Multiple Myeloma CME ACCREDITED Watch Time: 33 mins

touchPANEL DISCUSSION Improving outcomes in multiple myeloma with new treatment targets?

Watch a panel of experts discuss how novel targeted therapies are changing the treatment paradigm for multiple myeloma to achieve the best outcomes for patients.

Prof. Joseph Mikhael

Translational Genomics Research Institute, Phoenix, AZ, USA

CHAIR

Panelists:
Dr Cristina Gasparetto and Dr Elena Zamagni
 
Video Chapters
Introduction

Prof. Joseph Mikhael introduces the panel of leading experts in multiple myeloma and outlines the agenda for discussion on novel targets and improving outcomes for patients with relapsed/refractory multiple myeloma.

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Which novel targets are currently being investigated in relapsed/refractory multiple myeloma?

The panel discusses novel treatment targets for multiple myeloma that are currently being investigated or have recently entered their clinical practice.

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How can we best manage the adverse events associated with these treatments?

Novel targeted therapies are associated with different safety profiles. The panel offers practical guidance on how to manage adverse events in the clinic.

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Could agents with novel targets be used earlier in the multiple myeloma treatment pathway?

The panel considers the latest efficacy data for novel targeted therapies in the context of the evolving treatment paradigm for multiple myeloma.

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Overview & Learning Objectives
Overview

In this activity, experts in multiple myeloma discuss the modes of action and latest data, safety profiles and developing roles of novel targeted therapies in the treatment paradigm for multiple myeloma.

This activity has been jointly provided by Oakstone and touchIME ONCOLOGY. Oakstone Publishing is accredited by the ACCME to provide continuing medical education to physicians.
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Target audience

This activity has been designed to meet the educational needs of oncology and haematology specialists who are involved in the management of patients with multiple myeloma

Disclosures

Oakstone Publishing has assessed conflict of interest with its faculty, authors, editors, and any individuals who were in a position to control the content of this CME activity. Any identified relevant conflicts of interest were resolved for fair balance and scientific objectivity of studies utilized in this activity. Oakstone Publishing’s planners, content reviewers, and editorial staff disclose no relevant commercial interests.

Faculty

Prof. Joseph Mikhael discloses: Honoraria fees from Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Sanofi and Takeda.

Dr Cristina Gasparetto discloses: Honoraria fees from: Bristol Myers Squibb/Celgene, GlaxoSmithKline, Karyopharm Therapeutics and Sanofi; Consultancy fees from: Abbvie, Bristol Myers Squibb/Celgene, GlaxoSmithKline, Janssen-Cilag, Karyopharm Therapeutics and Sanofi.

Dr Elena Zamagni discloses: Honoraria fees from Amgen, Bristol Myers Squibb, Celgene, Janssen-Cilag and Takeda; Consultancy/Advisory Board fees from Amgen, Celgene, Janssen-Cilag and Sanofi.

Content reviewer

Walter Murray Yarbrough, MD, FACP has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Oakstone Publishing and touchIME. Oakstone Publishing is accredited by the ACCME to provide continuing medical education for physicians.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 Credit™ into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

Oakstone Publishing designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In order to receive credit for this activity, participants must review and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

Date of original release: 29th March 2021. Date credits expire: 29th March 2022.

Learning Objectives

After watching this activity, participants should be better able to:

  • Recall the mechanisms of action and data for relapsed/refractory multiple myeloma treatments with novel agents
  • Discuss the adverse event (AE) profiles of treatments with novel targets and how AEs could be managed in clinical practice
  • Describe the possible role of agents with novel targets earlier in the multiple myeloma treatment pathway
Faculty & Disclosures
Prof. Joseph Mikhael

Translational Genomics Research Institute, Phoenix, AZ, USA

Joseph Mikhael, MD, is Professor in the Applied Cancer Research and Drug Discovery Division at the Translational Genomics Research Institute (TGen), an affiliate of City of Hope Cancer Center. He is also the Chief Medical Officer of the International Myeloma Foundation (IMF). He facilitates and promotes myeloma research worldwide, especially in underprivileged countries. read more

Prof. Mikhael is a consultant hematologist and Director of Myeloma Research at the HonorHealth Research Institute, where he conducts phase I clinical trials. He also serves as a councillor on the Executive Committee of the American Society of Hematology. He recently led the American Society of Clinical Oncology (ASCO) guidelines for multiple myeloma.

He specializes in plasma cell disorders, namely multiple myeloma, amyloidosis and Waldenstrom’s macroglobulinemia. Prof. Mikhael is currently the principal investigator of many clinical trials, primarily in multiple myeloma. His other clinical research interests also include pharmacoeconomics, communication skills and media relations. He has published over 150 peer reviewed articles in these fields. He lectures internationally on a regular basis. He is an active member of the International Myeloma Working Group, and serves on the editorial board of the Journal of Clinical Oncology.

Prof. Mikhael is leading the IMF African American initiative which seeks to improve the care delivered to African Americans with myeloma – a disease with double the incidence in African Americans than Caucasians. Prof. Mikhael also spends about 20% of his time in developing nations, seeking ways to enhance access to myeloma therapies in underprivileged countries.

Prof. Joseph Mikhael discloses: Honoraria fees from Amgen, Bristol Myers Squibb, GlaxoSmithKline, Janssen, Sanofi and Takeda.

Dr Cristina Gasparetto

Duke Cancer Institute, Durham, NC, USA

Cristina Gasparetto, MD, has devoted her professional career to developing the Multiple Myeloma and Amyloidosis Program at Duke University in Durham, NC, USA. This comprises a multidisciplinary team managing all aspects of care for patients with multiple myeloma (MM) and amyloidosis, from diagnosis through all phases of care. read more

Dr Gasparetto has led numerous studies in both the transplant and non-transplant settings. She has co-authored numerous investigations on new target therapies in myeloma, as well as novel approaches for transplantation. Her current work is focused on expanding allogeneic immunotherapy for high-risk patients and using natural killer cells post-transplant for enhanced recovery, as well as exploring the role of allogeneic chimeric antigen receptor (CAR)-T cells in difficult-to-treat patients.

During her career, she has been invited to be a member of numerous national and international plasma cell dyscrasias committees, including the Center for International Blood and Bone Marrow Transplant Research (CIBMTR), the National Comprehensive Cancer Network (NCCN) guidelines, the Cancer and Leukemia Group B (CALGB)/Alliance myeloma executive committee, the Clinical Trials Network (CTN), the International Myeloma Working Group (IMWG) and the Connect® MM Registry. As the leader of the Myeloma Program at Duke, she is also responsible for mentoring early career investigators and for developing, opening and supervising new studies targeting MM, amyloidosis and other plasma cell disorders.

Dr Cristina Gasparetto discloses: Honoraria fees from: Bristol Myers Squibb/Celgene, GlaxoSmithKline, Karyopharm Therapeutics and Sanofi; Consultancy fees from: Abbvie, Bristol Myers Squibb/Celgene, GlaxoSmithKline, Janssen-Cilag, Karyopharm Therapeutics and Sanofi.

Dr Elena Zamagni

University of Bologna, Italy

Elena Zamagni, MD, PhD, is Associate Professor of Haematology at the Bologna University, Italy.

Her research interests include areas related to multiple myeloma, in particular, the role of high-dose therapy with stem-cell support, prognostic factors, minimal residual disease and imaging techniques. read more

She has published over 120 papers in peer-reviewed journals, mainly in the field of plasma cell dyscrasia. She has contributed to the educational sessions of the Italian Society of Haematology (SIE) and American Society of Clinical Oncology (ASCO). She reviews abstracts for SIE, the European Hematology Association (EHA) and the American Society of Hematology.

She is an editorial board member for several haematological journals. She is an active member of the board of the GIMEMA (Gruppo Italiano Malattie EMatologiche dell’Adulto) and the European Myeloma Network working party, and she has served as the scientific secretary and as principal investigator in several national randomized trials in multiple myeloma.

She is a member of the Italian Society of Haematology, the International Myeloma Working Group and the International Myeloma Society. She has served on the EHA’s Scientific Program Committee since 2017, and she has led the career development committee of the International Myeloma Society since 2019.

Dr Elena Zamagni discloses: Honoraria fees from Amgen, Bristol Myers Squibb, Celgene, Janssen-Cilag and Takeda; Consultancy/Advisory Board fees from Amgen, Celgene, Janssen-Cilag and Sanofi.

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Question 1/4
Which of the following new therapies use the B-cell maturation antigen (BCMA) as a target for multiple myeloma therapy?
Correct

Selinexor targets nuclear export protein XPO1,1 isatuximab targets CD38,2 melphalan flufenamide targets aminopeptidases causing robust and irreversible DNA damage,3 and belantamab mafodotin targets BCMA.4

BCMA, B-cell maturation antigen.

References
1. Chari A, et al. New Engl J Med. 2019;381:727–38.
2. Richardson PG, et al. Exp Opin Biol Ther. 2020;20:1395–404.
3. Richardson PG, et al. J Clin Oncol. 2021;39:757–67.
4. Lonial S, et al. Lancet Oncol. 2020;21:207–21.

Question 2/4
For patients with relapsed or refractory multiple myeloma who have progressed after one prior systemic regimen, which novel agents have data from phase III trials to support their use in this setting?
Correct

Isatuximab and selinexor were investigated in patients who had received 1–3 prior regimens in the IKEMA1 and BOSTON2 trials, respectively. Belantamab mafodotin was investigated in patients with ≥3 prior regimens,3 and melphalan flufenamide has been investigated in patients with ≥2 prior regimens.4

IKEMA, Multinational Clinical Study Comparing Isatuximab, Carfilzomib And Dexamethasone To Carfilzomib And Dexamethasone In Relapse And/Or Refractory Multiple Myeloma Patients (NCT03275285); BOSTON, Bortezomib, Selinexor, and Dexamethasone in Patients With Multiple Myeloma (NCT03110562).

References
1. Moreau P. et al. EHA25 2020;abstract LB2603
2. Dimopoulos MA, et al. J Clin Oncol. 2020;38(Suppl.):abstract 8501
3. Lonial S, et al. Lancet Oncol. 2020;21:207–21
4. Richardson PG, et al. J Clin Oncol. 2021;39:757–67

Question 3/4
Which of the following adverse events are common to all of the new agents for the treatment of multiple myeloma?
Correct

Thrombocytopenia and haematologic cytopenias are common to all of the new multiple myeloma therapies1-4

References
1. Gavriatopolou M, et al. Leukemia. 2020;34:2430–40.
2. Richardson PG, et al. J Clin Oncol. 2021;39:757–67.
3. Lassiter G, et al. Curr Oncol. 2021;28:640–60.
4. Richardson PG, et al. Expert Opin Biol Ther. 2020;20:1395–403.

Question 4/4
Your patient with relapsed/refractory multiple myeloma has been receiving selinexor 80 mg twice weekly plus dexamethasone for 3 months and is responding well to treatment. However, she has been experiencing grade 2 fatigue with no apparent anaemia or dehydration, and is finding it difficult to cope with treatment. Despite supportive care and a short drug holiday, her fatigue returned when therapy was restarted. What would be a sensible course of action?
Correct

Dose reduction is a valuable strategy to ameliorate adverse events and continue therapy; for grade 2 fatigue, reduction to 100 mg once weekly from 80 mg twice weekly is advised if symptoms persist after a dose interruption.

References
1. Mikhael J, et al. Clin Lymphoma Myeloma Leuk. 2020;20:351–7.

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