In this, the seventh part (originally held July 26, 2011) of our eight-part online, integrated educational course, Drs Stephanie A Gregory and John P Leonard discuss recent advances in the treatment of non-Hodgkin lymphoma/chronic lymphocytic leukemia. (Webinar)
CE Disclosures and Faculty Information
TARGET AUDIENCE
This activity is intended for hematologists, medical oncologists, hematology-oncology fellows and other healthcare providers involved in the treatment of non-Hodgkin lymphoma.
OVERVIEW OF ACTIVITY
Hematologic cancer includes the lymphomas, the leukemias, multiple myeloma and other related disorders such as myelodysplastic syndromes and myeloproliferative diseases, all stemming from lymphoid and myeloid progenitor cell lines. Cytotoxic chemotherapies, autologous and/or allogeneic hematopoietic stem cell transplant and biologic or molecular-targeted therapies have been the focus of treatment algorithms designed to assist clinicians in the clinical care of patients with hematologic cancer. Despite the existence of such tools, many areas of controversy persist within the academic and community settings, especially within the area of non-Hodgkin lymphoma. The recent entry of novel agents and the emergence of extensive practice-changing clinical trial data have created clinical scenarios in which multiple treatment options may be available but the optimal strategy is highly debatable. To bridge the gap between research and patient care, this CME activity will use a review of recent ASCO papers and other relevant publications, faculty case presentations, Q&A and discussion of community practice patterns to assist practicing clinicians in the formulation of up-to-date and appropriate treatment strategies.
LEARNING OBJECTIVES- Use case-based learning to refine or validate your current management of follicular lymphoma, mantle-cell lymphoma and chronic lymphocytic leukemia.
- Develop a long-term treatment plan for patients receiving maintenance therapy.
- Counsel patients about clinical trial options investigating novel agents and strategies.
ACCREDITATION STATEMENT
Research To Practice is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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 CME ACTIVITY
CME credit is no longer available for this issue
This CME activity consists of a video component. The participant should watch the video.
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 CME 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 physician 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:
Stephanie A Gregory, MD
The Elodia Kehm Chair of Hematology
Professor of Medicine
Director, Section of Hematology
Rush University Medical Center
Chicago, Illinois
Advisory Committee: Amgen Inc, Cephalon Inc, Genentech BioOncology, Novartis Pharmaceuticals Corporation, Spectrum Pharmaceuticals Inc; Speakers Bureau: Cephalon Inc.
John P Leonard, MD
Richard T Silver Distinguished Professor of Hematology and Medical Oncology
Professor of Medicine, Weill Cornell Medical College
New York, New York
Consulting Agreements: Biogen Idec, Bristol-Myers Squibb Company, Celgene Corporation, Cephalon Inc, EMD Serono Inc, Genentech BioOncology, GlaxoSmithKline, Millennium: The Takeda Oncology Company, Novartis Pharmaceuticals Corporation, Pfizer Inc, Sanofi.
MODERATOR — Dr Love is president and CEO of Research To Practice, which receives funds in the form of educational grants to develop CME activities from the following commercial interests: Allos Therapeutics, Amgen Inc, Astellas Pharma Global Development Inc, AstraZeneca Pharmaceuticals LP, Aureon Laboratories Inc, Bayer HealthCare Pharmaceuticals/Onyx Pharmaceuticals Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Bristol-Myers Squibb Company, Celgene Corporation, Cephalon Inc, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, EMD Serono Inc, Genentech BioOncology, Genomic Health Inc, ImClone Systems, a wholly owned subsidiary of Eli Lilly and Company, Lilly USA LLC, Millennium: The Takeda Oncology Company, Mundipharma International Limited, Myriad Genetics Inc, Novartis Pharmaceuticals Corporation, OSI Oncology, Sanofi and Seattle Genetics.
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 Genentech BioOncology/Biogen Idec and Millennium: The Takeda Oncology Company.
Hardware/Software Requirements:
An Internet connection that is at least 28.8 Kbps
A monitor set to 1280 x 1024 pixels or more
Internet Explorer 6.x or newer, Firefox 2.x or newer, or Safari 2.x or newer
Macromedia Flash plug-in 6.0 or greater
Adobe Acrobat Reader
(Optional) Sound card and speakers for audio
Last review date: August 2011
Expiration date: August 2012
Acknowledge and close
(WiFi is recommended for best performance):
1. Rituximab (R) maintenance in mantle-cell lymphoma (MCL)
Since the PRIMA study in follicular lymphoma (FL) was first presented at ASCO 2010 demonstrating improved progression-free survival with two years of maintenance R, this strategy has become well established in FL. However, a lack of data led to lingering doubt/skepticism about its effectiveness in MCL. At the June European Hematology Association meeting in London this began to change as a trial for patients with MCL over age 60 demonstrated that R maintenance following R/chemo induction resulted in a median remission duration of 51 months compared to 24 months with low-dose maintenance interferon. Interestingly, the current ECOG trial evaluating induction bortezomib/bendamustine/R in MCL provides another sign that maintenance may be taking hold as all patients continue R for two years.
2. Promising agents and novel strategies
During our broadcast John presented a 66-year-old patient with MCL and disease progression after multiple prior regimens, including R-CHOP and BR. With a rapidly deteriorating performance status, the patient chose to enter a Phase I trial of the Bruton’s tyrosine kinase inhibitor PCI-32765, and John showed a stunning set of CT scans demonstrating a major response in this woman. Stephanie then mentioned other small molecules in development with apparent efficacy and tolerability in B-cell neoplasia, including CAL-101, and both faculty noted ongoing trials evaluating proteasome inhibitors (bortezomib) and IMiDs (lenalidomide).
3. “Watch and worry” versus R induction and maintenance
John commented on data presented in June at the International Conference on Malignant Lymphoma in Lugano evaluating quality of life for patients on the landmark UK trial first presented at ASH demonstrating a 33% three-year PFS rate with observation compared to an 81% PFS rate with R induction and maintenance for two years. Quality of life trial data are often difficult for clinicians to apply in their practices, but these new findings are interesting in that the untreated group actually experienced an improved quality of life with time but patients who received R demonstrated an additional incremental benefit. The faculty speculated that in this and other cancers, after the initial life-shock of diagnosis begins to subside, many patients feel more at ease over time, and in this psychological milieu of adapting to life with a treatable but not curable illness, patients seem to feel even better when receiving a relatively nontoxic treatment that slows disease progression.
4. CLL
John presented a 75-year-old man with CLL and a trisomy 12 mutation (intermediate risk), and the audience was split in terms of their preferred induction regimen (BR 37%, FR 25%, FCR 20% and other 18%). This patient received FR and is doing well, but Stephanie verbalized her hope that the ongoing large German CLL study will show at least equal efficacy and perhaps greater tolerability for BR compared to FCR.
5. Bonus item for Andy Zelenetz
Prompted by an impassioned plea from Dr Z at a recent Think Tank in our Miami studio, we asked the webcast audience how they approach screening for hepatitis in patients slated to receive R. Andy — head of the NCCN NHL guidelines committee — wants to be certain clinicians realize the importance of screening such patients, and sure enough, 23% of our webcast viewers indicated they don’t routinely conduct these tests. Stephanie then described a patient in her practice who wasn’t screened and experienced reactivated hepatitis and a catastrophic clinical course after receiving R/chemo.
Neil Love, MD
Research To Practice
Miami, Florida