Spotlight from JADPRO Live 2023

New Drug Updates in Hematologic Malignancies, Development of an Advanced Practice Provider-Led Virtual Anemia Consult Clinic, Indirect Treatment Comparison of Momelotinib vs Pacritinib Safety and Anemia Outcomes in Patients With Myelofibrosis

Susan Woodward, MSN, APRN, AOCNP®, of Moffitt Cancer Center, discusses bispecific antibodies that were approved in the past year as well as other drugs for FL, MM, and MF, and the new set of toxicities these agents bring with them. She also reviewed a poster that showed a model developed by APs to expedite the evaluation and management of anemia in patients with cancer, improving health-care access for patients coping with anemia (Abstract JL1112C). Another poster she reviewed compared safety outcomes between momelotinib and fedratinib separately in JAK inhibitor–experienced and JAK inhibitor–naïve patients with myelofibrosis (Abstract JL1109EH).


Susan Woodward:

I attended “New Drug Updates in Hematologic Malignancies,” and as a hematology nurse practitioner specializing in lymphoma, it was a really exciting session. It's been an exciting year for multiple myeloma, lymphoma, myelofibrosis, but as a lymphoma specialist, I'm particularly excited about the bispecific antibodies. There have been 3 approved in the past year: mosunetuzumab for follicular lymphoma, and epcoritamab and glofitamab for diffuse large b-cell lymphoma. All of those will be in a third-line-plus setting. Bispecific antibodies are an exciting new treatment option for patients. They are bispecific t-cell engagers that bring the CD20 positive cancer cells, lymphoma cells, with the CD3 positive t-cells. And as they're brought together, they set up an immune storm, which results in the death of the cancer cell.

These are new and exciting therapies that come with a whole set of new toxicities that will be managed by APPs in the tertiary care centers, as well as the community settings. We're hoping that these therapies will be more available in the community as APPs become more comfortable with managing the toxicities. The two particular ones that are going to be at the forefront are cytokine release syndrome and ICANS, or immune effector cell mediated neurotoxicity. There's a lot of information available and it's going to be an exciting year for lymphoma treatment.

Another interesting development in the topic of myelofibrosis is the approval in September 2023 of momelotinib, which is approved for adults with intermediate- and high-risk myelofibrosis with anemia. It's looking like this drug may have less grade 3 and 4 toxicities, particularly GI toxicity and anemia and thrombocytopenia, and may have improved outcomes in terms of improving anemia.

As a follow-up, I was over in the exhibit hall and saw a great poster on momelotinib. It was an indirect comparison with an already-approved drug, pacritinib, and the data that was presented on the poster highlighted that the probably improved outcomes as far as hemoglobin improvement, as well as seeing less grade 3 and 4 toxicities. And when you're talking about GI toxicities for patients, that can be very important, as well as less serious cytopenias, including anemia and thrombocytopenia.

Another poster I was extremely excited about was a virtual APP-led anemia clinic that was piloted at the Cleveland Clinic. And what they had found was that there were underutilized spaces in some of their satellite clinics where their APPs had a lot of clinic openings, but there was also a need to see anemia patients much more quickly. It was about a 20-day average to get in for a consult. After implementing this virtual clinic, they were able to get that down to about 8 days to see the patient in consult. And the APPs could virtually do these anemia consults with patients. It was great for the patients because they didn't have to leave work, they could set up a consult in the car, or at work. They didn't have to drive to the cancer center. And they could at least get a start on getting their anemia problems diagnosed and corrected. What was one thing that was great for APPs is that it resulted in a 276% improvement in their benign hematology APP revenue over the period of time that they piloted this program.