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Adding E-602 to cemiplimab demonstrated anti-tumor effects in patients PD-L1–resistant solid cancers. 

Novel Drug Combo Is Promising for PD-L1-Resistant Solid Cancers

Mitazalimab combined with mFOLFIRINOX led to responses and survival benefits in patients with metastatic pancreatic ductal adenocarcinoma. 

Mitazalimab Plus mFOLFIRINOX Improves Survival in Pancreatic Cancer

The novel drug SHR-A1921 was safe and efficacious in patients with platinum-resistant ovarian cancer, according to phase 1 data. 

Novel ADC Shows Promise in Platinum-Resistant Ovarian Cancer

Docetaxel was associated with lower rates of peripheral neuropathy compared with paclitaxel for Black patients with breast cancer. 

Chemo Should be Tailored to Decrease Neuropathy in Black Patients

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Lunresertib plus camonsertib showed promising efficacy in advanced endometrial and platinum-resistant ovarian cancers, with ORRs of 25.9% and 37.5%, respectively.

Lunresertib/Camonsertib Combo Yields Promising Response in Gynecologic Cancers

Nurse Practitioner at West Cancer Center & Research Institute

Heather Greene, MSN, FNP, AOCNP, shares insight into the use of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma.

RX Road Map: Erdafitinib (Balversa)

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

The haplotype is more common in patients achieving a complete hematologic response, indicating its potential as a treatment response biomarker.

Ropeginterferon Alfa-2b Response Improves With NFKB1 Haplotype in PV and ET

Patients treated with ide-cel, Abecma for relapsed/refractory multiple myeloma affecting the central nervous system had similar outcomes to matched patients with non-CNS multiple myeloma.

Real-World Use of Ide-cel Provides Favorable Outcomes in CNS Myeloma

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 Beth Finley-Oliver, MSN, ARNP, AGNP-BC, a nurse practitioner who works in the outpatient hematology clinic at Moffitt Cancer Center, revisits her presentation from the 2023 JADPRO Live Annual Meeting and discusses the growing number of therapies for patients with relapsed or refractory multiple myeloma.

“A clinical trial upfront would be my first option. After that, I have to try and find something their myeloma hasn't seen yet.”

“With CAR T, the CRS incidence is higher, and I think we're doing better [at managing it] because we have multiple interventions. We see viral infections with [both] the CAR T and the bispecifics. We always have to kind of keep that in the back of our mind.”

“The more medications we have, the more this is turning into a chronic illness.”

Delivering Teclistamab in the Outpatient Setting

Ambulation Improves Frailty Scores in Patients With Multiple Myeloma

With New Bispecific Antibodies in Multiple Myeloma, Nurses Need To Know How to Manage CRS

Managing Teclistamab-Induced CRS for Patients With Multiple Myeloma

Data Supporting Elranatamab Approval in Multiple Myeloma

Data Behind Talquetamab Approval in Multiple Myeloma

Beth Faiman Discusses Recent Changes in Multiple Myeloma Treatment Landscape

ASH Data Offer Treatment Direction for Oncology Nursing Professionals

A Look Back at 2022 FDA Approvals in Oncology

Conversations Around Selinexor: Best Nursing Practices in Multiple Myeloma

Beth Finley-Oliver, MSN, ARNP, AGNP-BC, recaps part of her presentation from the 2023 JADPRO meeting about caring for patients with high-risk multiple myeloma. 

Finley-Oliver Talks Talquetamab and Other Later Line Multiple Myeloma Therapies

, Beth Faiman, PhD, CNP, weighs in on the current trajectory of research and clinical practice in multiple myeloma.

Faiman is a nurse practitioner and researcher with the Cleveland Clinic, as well as a board member of the NP/PA Center of Excellence in Multiple Myeloma. According to her, one of the biggest changes of late was the publication of a study in 

, findings of which suggest that patients with biomarker-defined defined disease, as well as 60% or more bone marrow plasma cells (BMPCs), or a free light chain ratio (FLCratio) of at least 10, have a longer time to progression and a lower 2-year progression risk than was previously believed.

Whereas the median time to progression was previously reported to be 9.2 months, the new study found the median time to be 30.1 months. Moreover the 2-year progression risk was 45.45%, rather than the previously reported 85.21%.

As Faiman points out, in 2014, the International Myeloma Working Group had added patients with at least 60% BMPCs, FLCratio equal to or greater than 100, and greater than 1 MRI-defined focal lesion of at least 5 mm (SLiM CRAB multiple myeloma) to the diagnostic category of multiple myeloma. However, this newer review suggests that this classification may need to be revisited.

Faiman also touches on shifts in approved BCMA-directed therapies for patients, namely, the accelerated approval of teclistamab-cqyv (Tecvayli) in October of 2022, and the removal of belantamab mafodotin-blmf (Blenrep) from the market in November 2022.

 She notes that there are ongoing efforts to reincorporate belantamab mafodotin into clinical practice and that she is optimistic about reintroducing this treatment back into her practice—as the dosing schedule and toxicity profile was favorable for patients. 

“Supporting [a] patient while they are in their maintenance phase [of treatment]; checking the blood counts, keeping up [with] health maintenance, making sure their bones are strong and all those other supportive care things, are so important.”

“If you have a heavily pretreated patient on some of the new cellular therapies or bispecifics, that they have to be admitted to the hospital, we have to logistically manage who’s going to be admitted on what day and when.”

“The nice thing about belantamab was that it was an [intravenous] IV [therapy] every 3 weeks, it is directed against BCMA, and it was very well tolerated.”

Hematologic Oncology Undergoes Transformation With Drug Updates and Approvals

Teclistamab-cqyv Snags Accelerated Approval for Relapsed or Refractory Multiple Myeloma

Belantamab Mafodotin Will No Longer Be Available For Multiple Myeloma

Ocular Visits Are a Necessity for Patients With Multiple Myeloma Who Receive Belantamab Mafodotin

Ludwig H, Kainz S, Schreder M, Zojer N, Hinke A. SLiM CRAB criteria revisited: temporal trends in prognosis of patients with smoldering multiple myeloma who meet the definition of ‘biomarker-defined early multiple myeloma’-a systematic review with meta-analysis. 

. 2023;58:101910. doi:10.1016/j.eclinm.2023.101910

FDA approves teclistamab-cqyv for relapsed or refractory multiple myeloma. FDA. October 25, 2022. Accessed April 10, 2023. 

GSK provides an update on Blenrep (belantamab mafodotin-blmf) US marketing authorization. News release. GlaxoSmithKline. November 22, 2022. Accessed April 10, 2023. 

Beth Faiman, PhD, CNP, discusses reclassifying patients with multiple myeloma, the accelerated approval of teclistamab, and the removal of belantamab mafodotin from the US market. 

Initial therapy with isatuximab plus VRd followed by its addition to Rd maintenance therapy led to significantly improved MRD negativity and PFS in transplant-ineligible multiple myeloma.

Isatuximab Quadruplet Yields Rapid, Deep Responses in Newly Diagnosed Myeloma

Updated data from the DREAMM-7 trial support the use of belantamab mafodotin plus bortezomib/dexamethasone as a potential new standard of care in relapsed or refractory multiple myeloma, according to Vania Hungria, MD, PhD.

Belantamab Mafodotin Combo Yields Improved OS in Relapsed/Refractory Multiple Myeloma

Treatment with subcutaneous daratumumab significantly improved progression-free survival in patients with intermediate- or high-risk smoldering multiple myeloma.

Daratumumab Monotherapy Shows Survival Benefit in Smoldering Myeloma

An expanded analysis from the phase 3 CEPHEUS trial showed that daratumumab plus VRd improved MRD responses as well as progression-free survival among patients with transplant-ineligible or -deferred newly diagnosed multiple myeloma.

Adding Daratumumab to VRd Improves MRD Response in Newly Diagnose Myeloma

Lindsey Halbrook in an interview with Oncology Nursing News

Lifestyle preferences and baseline health status should be taken into account when deciding between CAR T-cell therapy versus bispecific antibodies for patients with pretreated relapsed or refractory multiple myeloma, explained Lindsey Halbrook, NP-BC, MSN.

Consider Patient Characteristics, Goals When Planning Myeloma Treatment

Halbrook is an advanced practice provider at the Colorado Blood Cancer Institute in Denver. In a recent interview with 

, she weighed the pros and cons of each type of therapy, mentioning that although bispecific antibodies may tend to be less toxic, patients have to come into the clinic each week to receive them. Conversely, CAR-T cell therapy tends to have an intense toxicity and monitoring period upfront, but then patients do not need to undergo maintenance therapy.

Providers should also consider the health status of patients. For example, patients who already struggle with weight loss or appetite difficulties may not be good candidates for the bispecific antibody, talquetamab (Talvey), as the drug may exacerbate those conditions.

Because CAR T-cell [therapies] are approved for earlier lines, sometimes that's the best option, especially depending on how many lines of therapy a patient has had. In my experience too, sometimes the CAR T-cell may not be the best option for a patient, so then the bispecific therapy is actually a better choice.

I feel [that] we sometimes tend to see a little less side effects with the bispecific [therapies] so if a patient is able to come into clinic every week for a visit and treatment, then that can be more feasible. … Some of it is the lifestyle approach of, what does a patient want to get out of this? Are they OK with getting this CAR T-cell therapy that's a lot of intensive monitoring in the beginning, but then they don't have any maintenance treatment, so then they can go off and live their life after getting it? Versus the bispecific, where you're seeing a patient every week, or every other week, depending on if you can space the therapy out too.

Also … like with talquetamab, there are a lot of side effects that come with it. So we have even steered away from it sometimes if a patient's already struggling with like weight loss or appetite, because … you're going to make it worse and that's not ideal for some people. Those are some of the things to think about, too.

Providers should consider lifestyle preferences and other conditions/comorbidities before deciding between bispecific antibodies or CAR T-cell therapy in myeloma. 

Onc Nurse TV

Advanced Practice Corner

Making the Decision: Bispecifics Vs. CAR T-Cell Therapy in Myeloma

Bispecific antibodies like teclistamab offer “more potent” treatment than monoclonal antibodies for patients with relapsed or refractory multiple myeloma.

Long-Term Data Support Teclistamab in Relapsed, Refractory Myeloma

Bispecific antibodies like teclistamab (Tecvayli) work similarly to CAR T-cell therapies, in that they bring together myeloma cells and the T cells that will destroy them. However, bispecific antibodies are administered subcutaneously and therefore can be given without lymphodepleting regimens, explained Alfred L. Garfall, MD.

Garfall is the director of autologous hematopoietic stem cell transplantation, section chief of Myeloma, Hematology-Oncology and associate professor of Medicine at the Hospital of the University of Pennsylvania. He sat down with Oncology Nursing News at the 2024 American Society of Clinical Oncology Annual Meeting to discuss long-term follow-up from the phase 1/2 MajesTEC-1 clinical trial evaluating teclistamab in patients with relapsed or refractory multiple myeloma.

MajesTEC-1 was the longest follow-up of any bispecific antibody in multiple myeloma. Findings showed that at a median follow-up of 30.4 months, the overall response rate (ORR) was 63%, with 46.1% of patients achieving a complete response (CR) or better.

“Bispecific antibodies are…grabbing with one end of myeloma cell and the other end of the T cell and kind of pulling them together in the body,” Garfall explained in the interview. “And that is a different mechanism of immune activation than we see with conventional monoclonal antibodies like daratumumab [Darzalex], and it's essentially more potent.”

So we can think of bispecific antibodies as working in a similar fashion to CAR T cells. So bispecific antibodies are kind of grabbing with one end the myeloma cell and the other end the T cell and kind of pulling them together in the body. And that is a different mechanism of immune activation than we see with conventional monoclonal antibodies like daratumumab, and it's essentially more potent. 

So this is a way to kind of get the same engagement of the T cell arm of the immune system that we're going for with CAR T-cell therapy but with the simplicity of a subcutaneous injection that can be started without the need for all the infrastructure that's required for CAR T-cell therapy, and also without the need for things like lymphodepleting chemotherapy, which is required for CAR T-cell therapy.

Bispecific antibodies like teclistamab offer “more potent” treatment than monoclonal antibodies for patients with relapsed or refractory multiple myeloma. 

Andrea Wagner, M.S.N., RN, OCN, in an interview with Oncology Nursing News discussing her abstract on verbal orders for CRS. 

Nurse-Driven Orders May Expedite Tocilizumab Administration for CRS

Since patients experiencing cytokine release syndrome (CRS) tend to have better outcomes when administered tocilizumab (Actemra) soon after symptom onset, a group of clinicians from Hackensack Meridian Health established a nurse-driven order for the immunosuppressive drug in patients being treated with bispecific antibodies.

Findings from their intervention were presented at the 49th 

The use of bispecific antibodies for blood cancers — namely lymphoma and multiple myeloma — has grown over the last year. While these drugs are promising for the treatment of hematologic malignancies, they do come with a risk of CRS.

T-Cell Engagers Take Center Stage in Large B-Cell Lymphoma

“As a team, we decided that while tocilizumab falls under the umbrella of chemotherapy biotherapy, for which verbal orders should not be accepted per ONS guidelines and per Hackensack guidelines as well, we wanted to come up with a way that kind of still acts that way, but allows verbal orders to also be part of the workflow,” lead study author, Andrea Wagner, M.S.N., RN, OCN, an oncology clinical nurse specialist at Hackensack Meridian Health, said in an interview at the congress.

Wagner and colleagues established a system where patients consent to receiving tocilizumab upon admission for their bispecific antibody treatment. They also established a physician communication order on admission orders. This states that once it was confirmed that a patient had CRS, the nurse would be able to put in the order for tocilizumab with the proper dosing based on the patient’s weight.

With this new nurse-driven process, the majority of patients (82%) were given tocilizumab within 1 hour of the order entry — an increase from the 60% of patients who received tocilizumab within an hour after physicians or advanced practice providers placed the order entry.

“This really capitalized on getting the patient the drugs that they needed in a timely manner so we did not have any medication errors using the protocol or in general, which is good,” Wagner said.

Establishing a nurse-led system to administer tocilizumab in patients receiving bispecific antibodies tended to get the immunosuppressive drug to patients faster. 

Elranatamab (Elrexfio) a BCMA-CD3-directed bispecific antibody immunotherapy that is delivered subcutaneously, was granted accelerated approval on August 14, 2023, to treat patients with relapsed or refractory multiple myeloma (RRMM) who have already undergone 4 prior lines of treatment, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Of note, the new agent is the first off-the-shelf, or ready-to-use, fixed-dose subcutaneous BCMA-directed agent approved for this population that has an every-other-week dosing schedule following 24 weeks of weekly treatment.

 Elizabeth Aronson, MSN, FNP-BCN, OCN, who is a clinical nurse practitioner specializing in bone marrow transplant and immune effector cell therapies at Mount Sinai Hospital, walked through the clinical trial data supporting the approval and underscored what stood out to her about the current evidence.

The approval was supported by data from the phase 2 MagnetisMM-3 trial (NCT04649359). This single-arm trial demonstrated that patients with heavily treated RRMM (n = 97) achieved a 58% overall response rate (ORR) with treatment. Further, 82% of responders maintained a response for at least 9 months.

Additionally, long-term efficacy data presented at the 2023 European Hematology Association meeting, showcased a 61% ORR and a median duration of response, overall survival, and prepgression-free survival that had not yet been reached at 14.7 months. Investigators estimated that for the remaining patients, the probability of maintaining a response at 15 months of follow-up was 72%.

According to Aronson, MagnetisMM-3 trial is a unique trial because it allowed patients who were heavily pretreated to enroll. She explained that over 90% of patients who enrolled on the trial were triple-class refractory, meaning that they had already undergone standard-of-care drugs and yet their multiple myeloma had continued to progress. Further, she noted that many studies evaluating BCMA-directed agents do not enroll patients who have already undergone BCMA-directed therapy. However, MagnetisMM-3 did enroll patients who BCMA-targeted therapy refractory, making it different.

Finally, Aronson noted that the toxicity profile with elranatamab was comparable to other bispecific antibodies and CAR T-cell therapies approved for patients with RRMM. In the trial, most patients who developed cytokine release syndrome (CRS), and neurotoxicity had low grade reactions and the toxicities were managed with acetaminophen and tocilizumab (Actemra) supportive care, she said, noting that patients were not requiring intensive care unit admission to manage CRS.

Pfizer’s ELREXFIO™ receives U.S. FDA accelerated approval for relapsed or refractory multiple myeloma. Pfizer. Press release. August 14, 2023. Accessed September 25, 2023. 

https://www.pfizer.com/news/press-release/press-release-detail/pfizers-elrexfiotm-receives-us-fda-accelerated-approval

Elizabeth Aronson, MSN, FNP-BCN, OCN, shares what stood out to her about the phase 2 MagnetisMM-3 trial assessing elranatamab in multiple myeloma. 

Elizabeth Aronson Walks Through the Data Supporting Elranatamab Approval in Multiple Myeloma

Elizabeth Aronson, MSN, FNP-BCN, OCN, shares what stood out to her about the phase 2 MonumenTAL-1 study assessing talquetamab in multiple myeloma.

Elizabeth Aronson Breaks Down Data From Behind Talquetamab Approval in Multiple Myeloma

Talquetamab-tgsv (Talvey), a GPRC5D bispecific antibody that is delivered subcutaneously, 

received accelerated approval on August 10, 2023

, to treat patients with relapsed or refractory multiple myeloma (RRMM) who have already undergone 4 prior lines of treatment, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Data from the phase 2 MonumenTAL-1 study (NCT04634552) supported the regulatory decision, which enrolled 187 patients with heavily pretreated multiple myeloma.

 Elizabeth Aronson, MSN, FNP-BCN, OCN, who is a clinical nurse practitioner specializing in bone marrow transplant and immune effector cell therapies at Mount Sinai Hospital, 

walked through the clinical trial data supporting the approval

 and shared what stood out to her about the current evidence.

Aronson’s institution hosted a large portion of the MonumenTAL-1 study, so she already has had lots of experiencing caring for patients receiving talquetamab. She shared that her and her team are excited about this new agent, especially because it is the first approved therapy that targets GPRC5D.

As Aronson explained, talquetamab is a bispecific that is given subcutaneously. It should be administered through a step-up dosing schedule to mitigate cytokine release syndrome and other immune effector cell-associated neurotoxicity syndrome (ICANS).

The MonumenTAL-1 trial enrolled patients who were heavily pretreated, so they had already received the standard-of-care therapies and their disease had progressed. As Aronson pointed out, approximately three quarters of patients were triple-class refractory. Of note, the trial also included a cohort of patients who had undergone prior treatment with a bispecific antibody or CAR T-cell therapy, as well as a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.

Elizabeth Aronson, MSN, FNP-BCN, OCN, shares what stood out to her about the phase 2 MonumenTAL-1 study assessing talquetamab in multiple myeloma. 

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