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Accreditation/Credit Designation

Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians’ Education Resource®, LLC, designates this enduring material for a maximum of 8.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity

Physicians' Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669 for 8.0 Contact Hours.

Repurposing Statement

If you previously attended and received credit for the live CME/CE-certified conference, 1st Annual Live Medical Crossfire®: Expert Exchanges in Hematologic Malignancies, which was held July 15, 2017, in New York, New York, please note that you will not receive credit for completing this activity. Participants who take part in an identical activity, even to validate learning or to clarify specific topics, cannot claim, nor will Physicians’ Education Resource®, LLC award, duplicate credit for the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AbbVie, Inc., AstraZeneca, Jazz Pharmaceuticals, Inc., Kite Pharma, Inc., Novartis Pharmaceuticals Corporation, and Takeda Oncology.

1st Annual LIVE Medical Crossfire®: Expert Exchanges in Hematologic Malignancies Online

Release Date: September 30, 2017
Expiration Date: September 30, 2018
Media: Internet - based

 

Activity Overview

Live Medical Crossfire®: Expert Exchanges in Hematologic Malignancies is a live, full-day version of the renowned Medical Crossfire format. This 1-day conference is designed to discuss some of the hottest clinical issues in the management of hematologic malignancies. The meeting is designed to facilitate the practical application of emerging data key to treating various forms of cancer, provide participants with the information they need to inform clinical decision making that allows for personalized approaches, and will ensure participants have the ability to safely apply novel strategies to real-world clinical case scenarios they routinely encounter in their practices.

For the Live Medical Crossfire®, we have assembled renowned experts in the management of leukemias, lymphomas, and myeloma to facilitate the Medical Crossfire. The program format for this meeting is unique. Each tumor’s section will begin with an evidence-based assessment of the evolving therapeutic space and transition quickly to the accompanying clinical questions that will be the focus of the expert crossfire session. Each section will conclude with a crossfire from the live audience at the meeting

Acknowledgment of Commercial Support

This activity is supported by educational grants from AbbVie, Inc., AstraZeneca, Jazz Pharmaceuticals, Inc., Kite Pharma, Inc., Novartis Pharmaceuticals Corporation, and Takeda Oncology.

Instructions for This Activity and Receiving Credit

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a cme/ce certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a cme/ce certificate upon completion of these steps.

Target Audience

This educational activity is directed toward medical oncologists. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other health care professionals interested in the treatment of cancer are also invited to participate.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  • Describe major clinically unmet needs in the management of hematologic malignancies 
  • Explain clinical trial findings that inform decision-making concerning the management of hematologic malignancies
  • Detail proactive methods to mitigate and manage the impact of treatment-related toxicities associated with novel targeted and immunotherapeutic approaches
  • Place emerging data sets in the context of evolving treatment paradigms in the management of leukemias, lymphomas, and multiple myeloma

Faculty, Staff, and Planners' Disclosures

Faculty

Anjali Advani, MD
Director, Inpatient Leukemia Program, Taussig Cancer Institute
Associate Professor, Cleveland Clinic Lerner College of Medicine
Cleveland Clinic
Cleveland, OH
 

Disclosure: Grant/Research Support: Amgen, Pfizer, Gilead; Consultant: Pfizer

Jessica K. Altman, MD
Associate Professor of Medicine (Hematology and Oncology)
Northwestern University
Chicago, IL
 
 

Disclosure: Honoraria: Syros, Bristol-Myers Squibb (BMS); Advisory Committee: American Society of Hematology (ASH), Syros, BMS, Immune Pharmaceuticals (unpaid); Advisory Board Travel: Astellas, National Comprehensive Cancer Network (NCCN), ASH

Jacqueline Barrientos, MD
Associate Professor, Division of Hematology and Medical Oncology
Department of Medicine
Hofstra Northwell School of Medicine
Hempstead, NY
 

Disclosure: Grant/ Research Support: Gilead; Pharmacyclics/Abbvie; Consultant: Gilead, Pharmacyclics/Abbvie

Robert W. Chen, MD
Associate Professor, Department of Hematology & Hematopoietic Cell Transplantation
City of Hope
Duarte, CA
 
 

Disclosure: Grant/Research Support: Seattle Genetics, Pharmacyclics, BMS; Consultant: Seattle Genetics, Pharmacyclics, BMS, Merck; Speaker’s Bureau: Seattle Genetics, Genentech, Merck

Faith Davies, MBBCh, MRCP, MD, FRCPath
Professor of Medicine
Myeloma Institute
University of Arkansas for Medical Sciences
Little Rock, AR
 

Disclosure: Consultant: Amgen, BMS, Celgene, Seattle Genetics, Takeda

Daniel J. DeAngelo, MD, PhD
Associate Professor of Medicine
Harvard Medical School
Institute Physician, Adult Leukemia Program
Dana-Farber Cancer Institute
Boston, MA

Disclosure: Consultant: Novartis, Amgen, Pfizer, Incyte, Takeda, Shire

Harry Erba, MD, PhD
Albert F. LoBuglio Endowed Chair for Translational Cancer Research
Chair, SWOG Leukemia Committee
Associate Director for Clinical Research, UAB Comprehensive Cancer Center
Professor, Internal Medicine
University of Alabama at Birmingham
Birmingham, AL

Disclosure: Grant/Research Support: Agios, Amgen, Astellas, Daiichi Sankyo, ImmunoGen, Janssen, Juno, Millennium/Takeda, Seattle Genetics; Consultant: Celgene, Amgen, Jazz, Daiichi Sankyo, ImmuunoGen, Incyte, MacroGenics, Novartis, Ono, Settle Genetics; Speaker’s Bureau: Celgene, Incyte, Novartis

Neil E. Kay, MD
Professor of Medicine
Division of Hematology
Mayo Clinic
Rochester, MN
 

Disclosure: Grant/Research Support: Pharmacyclics, Tolero, Acerta; DSMB: Gilead, Morpho-sys, Infinity Pharm, Celgene, Cytomx Therapeutics

Dickran Kazandjian, MD
FDA-NCI Clinical Investigator
Attending Physician, Myeloma Program
National Cancer Institute, NIH
Bethesda, MD
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

Jeffrey E. Lancet, MD
Senior Member and Professor
Chair, Department of Malignant Hematology
Moffitt Cancer Center
Tampa, FL
 

Disclosure: Grant/Research Support: Biosight, Celegene; Consultant: Biosight, Celgene, Erylech, Janssen, Biopath Holdings

C. Ola Landgren, MD, PhD
Professor of Medicine and Chief of Myeloma Service,
Department of Medicine, Division of Hematologic Oncology
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

John P. Leonard, MD
Associate Dean, Clinical Research
Interim Chair, Department of Medicine
Weill Cornell Medicine
New York, NY
 

Disclosure: ADC Therapeutics, Biotest Pharmaceuticals, MedImmune, Hospira, Bayer, Juno Therapeutics, Teva Pharmaceuticals, OncoTracker, Gilead Sciences

Alexander M. Lesokhin, MD
Assistant Attending Physician, Myeloma Service
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosure: Consultant: Aduro Biotech, Inc, Bristol-Myers Squibb, Celldex Therapeutics; Grant/Research Support: Bristol-Myers Squibb, Genentech, Celgene, Merck, Serametrix

David Maloney, MD, PhD
Member, Clinical Research Division
Fred Hutchinson Cancer Research Center
Professor of Medicine, Division of Oncology
University of Washington
Seattle, WA

Disclosure: Grant/Research Support: Juno Therapeutics; Consultant: Celgene, F. Hoffmann La Roche, Gilead

Anthony R. Mato, MD
Assistant Professor of Medicine
Director, Center for Chronic Lymphocytic Leukemia
Hospital of the University of Pennsylvania
Philadelphia, PA

Disclosure: Grant/Research Support: TS Therapeutics, Gilead, Pharmacyclics, Regeneron, Abbvie, Portola, Acerta; Consultant: Celgene, Gilead, Abbvie, TG Therapeutics

Ruben Niesvizky, MD
Professor of Medicine
Weill Cornell Medical College
New York, NY
Director of Multiple Myeloma
New York Presbyterian Hospital/Weill Cornell Medical Center
New York, NY

Disclosure: Speaker’s Bureau: Janssen Biotech, Takeda Pharmaceuticals, Celgene, Bristol-Myers Squibb, Johnson & Johnson, Amgen; Jerald Radich, MD: Grant/Research Support: Novartis; Consultant: Novartis, Ariad, BMS, Gilead

Sattva S. Neelapu, MD
Associate Professor and Deputy Chair ad interim
Department of Lymphoma and Myeloma
The University of Texas M.D. Anderson Cancer Institute
Houston, TX
 

Disclosure: Grant/Research Support: Kite Pharma, Merck, BMS, Cellectis, Poseida; Advisory/Review Activies: Kite Pharma, Merck, Celgene

Jerald Radich, MD
Clinical Research Division
Fred Hutchinson Cancer Research Center
Professor, Medical Oncology Division
University of Washington School of Medicine
Seattle, WA

Disclosure: No relevant financial relationships with commercial interests to disclose.

Farhad Ravandi, MD
Janiece and Stephen A. Lasher Professor of Medicine
Chief, Section of Developmental Therapeutics, Department of Leukemia
University of Texas - MD Anderson Cancer Center
Houston, TX
 

Disclosure: Grant/Research Support: Bristol Myers Squibb, Amgen, Xencor; Consultant: Amgen, Ariad

Craig S. Sauter, MD
Assistant Attending, Division of Hematologic Oncology
Memorial Sloan-Kettering Cancer Center
New York, NY
 
 

Disclosure: Grant/Research Support: Sanofi Genzyme, Juno Therapeutics; Consultant: Sanofi Genzyme, Juno Therapeutics

Charles A. Schiffer, MD
Professor of Medicine and Oncology
Barbara Ann Karmanos Cancer Institute
Detroit, MI
 
 

Disclosure: Grant/Research Support: Celgene, Novartis, Bristol Myers, Ariad, Cephiad, Micromedix, Pharmacyclics; Data Safety and Monitoring Boards: Teva, Ambit, Pfizer, Takeda, Pharmacyclics, JUNO, Astellas; Consultant/Advisory Boards: Celgene, Curis, Macrogenics

Neil Shah, MD, PhD
Professor, Department of Medicine (Hematology/Oncology)
Program Leader, Hematopoietic Malignancies Program
Helen Diller Family Comprehensive Cancer Center
University of California San Francisco
San Francisco, CA

Disclosure: Grant/Research Support: Bristol-Myers Squibb, Pfizer, Plexxikon, Dalichi-Sankyo

A. Keith Stewart, MB, ChB
Carlson and Nelson Endowed Director, Center for Individualized Medicine
Vasek and Anna Maria Polak Professor of Cancer Research
Mayo Clinic
Scottsdale, AZ
 

Disclosure: Consultant: Celgene, Amgen, BMS, Janssen, Roche

Wendy Stock, MD
Anjuli Seth Nayak Professor of Medicine
Director, Leukemia Program
Section of Hematology | Oncology
University of Chicago
Chicago, IL

Disclosure: Consultant: Novartis, Amgen, Pfizer

Richard Stone, MD
Professor of Medicine
Harvard Medical School
Chief of Staff
Director, Adult Leukemia
Dana-Farber Cancer Institute
Boston, MA

Disclosure: Grant/Research Support: Novartis (Research); Consultant: Arog, Astellas, Abbive, Amgen, Agios, Fujifilm, Novartis, Pfizer, Sumitomo, Orsenix, Ono, Jazz, Celgene, Janssen, Juno

Kendra Sweet, MD
Assistant Member, Department of Malignant Hematology
Moffitt Cancer Center
Tampa, FL
Assistant Professor, Department of Oncologic Sciences
University of South Florida Morsani College of Medicine
Tampa, FL

Disclosure: Consultant: Novartis, Pfizer; Speaker’s Bureau: Novartis

Martin Tallman, MD
Professor of Medicine and Chief of Leukemia Service
Department of Medicine, Division of Hematologic Oncology
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

Saad Z. Usmani, MD, FACP
Chief, Plasma Cell Disorders; Director, Clinical Research
Department of Hematologic Oncology and Blood Disorders
Levine Cancer Institute/Carolinas Healthcare System
Charlotte, NC
 

Disclosure: Grant/Research Support: Amgen, Arrray Biopharma, BMS, Celgene, Janssen, Merck, Pharmacyclics, Sanofi; Consultant: Amgen, Celgene, Janssen, Merck, Seattle Genetics, Skyline DX; Speaker’s Bureau: Amgen, Celgene, Sanofi, Takeda

Wyndham Wilson, MD, PhD
Senior Investigator, Lymphoid Malignancies Branch
Head, Lymphoma Therapeutics Section
Center for Cancer Research
Bethesda, MD

Disclosure: No relevant financial relationships with commercial interests to disclose.

Anas Younes, MD
Professor of Medicine and Chief of Lymphoma Service
Department of Medicine, Division of Hematologic Oncology
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: Grant/Research Support: Novartis, Johnson & Johnson, Curis; Honoraria: Bayer, Bristol-Myers Squibb, Celgene, Janssen, Sanofi, Seattle Genetics, Takeda/Millennium

Clive S. Zent, MD
Professor of Medicine
Director, Lymphoma/CLL Program
James P. Wilmot Cancer Institute
University of Rochester Medical Center
Rochester, NY

Disclosure: Grant/ Research Support: Funding to University of Rochester to support research from Mentrik to Accerta

The staff of PER® have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME/CE activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME/CE activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME/CE activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME/CE activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse Recap™

PER Pulse Recap (1 of 3)

This first of 3 PER Pulse Recaps reviews the role of minimal residual disease (MRD) in multiple myeloma clinical practice and clinical trials.
 
Below are some highlights from the Medical Crossfire® panel discussion led by Dr Landgren:
  • Dr Landgren highlighted 2 recently published papers, one on newly diagnosed multiple myeloma and one from the relapsed/refractory setting, both of which showed significantly prolonged progression-free survival in the experimental arm. In these studies, this improvement was restricted to those patients who were MRD-positive, prompting him to ask the panel whether MRD status is more important than treatment modality.
    • Faith Davies, MBBCh, MRCP, MD, FRCPath and Saad Z Usmani, MD, FACP both agreed that it is, although Dr Usmani clarified that MRD negativity within the relapsed/refractory setting may not identify patients who can be cured.
  • When asked by Dr Landgren whether MRD is now the only important prognostic factor in myeloma, A. Keith Stewart, MB, ChB, responded that although MRD is quickly becoming the endpoint of choice in myeloma, cytogenetics remains a key prognostic factor and the speed of onset of MRD negativity may also be clinically relevant.
    • Dr Davies argued that measuring MRD over multiple timepoints is important because (1) patients may achieve MRD negativity at a later time point and still have a good prognosis and (2) patients need to remain MRD-negative at more than one time point for it to be meaningful.
  • Dr Davies also suggested that patients with MRD negativity still need a transplant because even MRD negativity at a 10-6 sensitivity threshold does not equate to a cure. Dr Stewart agreed, stating that patients with 10-6 MRD negativity recur at a fairly high rate.
  • During a discussion of the technology used to measure MRD, Dr Davies described her institution’s approach, which is to perform flow cytometry to obtain results quickly and order next-generation sequencing, which is more sensitive but takes weeks to obtain results.
    • Dr Stewart reported using MRD results to decide when to switch therapy and when to stop maintenance therapy. Dickran Kazandijan, MD, stated that he also considers stopping maintenance therapy if the patient is MRD-negative.

PER Pulse Recap (2 of 3)

This second of 3 PER Pulse Recaps discusses data with immunotherapy in diffuse large B-cell lymphoma (DLBCL).
 
Below are some highlights from the Medical Crossfire® panel discussion led by Dr Younes:
  • Dr Younes introduced several immunotherapy modalities under investigation for DLBCL, stating that the panel discussion would focus on immune checkpoint inhibitors and chimeric antigen receptor (CAR) T cells.
  • There are currently 3 CAR T cell therapies under investigation in DLBCL: axicabtagene ciloleucel (axi-cel) in the ZUMA-1 trial, tisagenlecleucel in the JULIET trial, and JCAR017 in the TRANSCEND trial. Robert W Chen, MD drew attention to differences in patient population between the ZUMA-1 and JULIET trials, including the fact that the ZUMA-1 trial enrolled more refractory patients than did the JULIET trial. He also pointed out that the ZUMA-1 results were dramatically better than those reported with current best available therapies in the SCHOLAR-1 trial (6-month overall survival, 80% vs 55%, respectively; complete response rate, 54% vs 8%).
    • Despite the excitement surrounding CAR T cells, several shortcomings in current CAR T-cell therapy were discussed. David Maloney, MD, PhD, discussed the needs to manufacture these products in less than 3 weeks and to standardize assessment of cytokine release syndrome (CRS). Craig S Sauter, MD, raised the issue that data from the intent-to-treat population in these studies should be presented to raise awareness of the percentage of patients who drop off the study before they can receive treatment.
    • There was disagreement among the panel regarding the magnitude of current clinical benefit of CAR T-cell therapy, with John P Leonard, MD arguing that a minority of patients with refractory disease have durable responses because of their ineligibility to receive this therapy, worsening disease before treatment initiation, and quick relapses. Wyndham Wilson, MD, PhD and Dr Maloney were more positive, arguing that they are seeing complete responses in patients who do not even qualify for autologous transplant or phase I trials.
    • Dr Chen raised the issue that education will be required to avoid providing this therapy to high-risk patients unable to tolerate the CRS and neurotoxicity that is part of the toxicity profile of CAR T cells.
  • In discussing the potential role of immune checkpoint inhibitors in non-Hodgkin lymphoma (NHL), Dr Leonard suggested that they show excellent promise in certain subtypes (eg, primary mediastinal large B-cell lymphoma) that have 9p chromosomal abnormalities. Dr Chen and others proposed that combination therapy is a promising path for checkpoint inhibitors, since their monotherapy activity in NHL is much lower than in Hodgkin lymphoma.
    • Dr Chen explained that most of the tumors that have response rates above 40% to immune checkpoint inhibitors have high levels of PD-L1 expression.

PER Pulse Recap (3 of 3)

This third of 3 PER Pulse Recaps describes novel compounds used to treat chronic lymphocytic leukemia (CLL).
 
Below are some highlights from the Medical Crossfire® panel discussion, led by Dr Kay:
  • When asked by Dr Kay how he treats patients with progressive CLL who are not eligible for chemoimmunotherapy, Anthony R Mato, MD responded that ibrutinib is his institution’s standard of care. He added that obinutuzumab without concomitant chlorambucil is another option for these patients. Clive S Zent, MD added that he has used obinutuzumab in patients over age 90 and in patients with end-stage renal failure, saying that it is well tolerated if carefully managed.
    • Jacqueline Barrientos, MD also reported giving ibrutinib to most patients, even to those with comorbidities that could be of concern.
    • Dr Mato reported that he reduces the dose of ibrutinib if he feels a patient has a dose-dependent toxicity, and he described a retrospective study’s results that showed similar outcomes with patients on ibrutinib, regardless of dose reductions.
  • Dr Mato shared that he treats patients who progress after first-line ibrutinib differently depending on the reason for progression. If the patient progresses after discontinuing ibrutinib due to toxicities, he will consider idelalisib, but if the patient progresses while taking ibrutinib, he considers venetoclax. He mentioned that both TGR-1202 (umbralisib) and acalabrutinib are being studied in the ibrutinib-intolerant setting. Dr Barrientos added that in patients progressing on ibrutinib, she starts venetoclax immediately without discontinuing ibrutinib because she has seen rapid disease progression in some patients upon ibrutinib discontinuation.
  • During a discussion on venetoclax management, Dr Barrientos shared her strategy for hospitalization prior to venetoclax initiation. Aside from following the hospitalization guidance in the package insert for high-risk patients, she hospitalizes patients she feels are at high risk of tumor lysis syndrome (TLS), including elderly patients who may not comply with hydration requirements and those with a history of TLS. Dr Zent reported admitting approximately half of his patients for at least the first 2 doses of venetoclax at his institution, which serves a rural population. Dr Kay added that nearly all of his patients are admitted to the hospital for at least a day or two during venetoclax initiation.
 
For additional commentary about this topic and the 1st Annual Live Medical Crossfire®: Expert Exchanges in Hematologic Malignancies symposium, please visit www.gotoper.com






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