Physicians' Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Physicians' Education Resource®, LLC, designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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Acknowledgment of Commercial Support
This activity is supported by an educational grant from Amgen.
Medical Crossfire®: BiTE Technology Around the Globe: Improving Outcomes for Patients With Acute Lymphoblastic Leukemia
Release Date: September 28, 2018
Expiration Date: September 28, 2019
Media: Internet - based
Acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic malignancy that continues to pose challenges for patients and oncologists alike. The foundation for the use of targeted therapies in the treatment of this disorder continues to grow, with new options such as bispecific T-cell engagers, CAR-T therapy, and antibody-drug conjugates shaping the treatment paradigm. While these treatment options have the potential to improve outcomes for your patients, they also present new challenges with respect to assessment of the safety and efficacy of new therapies and development of optimal strategies to incorporate them, when appropriate. Through a combination of didactic presentation and lively discussion, our panel of experts in the management of patients with ALL will cover a wide range of topics to help you meet these challenges. You will gain expert perspectives on key data from clinical studies in ALL, the implications of minimal residual disease (MRD) assessment, and the therapeutic implications of recent and ongoing studies.
Benefits of Completing Activity
By participating in this exciting program, you will learn about:
- Solidify your familiarity with the latest data on bispecific T-cell engagers and other new therapies used in the treatment of ALL
- Absorb the perspectives of leading clinical experts on methods to improve the management of patients with ALL
- Gain insights into the management of challenging real-world clinical scenarios for patients with ALL
Acknowledgment of Commercial Support
Instructions for This Activity and Receiving Credit
This educational activity is directed toward medical oncologists, hematologists, and fellows who treat patients with hematologic malignancies. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of hematologic malignancies are also invited to participate.
Upon completion of this activity, you should be better prepared to:
- Describe the biology of ALL in terms of biomarkers, testing strategies, and methods to stratify risk for patients with this hematologic malignancy
- Differentiate the role of bispecific T-cell engagers and MRD status in treatment decisions for patients with ALL following induction therapy
- Incorporate key findings from recent clinical trials concerning the use of bispecific T-cell engager treatment strategies for patients with ALL in the frontline and relapsed/refractory settings into practice
- Discuss the recent evidence and clinical trials involving bispecific T-cell engagers in other hematologic malignancies.
Faculty, Staff, and Planners' Disclosures
Professor, Department of Leukemia
Division of Cancer Medicine
The University of Texas MD Anderson Cancer Center
Disclosure: Grant/Research Support: Amgen, Pfizer, Takeda, Adaptive Biotechnologies, Novartis, Spectrum, AbbVie, Bristol-Myers Squibb
Professor of Medicine
Case Western Reserve University School of Medicine
Director, Hematologic Malignancies and Stem Cell Transplant Program
University Hospitals Seidman Cancer Center
Disclosure: Grant/Research Support: Celgene; Consultant: Celgene, Pfizer
Assistant Attending Physician
Department of Medicine, Leukemia Service
Memorial Sloan Kettering Cancer Center
New York, NY
Disclosure: Consultant: Amgen, Novartis, Adaptive Biotechnologies
Associate Professor in Medicine
Autonomous University of Barcelona
Head, Clinical Hematology
Catalan Institute of Oncology at HUGTP in Badalona
Director, Stem Cell Transplantation Unit, HUGTP
Disclosure: Grant/Research Support: Amgen, Pfizer, Shire; Consultant: Amgen, Pfizer, Shireies
The staff of Physicians’ Education Resource®, LLC 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™ Recaps
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PER Pulse™ Recap
Overview of Recent Advancements in ALL and Emerging Therapeutics in the Frontline Setting
Acute lymphoblastic leukemia (ALL) is a heterogeneous hematologic malignancy that continues to pose therapeutic challenges for patients and oncologists alike. Although pediatric ALL has a cure rate of ≥80% with the use of risk-directed therapy, outcomes among adult patients with these strategies have yielded lower rates of success. Several factors may account for this difference, and in this activity, Dr. Elias Jabbour addresses not only some of the key tumor features that may account for differences in outcomes, but also some of the new therapies that may help to shape treatment of patients with ALL in the frontline and salvage settings.
In addition, Dr. José María Ribera and other members of our expert panel discuss the latest therapeutic implications of different subtypes of ALL in the frontline setting, as well as the role of minimal residual disease assessment in guiding therapeutic selections. Dr. Ribera and the panel also present ALL treatment options for different age groups, including a case-based discussion.
- Several recent advancements in pharmacologic therapy have the potential to shape the treatment paradigm for adult patients with ALL, including the addition of tyrosine kinase inhibitors to chemotherapy in Philadelphia chromosome–positive ALL, the addition of rituximab to chemotherapy in Burkitt and pre-B-cell ALL, and bispecific T-cell engager and antibody-drug conjugate options for patients in frontline and salvage ALL treatment.
- Different ALL subtypes have distinct therapeutic implications that must be considered.
- Bargou R, Leo E, Zugmaier G, et al. Tumor regression in cancer patients by very low doses of a T cell-engaging antibody. Science. 2008;321:974-977. doi: 10.1126/science.1158545.
- Gökbuget N, Dombret H, Bonifacio M, et al. Blinatumomab for minimal residual disease in adults with B-cell precursor acute lymphoblastic leukemia. Blood. 2018;131:1522-1531. doi: 10.1182/blood-2017-08-798322.
- Kantarjian H, Ravandi F, Short NJ, et al. Inotuzumab ozogamicin in combination with low-intensity chemotherapy for older patients with Philadelphia chromosome-negative acute lymphoblastic leukaemia: a single-arm, phase 2 study. Lancet Oncol. 2018;19:240-248. doi: 10.1016/S1470-2045(18)30011-1.
- Ricart AD. Antibody-drug conjugates of calicheamicin derivative: gemtuzumab ozogamicin and inotuzumab ozogamicin. Clin Cancer Res. 2011;17:6417-6427. doi: 10.1158/1078-0432.CCR-11-0486.
- Velasquez MP, Bonifant CL, Gottschalk S. Redirecting T cells to hematological malignancies with bispecific antibodies. Blood. 2018;131:30-38. doi.org/10.1182/blood-2017-06-741058.
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PER Pulse™ Recap
Relapsed/Refractory ALL Advancements and Considerations for CAR-T Therapy in ALL
In this activity, Dr. Elias Jabbour and our panelists address several topics, including the treatment of patients with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL). Historical standards of care for these patients are reviewed, as well as how the treatment paradigm is evolving with the incorporation of new therapies, such as bispecific T-cell engager therapy and antibody-drug conjugate therapy. Recent studies are explored and assessed, and the faculty provide key insights into the management of patients with R/R ALL with another case-based discussion.
In addition, Dr. Jae Park and the panel discuss clinical evidence pertaining to the use of CAR T-cell therapy in patients with ALL. Studies in pediatric and adult patients with ALL are reviewed, as the faculty address safety and efficacy data of current therapies and new platforms. A case-based discussion highlights key points regarding treatment selection for patients who may be candidates for CAR T-cell therapy.
- The value of minimal residual disease (MRD) negativity has been established in both pediatric and adult patients with ALL, regardless of methods used to assess MRD, cutoff levels, and disease subtypes.
- CAR T-cell therapy has been approved for patients up to age 25 with B-cell precursor ALL that is refractory or in second or later relapse; it has also been studied in adult patients with relapsed ALL.
- Berry DA, Zhou S, Higley H, et al. Association of minimal residual disease with clinical outcome in pediatric and adult acute lymphoblastic leukemia: a meta-analysis. JAMA Oncol. 2017;3:e170580. doi: 10.1001/jamaoncol.2017.0580.
Maude SL, Laetsch TW, Buechner J, et al. Tisagenlecleucel in children and young
adults with B-cell lymphoblastic leukemia. N Engl J Med. 2018;378:439-448. doi: 10.1056/NEJMoa1709866.
- Park JH, Rivière I, Gonen M, et al. Long-term follow-up of CD19 CAR therapy in acute lymphoblastic leukemia. N Engl J Med. 2018;378:449-459. doi: 10.1056/NEJMoa1709919.
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PER Pulse™ Recap
Considerations for Transplant Therapy in ALL and Future Therapeutic Directions
As a key component of this activity, Dr. Marcos de Lima and the faculty present additional considerations for incorporating stem cell transplantation into the treatment of patients with acute lymphoblastic leukemia (ALL), including real-world clinical issues that oncologists may face in the management of these patients, such as posttransplant maintenance strategies.
In addition, Dr. Elias Jabbour provides a brief summary of the role of bispecific T-cell engagers in the management of patients with ALL, as well as a look toward active areas of investigation for this treatment modality in other hematologic malignancies, such as relapsed/refractory diffuse large B-cell lymphoma, multiple myeloma, and acute myeloid leukemia.
- There are numerous unresolved questions regarding ALL and transplant timing.
- The role of bispecific T-cell engager therapy is being explored in numerous studies addressing different hematologic malignancies.
- Dombret H, Gabert J, Boiron JM, et al. Outcome of treatment in adults with Philadelphia chromosome-positive acute lymphoblastic leukemia--results of the prospective multicenter LALA-94 trial. Blood. 2002;100:2357-2366. DOI: 10.1182/blood-2002-03-0704.
- Ravandi F, et al. US Intergroup study of chemotherapy plus dasatinib and allogeneic stem cell transplant in philadelphia chromosome positive ALL. Blood Adv. 2016;1:250-259. doi: 10.1182/bloodadvances.2016001495.
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