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Patterns of Care in Medical Oncology: Current Practice Patterns of General Medical Oncologists — Multiple Myeloma Module
Released January 2015

Patterns of Care in Multiple Myeloma is a unique CME activity that presents findings from a national survey of general oncologists and perspectives of clinical investigators on their approach to key management challenges in the treatment of multiple myeloma. Featuring commentary from Drs Nikhil C Munshi and Ravi Vij. (Text and Video Content)

CE Disclosures and Faculty Information

    Multiple myeloma (MM) is a plasma cell neoplasm that accounts for approximately 10% of all hematologic cancer cases. It is estimated that 26,850 new cases will be diagnosed and 11,240 deaths will occur in the United States in 2015. The introduction of new agents with substantial activity has improved outcomes and allowed patients to experience longer periods of remission. Both novel proteasome inhibitors and immunomodulatory agents have effectively transformed the standard treatment for patients with newly diagnosed and relapsed/refractory MM. Although various maintenance strategies have been incorporated into current treatment algorithms, little is known about the adoption of these therapeutic approaches in clinical practice. The current challenge facing the oncology community is identifying those patients who will obtain the greatest benefit from a specific regimen while incurring the least toxicity.

    In January 2014 more than 6,500 practicing oncologists from Research To Practice's proprietary email database were invited to complete an extensive case-based survey focused in part on the management of MM. This CME endeavor documents the self-reported practice patterns of 101 general medical oncologists who elected to participate. The activity also offers clinical investigator perspectives on these findings in addition to their preferred approaches to the same scenarios examined. This information is presented in an effort to allow practicing medical oncologists to compare and contrast their own practice patterns to those of their peers and hematologic oncology experts and modify them accordingly.


    • Compare and contrast induction and maintenance treatment strategies used by general oncologists and cancer clinical investigators, and apply this knowledge to individualize therapy for patients with MM.
    • Evaluate the effects of patient age and risk status on the selection of induction and maintenance therapy for patients with MM.
    • Determine the optimal duration of maintenance therapy for transplant-eligible patients with MM.
    • Assess the risk of second primary cancers with the use of maintenance lenalidomide, and use this information to counsel patients with MM.


    CME credit is no longer available for this issue


    CME credit is no longer available for this issue

    This CME activity contains text, slide and video components. The participant should read the text portion, review the slides and watch the video.

    CME credit is no longer available for this issue

    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:

    Nikhil C Munshi, MD
    Associate Professor of Medicine, Harvard Medical School
    Associate Director, Jerome Lipper Multiple Myeloma Center
    Dana-Farber Cancer Institute
    Boston, Massachusetts

    Advisory Committee: Celgene Corporation, Onyx Pharmaceuticals, an Amgen subsidiary; Consulting Agreement: Celgene Corporation; Ownership Interest: OncoPep.

    Ravi Vij, MD
    Associate Professor of Medicine
    Washington University School of Medicine
    Section of Stem Cell Transplant and Leukemia
    Division of Medical Oncology
    St Louis, Missouri

    Advisory Committee: Bristol-Myers Squibb Company, Celgene Corporation, Onyx Pharmaceuticals, an Amgen subsidiary; Consulting Agreements: Bristol-Myers Squibb Company, Celgene Corporation, Lilly, Onyx Pharmaceuticals, an Amgen subsidiary; Contracted Research: Celgene Corporation, Onyx Pharmaceuticals, an Amgen subsidiary; Speakers Bureau: Celgene Corporation, Onyx Pharmaceuticals, an Amgen subsidiary, Takeda Oncology.

    EDITOR — 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: AbbVie Inc, Amgen Inc, Astellas, AstraZeneca Pharmaceuticals LP, Aveo Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Biodesix Inc, Biogen Idec, Boehringer Ingelheim Pharmaceuticals Inc, Boston Biomedical Pharma Inc, Bristol-Myers Squibb Company, Celgene Corporation, Clovis Oncology, Daiichi Sankyo Inc, Dendreon Corporation, Eisai Inc, Exelixis Inc, Foundation Medicine, Genentech BioOncology, Genomic Health Inc, Gilead Sciences Inc, Incyte Corporation, Jazz Pharmaceuticals Inc, Lilly, Medivation Inc, Merck, Myriad Genetic Laboratories Inc, Novartis Pharmaceuticals Corporation, Novocure, Onyx Pharmaceuticals, an Amgen subsidiary, Pharmacyclics Inc, Prometheus Laboratories Inc, Regeneron Pharmaceuticals, Sanofi, Seattle Genetics, Sigma-Tau Pharmaceuticals Inc, Sirtex Medical Ltd, Spectrum Pharmaceuticals Inc, Taiho Oncology Inc, Takeda Oncology, Teva Oncology, Tokai Pharmaceuticals Inc and VisionGate Inc.

    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 and Takeda Oncology.

    Hardware/Software Requirements:
    A high-speed Internet connection
    A monitor set to 1280 x 1024 pixels or more
    Internet Explorer 7 or later, Firefox 3.0 or later, Chrome, Safari 3.0 or later
    Adobe Flash Player 10.2 plug-in or later
    Adobe Acrobat Reader
    (Optional) Sound card and speakers for audio

    Last review date: January 2015
    Expiration date: January 2016

Acknowledge and close

Click on the links below to review slides, editor's comments and select publications:
Chapter 1: Induction and Maintenance Treatment for Younger Patients
Induction treatment for younger, transplant-eligible patients at standard risk
Use of subcutaneous versus intravenous bortezomib in pretransplant induction therapy
Post-transplant maintenance for patients at standard risk
Duration of post-transplant maintenance for patients at standard risk
Dose of post-transplant lenalidomide maintenance
Initial treatment for younger, transplant-eligible patients at high risk
Corticosteroids with maintenance therapy
Up-front therapy for patients with renal failure
Chapter 2: Induction and Maintenance Treatment for Older Patients
Up-front therapy for older patients at standard risk
Maintenance therapy for patients not eligible for transplant
Dose of maintenance lenalidomide for older patients
Induction treatment for older patients at high risk
Chapter 3: Additional Treatment Considerations
Thromboprophylaxis for patients receiving maintenance lenalidomide
Risk of second primary cancers in patients receiving long-term lenalidomide
Prevention of herpes zoster reactivation in patients receiving proteasome inhibitors