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Axel Stuart Merseburger, MD, PhD, explained that with TKIs like axitinib, it is necessary for oncology nurses to spend time with each patient to provide the best care.

Becoming Familiar With Patients’ AEs is Essential, Says Expert

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

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Median time to sustained worsening of symptoms was 23.7 months with cilta-cel, compared with 23.7 months with SOC.

Cilta-Cel Associated With Higher HRQOL for Lenalidomide-Refractory MM

Kristi Rosa joined MJH Life Sciences in 2016 and has since held several positions within the company. Prior to working at the company, she served as lead copywriter and marketing coordinator at The Strand Theater. Email: krosa@onclive.com

The FDA granted SIGX1094 fast track status as a treatment option for diffuse gastric cancer.

SIGX1094 Receives FDA Fast Track Designation in Diffuse Gastric Cancer

Amanda Brink is a nurse practitioner at the University of Texas MD Anderson Cancer Center. When she is not tending to patients in the hospital or clinic, she finds great satisfaction in crafting content to enlighten the public and her fellow nurses about a range of health topics.

Similar to financial toxicity, time toxicity can have a profound impact on a patient’s quality of life.

Opinion: Oncology Nurses Can Ease the Burden of Time Toxicity in Cancer Care

AUTX-703, a novel, oral KAT2A/B degrader, has received fast track designation for use in relapsed/refractory AML.

FDA Fast Track Designation Given to AUTX-703 in Relapsed/Refractory AML

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Julia Manna, LMSW, Oncology Social Worker

The 3 fundamental coping mechanisms patients should have embedded into their care plan are self-compassion, gratitude, and kindness. 

The Transformative Power of Self-Compassion, Gratitude, and Kindness in Cancer

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

Empowering Community Oncologists in the Era of CAR-T Therapy

Video content above is prompted by the following:

How can academic centers and community practices work together effectively to deliver the best long-term care for CAR-T patients?

What resources or training programs have you found useful for community oncologists caring for CAR-T survivors?

How do you manage referrals for long-term follow-up between community and academic settings?

The conversation explores strategies for collaboration between academic centers and community practices in delivering optimal long-term care for CAR-T patients, highlighting useful resources for community oncologists and approaches to managing referrals for follow-up care.

Real World Experience of CAR-T in MM Patients

What are the essential components of patient education and support for long-term CAR-T survivors?

How do you support patients in sustaining their quality of life and managing potential late effects of therapy?

Are there any differences in long-term care needs between recipients of ide-cel and cilta-cel?

The discussion focuses on essential components of patient education and support for long-term CAR-T survivors, addressing strategies to sustain quality of life, manage late therapy effects, and meet the distinct long-term care needs of ide-cel and cilta-cel recipients.

Importance of Multidisciplinary Approach in Care of CAR-T MM Patients

How do you incorporate multidisciplinary collaboration in the ongoing care of CAR-T patients?

What methods have you found effective for coordinating among specialists, primary care providers, and community oncologists?

How do you maintain consistent communication and continuity of care, especially for patients like Jackson who may be located far from specialty centers?

The discussion highlights the role of multidisciplinary collaboration in CAR-T patient care, emphasizing effective coordination among specialists, primary care providers, and community oncologists, and strategies for ensuring consistent communication and continuity of care for patients in remote locations.

Approach to Long-Term Management of CAR-T MM Patients

What is your approach to the long-term monitoring of CAR-T patients?

In what ways does this monitoring vary between academic and community settings?

Are there any new long-term adverse effects emerging as we gain more experience with CAR-T therapy?

The discussion delves into long-term monitoring strategies for CAR-T patients, exploring differences between academic and community settings and emerging long-term adverse effects as clinical experience with CAR-T therapy grows.

Strategies for Managing Cytopenias and Infection Prophylaxis with CAR-T Therapy

Beyond CRS and neurotoxicities, are there other adverse events that require particular attention?

How do you address prolonged cytopenias following CAR-T infusion?

What is your approach to infection prophylaxis and management in these patients?

Are there any distinct adverse events associated specifically with ide-cel or cilta-cel that clinicians should be aware of?

The conversation examines adverse events beyond CRS and neurotoxicities in CAR-T therapy, focusing on strategies for managing prolonged cytopenias, infection prophylaxis, and unique adverse events associated with ide-cel and cilta-cel.

Julia Manna, LMSW

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