Spotlight from JADPRO Live 2023

New Drug Updates in Hematologic Malignancies & Establishing a Survivorship Program in a Malignant Hematology and Cellular Therapy Practice

Kirollos S. Hanna, PharmD, BCPS, BCOP, FACCC, of Minnesota Oncology and the Mayo Clinic College of Medicine, discusses notable FDA approvals and expansions in the BTKi space and antibody drug conjugates, aimed at B-cell cancers, including DLBCL, and the BRUIN study, which looked at the promising use of pirtobrutinib in patients with CLL and SLL. He also reviewed some of the challenges of setting up a survivorship program for patients with hematologic malignancies. He describes the crucial role advanced practice providers can play in determining the optimal timing for survivorship care plans and referral to survivorship care, as well as developing long-term follow-up strategies (Abstract JL1130C).


Kirollos Hanna:

We are here at the JADPRO Annual Conference, and we've seen some really exciting updates and some really exciting sessions. One of the sessions that really stood out to me was the “New Drug Updates in Hematologic Malignancies.” We saw quite a few updates and FDA approvals, FDA expansions in the hematologic space. I think a couple of notable ones that we saw in this past year, some of which were around the BTK space in various B-cell cancers. We saw updates in CLL. We also saw some updates in relapsed refractory mantle cell lymphoma.

Going in CLL, we saw an additional BTK inhibitor approved, which is zanubrutinib. The ALPINE study reported out, there was some superiority data that came out of the ALPINE study looking at a head-to-head BTK versus BTK. And now we have 2 second-generation BTK inhibitors that are approved in the CLL space, which is something very exciting, I think, for patients.

Another update within the BTK space is looking at data that was reported out of the BRUIN study in the relapsed/refractory mantle cell population. So this was looking at pirtobrutinib in patients who have progressed on prior therapies. Looking at pirtobrutinib, it is a unique BTK inhibitor in that it can still be utilized after patients progress following a BTK inhibitor or if they develop some type of resistance mutation around something we call C481S. So it was really exciting to see that we do have active BTKs coming to market. Something like Pirto is also being studied in the CLL space, various other B-cell cancers, so it's likely that we're going to see this shift.

A couple other exciting updates. I always have to talk about antibody-drug conjugates. They're a drug class that's near and dear to my heart. We saw polatuzumab vedotin in the diffuse large B-cell lymphoma patient population. So combining polatuzumab with CHP instead of R-CHOP has demonstrated really impressive outcomes on this patient population.

We saw updates with brentuximab vedotin in the pediatric population, combining brentuximab with chemotherapy for curative intent, classical Hodgkin's lymphoma in the kiddos. That was also something really exciting that we saw come from the ADC space.

Even going a little bit further, we saw updates within the bispecific therapeutics. How many bispecifics were approved this year? I have to use both hands to count. We saw 3 in myeloma, we saw teclistamab, talquetamab, as well as elranatamab. We saw epcoritamab, glofitamab. All of these therapeutics within the lymphoma and the myeloma space are really exciting.

But I think, too, from what we learn in the bispecific space, that it really highlighted what the role of the APP is and can be in this patient population, because bispecifics, there's a lot of logistics that we have to think through. There is hospital administration or initiation of therapy, there are the REMS programs, the risk for CRS and ICANS, and many of these therapeutics institutions are looking to adopt a strategy to initiate therapy only in the outpatient setting. So not just the maintenance phase of the dosing, but to kind of transition patients out. So a lot of exciting things going on within the bispecific space. And I do think that, probably over the next year or so, we're going to become more and more accustomed to how we should operationalize these, what are best practices, as we continue to see expansions within the bispecific space, as we continue to see them move into earlier lines of therapy. So a lot of exciting things going on within the space.

To kind of segue also to one of the posters presented, talked about the role of an APP within a survivorship program. There was a poster that we saw of how they implemented a survivorship clinic or a survivorship program within a large cancer center. And ultimately they highlighted how they developed a task force, who were the key stakeholders involved in the task force, what they looked at to identify how much FTEs do you need, what protocols should be built, when should a patient be identified to go to the survivorship clinic? It was really interesting just kind of seeing their take and perspective on it, and from what was presented in the poster is that it has had a significant impact on patient outcomes in terms of various quality metrics. So it was something that we saw here and it was very, very exciting.