Oncology Nursing Update: Multiple Myeloma Edition, Issue 2, 2012

Submitted by mphilemon@resea... on Thu, 12/13/2012 - 13:08

To bridge the gap between research and patient care, this activity features one-on-one interviews conducted by Dr Neil Love with leading multiple myeloma investigators. By providing information on the latest research developments in the context of expert perspectives, this activity is designed to assist oncology nurses, clinical nurse specialists and nurse practitioners with the formulation of state-of-the-art clinical management strategies to facilitate optimal patient care. This content is available in a number of formats for listening on the go with a mobile device or in the office or at home on a computer.

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TOPICS DISCUSSED


	Sagar Lonial, MD Professor Vice Chair of Clinical Affairs Director of Translational Research B-Cell Malignancy Program Department of Hematology and Medical Oncology Winship Cancer Institute Emory University School of Medicine Atlanta, Georgia		INTERVIEW WITH DR LONIAL Activity of the newly FDA-approved, irreversible proteasome inhibitor carfilzomib in patients with bortezomib-naïve and bortezomib-resistant multiple myeloma (MM) Infrequent carfilzomib-related peripheral neuropathy Mechanism(s) of action of proteasome inhibitors Synergy of bortezomib with chemotherapy and immunomodulatory drugs (IMiDs) in MM Etiology of renal failure in patients with MM and benefit from treatment with bortezomib Subcutaneous administration and/or weekly dosing to ameliorate bortezomib-related neuropathy Improving long-term outcomes with longer duration of treatment with IMiDs and proteasome inhibitors during initial induction therapy Predisposing factors (eg, diabetes) for the development of bortezomib-associated neuropathy MLN9708, a next-generation, investigational oral proteasome inhibitor Tolerability and side-effect profile of carfilzomib Lenalidomide-associated neutropenia, thrombocytopenia and thrombosis Perspective on preferred induction therapy in younger patients — lenalidomide, bortezomib and dexamethasone (RVD) versus cyclophosphamide, bortezomib and dexamethasone (CyBorD) Role of immediate versus deferred autologous stem cell transplant (ASCT) in the era of novel agents Post-transplant maintenance lenalidomide and second primary cancers Dose and schedule of maintenance lenalidomide Potency and side effects of the third-generation IMiD pomalidomide Cereblon expression as a prerequisite for the antimyeloma activity of IMiDs Incorporation of carfilzomib into up-front induction therapy regimens for transplant-eligible and transplant-ineligible patients with MM Rationale for combining the anti-CS1 monoclonal antibody elotuzumab with lenalidomide and dexamethasone Benefits of bisphosphonates and the rank ligand inhibitor denosumab as bone-targeted treatments in MM Prevention of bisphosphonate-associated osteonecrosis of the jaw (ONJ) Duration of bisphosphonate therapy in patients with active myeloma Defining characteristics of smoldering myeloma Investigations of risk-adapted treatment approaches for smoldering myeloma

	Tiffany Richards, MS, ANP-BC, AOCNP Nurse Practitioner Department of Lymphoma/Myeloma The University of Texas MD Anderson Cancer Center Houston, Texas		INTERVIEW WITH MS RICHARDS Counseling patients who are about to initiate induction therapy Impact of subcutaneous administration and/or weekly dosing of bortezomib on the incidence of peripheral neuropathy Importance of hydration prior to carfilzomib administration Thromboembolic prophylaxis in patients receiving RVD induction therapy Educating patients who are about to undergo ASCT Defining autologous and allogeneic stem cell transplants and graft versus host disease Conventional cytogenetics and FISH to identify patients with a poor prognosis Monitoring and management of patients receiving post-transplant maintenance lenalidomide Treatment approach for relapsed MM Newly approved (carfilzomib) and promising novel (pomalidomide and elotuzumab) agents in MM Selection of up-front treatment for patients with MM who are ineligible for transplant — MPV versus MPR Dosing and duration of initial treatment for elderly patients Treatment and reversibility of renal dysfunction in MM Selection and duration of bone-targeted treatment in MM Importance of dental evaluation for patients prior to receiving bisphosphonates to ameliorate risk of ONJ Local treatments for bone disease — radiation therapy and kyphoplasty Counseling patients with MM about their expected prognosis

	EDITOR: Neil Love, MD Research To Practice Miami, Florida

OVERVIEW OF ACTIVITY

Multiple myeloma (MM) is a plasma cell neoplasm that accounts for approximately 10% of all hematologic cancers and carries with it the worst death to new cases ratio (3:4) among all the blood cancer subtypes. Patients with smoldering (asymptomatic) myeloma may be cared for by observation only because the course of the disease is often indolent for many years without therapy. However, patients with more advanced, active disease require immediate induction therapy in an effort to prepare eligible candidates for autologous stem cell transplant (ASCT). Optimal initial induction therapy for both ASCT candidates and those not eligible remains an area of clinical controversy, and multiple acceptable treatment options appear to merit consideration. Recent clinical research demonstrates an abundance of treatment options now available to patients with both newly diagnosed and relapsed or refractory MM. To provide oncology nurses with therapeutic strategies to address the disparate needs of patients with MM, the Oncology Nursing Update audio series employs one-on-one interviews with medical oncologists and nurses who are experts in caring for patients with MM. Upon completion of this CNE activity, oncology nurses should be able to formulate an up-to-date and more complete approach to the care of patients with MM.

LEARNING OBJECTIVES

Discuss the benefits and risks associated with evidence-based systemic therapies used in the treatment of MM, including chemotherapy, proteasome inhibitors, corticosteroids and immunomodulatory agents, in the pre- and post-ASCT settings and in patients who are not candidates for ASCT or those with renal insufficiency.
Develop a plan of care to manage the side effects associated with these therapies to support quality of life and continuation of treatment.
Evaluate the preliminary safety profiles and response outcomes observed in studies of next-generation proteasome inhibitors, immunomodulatory agents and monoclonal antibodies for patients with relapsed or refractory and previously untreated MM.
Integrate recent clinical research findings with immunomodulatory agents into the development of individualized maintenance treatment strategies — including factors such as treatment dose and schedule, quality of life and side effects — for patients with MM.

ACCREDITATION STATEMENT

Research To Practice is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

CME credit is no longer available for this issue

CREDIT DESIGNATION STATEMENT

CME credit is no longer available for this issue

HOW TO USE THIS CNE ACTIVITY

This is an audio CNE program. Participants should listen to the audio MP3s.
CME credit is no longer available for this issue

CONTENT VALIDATION AND DISCLOSURES

Research To Practice (RTP) is committed to providing its participants with high-quality, unbiased and state-of-the-art education. We assess potential conflicts of interest with faculty, planners and managers of CNE activities. Real or apparent conflicts of interest are identified and resolved through a conflict of interest resolution process. In addition, all activity content is reviewed by both a member of the RTP scientific staff and an external, independent reviewer for fair balance, scientific objectivity of studies referenced and patient care recommendations.

FACULTY — The following faculty (and their spouses/partners) reported real or apparent conflicts of interest, which have been resolved through a conflict of interest resolution process:

Sagar Lonial, MD
Professor
Vice Chair of Clinical Affairs
Director of Translational Research, B-Cell Malignancy Program
Department of Hematology and Medical Oncology
Winship Cancer Institute
Emory University School of Medicine
Atlanta, Georgia

Advisory Committee and Consulting Agreements: Acetylon Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Merck, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals Inc.

Tiffany Richards, MS, ANP-BC, AOCNP
Nurse Practitioner
Department of Lymphoma/Myeloma
The University of Texas MD Anderson Cancer Center
Houston, Texas

Consulting Agreements: Millennium: The Takeda Oncology Company, Onyx Pharmaceuticals Inc.

EDITOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME/CNE activities from the following commercial interests: Abbott Laboratories, Allos Therapeutics, Amgen Inc, ArQule Inc, Astellas, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, EMD Serono Inc, Foundation Medicine Inc, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Lilly USA LLC, Medivation Inc, Merck, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Spectrum Pharmaceuticals Inc and Teva Oncology.

RESEARCH TO PRACTICE STAFF AND EXTERNAL REVIEWERS — The scientific staff and reviewers for Research To Practice have no real or apparent conflicts of interest to disclose.

This educational activity contains discussion of published and/or investigational uses of agents that are not indicated by the Food and Drug Administration. Research To Practice does not recommend the use of any agent outside of the labeled indications. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. The opinions expressed are those of the presenters and are not to be construed as those of the publisher or grantors.

This activity is supported by educational grants from Celgene Corporation, Millennium: The Takeda Oncology Company and Onyx Pharmaceuticals Inc.

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There is no implied or real endorsement of any product by RTP or the American Nurses Credentialing Center.