dexamethasone, carfilzomib, elotuzumab and BCMA directed CAR T therapy

History of hypertension, respiratory infections (2 episodes of pneumonia and multiple episodes of bronchitis), type 2 diabetes – all have been managed well, active lifestyle, strong support system

Eva’s Treatment Journey with R/R MM

Managing and Monitoring Infections and Neurological Toxicities in Patients Receiving Bispecific Therapies

How do you approach the prevention and management of infections in patients receiving bispecific therapies, particularly considering the unique target of talquetamab (GPRC5D)? 

What are your protocols for monitoring and managing neurological toxicities in patients receiving bispecific therapies?

Are there any specific considerations for talquetamab?

Dr. Mohan discusses with Nurse Goff and Nurse Brigle the prevention and management of infections and neurological toxicities in patients receiving bispecific therapies, with a particular focus on the unique considerations of talquetamab targeting GPRC5D.

Handling Dose Modifications and Treatment Interruptions Due to AEs With Bispecifics

How do you handle dose modifications or treatment interruptions due to AEs?

Can you share any experiences where such modifications significantly impacted patient outcomes?

Dr Mohan discusses with Nurse Distaso and Dr Nadeem approaches to handling dose modifications or treatment interruptions due to adverse events (AEs), including experiences where these adjustments significantly impacted patient outcomes.

Emily Ryttse, MSN, FNP-C

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