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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 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from AstraZeneca Pharmaceuticals LP.

Oncology Briefings™: Updates in Waldenström Macroglobulinemia


Release Date: December 30, 2018
Expiration Date: December 30, 2019
Media: Internet - based

Activity Overview

This activity, Oncology Briefings™: Updates in Waldenström Macroglobulinemia, developed in Physicians’ Education Resource®, LLC established Oncology Briefings™ legacy format, is an online interactive monograph that provides treatment strategies for patients with Waldenström macroglobulinemia (WM). This presentation features a national thought leader, Steven P. Treon, MD, MA, PhD, who provides key insights.

Benefits of Participating:

  • Learn about new standards of care with the addition of BTK inhibitors in patients diagnosed with Waldenström macroglobulinemia (WM)
  • Find out how experts choose treatment regimens for WM in the frontline and relapsed/refractory settings
  • Gain insight into emerging targets and therapeutic options in clinical trials for the treatment of WM

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca Pharmaceuticals LP.

Instructions for This Activity and Receiving Credit

  • You will need to log in 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 audio files/content until you finish the presentation.
  • At the end of the activity, educational content/audio files will be available for your reference.
  • In order to receive a CME certificate, you 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.” You may immediately download a CME certificate upon completion of these steps.


Target Audience

This educational initiative is directed toward medical oncologists and hematologists who treat patients with cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, fellows, and other healthcare professionals interested in the treatment of cancer are also invited to participate.

Learning Objectives

Upon successful completion of this activity, you should be better prepared to:

  • Describe the rationale for treatment of WM with BTK inhibitors
  • Outline mechanisms of treatment resistance and strategies to address the management of patients with WM in multiple lines of care, including relapsed/refractory disease
  • Evaluate practice-changing clinical trial findings on the efficacy and safety of current and emerging BTK inhibitors as monotherapy and combination therapy for WM

Faculty, Staff, and Planners' Disclosures

Faculty

Steven Treon, MD, PhD
Director, Bing Center for Waldenström's Macroglobulinemia
Dana-Farber Cancer Institute
Professor of Medicine
Harvard Medical School
Boston, MA

Disclosures: Consultant: Janssen Pharmaceuticals, Inc., Pharmacyclics, Inc.

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 activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME 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 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 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

1 of 3
Evolution of Targeted Treatment Strategies in Waldenström Macroglobulinemia

The online Oncology Briefings CME activity, Updates in Waldenström Macroglobulinemia, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment of Waldenström macroglobulinemia (WM). Leading expert Steven Treon, MD, PhD, professor and director of the Bing Center for Waldenström Macroglobulinemia at the Dana-Farber Cancer Institute at Harvard Medical School, Boston, MA, answers key questions supported by the presentation of clinical science about WM. The first of 3 PER Pulse Recaps from this program focuses on the evolution of targeted treatment strategies for WM.

Dr. Treon discusses important diagnostic features of WM that direct the management of this disease and presents the results of the phase 3 iNNOVATE clinical trial, evaluating the combination of ibrutinib and rituximab in both treatment-naïve and refractory WM:

  • The presence of the MYD88 mutation is significant in diagnosis and for clinical decision making and is incorporated into the National Comprehensive Cancer Network (NCCN) Guidelines as an essential component of diagnostic work-up.
  • The Bruton tyrosine kinase (BTK) inhibitor, ibrutinib, can be considered for treatment of MYD88-mutated disease but not for the treatment of wild-type MYD88 disease which has shown poor major response rates (MRRs) to ibrutinib monotherapy.
  • The iNNOVATE trial showed a higher overall response rate (ORR) and MRR with ibrutinib-plus-rituximab versus placebo-plus-rituximab and may be beneficial in treating both MYD88- and CXCR4-mutated disease.
  • Clinical treatment strategies of WM should consider several factors including the underlying genomics of a tumor, bulky disease, and complications such as amyloidosis and IgM-related neuropathy.

2 of 3
Mechanisms of Resistance to Therapy in Waldenström Macroglobuliemia

The online Oncology Briefings CME activity, Updates in Waldenström Macroglobulinemia, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment standards in Waldenström macroglobulinemia (WM). Leading expert Steven Treon, MD, PhD, professor and director of the Bing Center for Waldenström Macroglobulinemia at Dana-Farber Cancer Institute at Harvard Medical School, Boston, MA, answers key questions supported by the presentation of clinical science about WM. The second of 3 PER Pulse Recaps from this program focuses on the mechanisms of resistance to therapy in Waldenström macroglobulinemia.

Dr. Treon provides insights regarding mechanisms of resistance to ibrutinib therapy in WM and discusses management strategies for relapsed/refractory (R/R) disease, including novel targets and treatment strategies:

  • BTK Cys mutations are very common in WM, especially in CXCR4-mutated disease, and are implicated in ibrutinib resistance and are attributed to more than half of the progression events that occur.
  • Ongoing studies of progressive WM are investigating the role of the extracellular receptor kinase (ERK) pathway as an escape mechanism activated in response to BTK Cys mutations.
  • Immunoglobulin M (IgM) levels must be closely monitored when abruptly discontinuing ibrutinib because of a rebound effect.
  • Managing R/R disease depends on duration of response to first-line therapy and may include prior therapy for good initial responses (>2 years) or ibrutinib.
  • Data from a phase II trial of venetoclax in the R/R setting indicates that this agent is a promising emerging agent for the treatment of WM.

3 of 3
Emerging Treatment Strategies in Waldenström Macroglobulinemia

The online Oncology Briefings CME activity, Updates in Waldenström Macroglobulinemia, provides oncologists and other healthcare professionals with an engaging presentation on the current and evolving treatment standards in Waldenström macroglobulinemia (WM). Leading expert Steven Treon, MD, PhD, professor and director of the Bing Center for Waldenström Macroglobulinemia at Dana-Farber Cancer Institute at Harvard Medical School, Boston, MA, answers key questions supported by the presentation of clinical science about WM. The third and final PER Pulse Recaps from this program focuses on emerging treatment strategies for Waldenström macroglobulinemia.

Dr. Treon discusses data from clinical trials investigating novel BTK inhibitors and combination therapies as well as other therapeutic strategies, including targeting novel binding sites in MYD88 mutated disease:

  • Clinical trial of acalabrutinib showed high overall response rate (ORR) of 93 percent over 27-month follow-up and was observed in both treatment-naïve and relapsed/refractory disease which is in line with what has been seen with ibrutinib.
  • Zanabrutinib shows high levels of activity in WM; a response rate of about 90% which included both treatment-naïve and previously treated patients and was well tolerated. An ongoing phase III clinical trial is comparing zanubrutinib versus ibrutinib.
  • An ongoing phase I/II clinical trial is evaluating the safety of the CXCR4-inhibitor, ulocuplumab, in combination with ibrutinib in CXCR4-mutated disease.
  • A phase II study of the BCL2 inhibitor, venetoclax, showed that it was well tolerated and produced high levels of response in previously treated disease with BTK inhibitors.
  • Novel strategies for treating WM include the development of noncovalent BTK inhibitors and BTK inhibitors that target different binding sites than ibrutinib, in addition to inhibitors of hemopoietic cell kinase inhibitors, IRAK molecules, the CXCR4 pathway, and the BCL-2 transcription factor.

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