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Spotlight

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Authors

Yelena Ginzburg, MD, discusses a long-term goal of the use of rusfertide in patients with chronic polycythemia vera. 

Rusfertide May Reduce Need for Therapeutic Phlebotomy in Polycythemia Vera

Yelena Ginzburg, MD, discusses the prognosis and standard-of-care treatment in patients diagnosed with polycythemia vera. 

Risk Assessment and Treatment of Polycythemia Vera

ASH 2024 Preview for Community Oncologists: The Show and After Show

The American Society of Hematology (ASH) Annual Meeting and Exposition aims to educate oncology providers across an array of hematologic malignancies, with a focus on novel agents, drugs across the FDA pipeline, and more.

, co-hosts Kristie L. Kahl and Andrew Svonavec offer a glimpse at some of the presentations guaranteed to spark one’s curiosity, spur debate, and enhance the field even further. Some key highlights include:

 Continued advancements in CAR T-cell therapy are expected to revolutionize the treatment of hematologic malignancies.

 Bispecific antibodies, such as Epcoritamab (Epkinly), offer a novel approach to target multiple antigens on cancer cells.

 The assessment of MRD is becoming increasingly important in predicting treatment response and overall survival.

Advances in Acute Lymphoblastic Leukemia (ALL)

Blinatumomab (Blincyto) in pediatric ALL:

 The addition of blinatumomab to chemotherapy has shown promise in improving disease-free survival in high-risk pediatric ALL. This combination therapy may offer a more effective treatment option for young patients.

Acalabrutinib (Calquence) in mantle cell lymphoma (MCL):

 The FDA is set to review the approval of acalabrutinib with bendamustine or rituximab (Rituxan) for previously untreated MCL, based on data from the phase 3 ECHO trial (NCT02972840).

Asciminib (Scemblix) in chronic phase chronic myelogenous leukemia (CML-CP):

 The FDA recently granted accelerated approval to asciminib for newly diagnosed CML-CP. This tyrosine kinase inhibitor has shown favorable safety and tolerability profiles.

 isn't just about data, as the duo also offers food recommendations, tourist attractions and fun activities to partake in, as well as interesting facts about San Diego.

This is just a taste of the wealth of information and inspiration waiting at the 2024 ASH Annual Meeting. Check back for future meeting previews with 

Targeted Oncology co-hosts Kristie L. Kahl and Andrew Svonavec highlight abstracts for community oncologists to look out for at the upcoming ASH Annual Meeting in San Diego, with some additional tidbits to round out the main event.

News

The biologics license application (BLA) of the subcutaneous formulation of nivolumab (Opdivo) coformulated with human hyaluronidase (rHuPH20) has been accepted by the FDA.

Findings from the CheckMate -67T (NCT04810078) support this BLA of subcutaneous nivolumab as the trial met its coprimary pharmacokinetic end points and key secondary end point of overall response rate (ORR) vs intravenous (IV) nivolumab in clear cell renal cell carcinoma.

The FDA has set a Prescription Drug User Fee Act (PDUFA) goal date for December 29, 2024.

The FDA has accepted the BLA of the subcutaneous formulation of nivolumab coformulated with rHuPH20, also known as subcutaneous nivolumab, for all previously approved adult solid tumor indications of nivolumab as a monotherapy, monotherapy maintenance following completion of the combination therapy with nivolumab plus ipilimumab (Yervoy), or in combination with chemotherapy or cabozantinib (Cabometyx).

Results from the phase 3 CheckMate -67T trial of subcutaneous nivolumab support this application. In the trial, experts sought to evaluate subcutaneous nivolumab vs its intravenous (IV) formulation.

 Here, the subcutaneous form demonstrated noninferior pharmacokinetics and efficacy, as well as consistent safety compared with the IV formulation of nivolumab among patients with advanced or metastatic clear cell renal cell carcinoma (ccRCC) who have received prior systemic therapy.

A PDUFA goal date has been set for December 29, 2024. With this, subcutaneous nivolumab shows promise to become the first and only subcutaneously administered PD-1 inhibitor.

“We believe subcutaneous nivolumab has the potential to make a significant difference in the lives of patients, which is reinforced by the FDA’s acceptance of our application,” said Gina Fusaro, PhD, vice president, global program lead, Bristol Myers Squibb, in a press release.

“[Nivolumab] is a foundational PD-1 inhibitor approved for many different types of cancer, and our continued investment in research that puts patients first remains a priority. If approved by the FDA, the subcutaneous administration of nivolumab would provide patients and their physicians with a new option that delivers the same well-known benefits as IV [nivolumab] but with the improved convenience of an injection administered in 3 to 5 minutes rather than a 30- to 60-minute infusion,” Fusaro continued.

The phase 3, randomized, open-label CheckMate -67T trial is exploring subcutaneous administration of nivolumab coformulated with rHuPH20 vs IV nivolumab for the treatment of patients with advanced or metastatic ccRCC who were previously treated with systemic therapy.

In the study, 495 patients were randomly assigned to receive either subcutaneous nivolumab or IV nivolumab. Enrollment was open to patients with a histological confirmation of ccRCC, advanced RCC not amenable to curative or radiation therapy, metastatic RCC, those who received no more than 2 prior systemic therapies, those with intolerance or progression after last treatment regimen within 6 months of randomization, and those with a Karnofsky performance score ≥ 70 at screening.

Experts assessed the coprimary end points of time-averaged serum concentration over 28 days and trough serum concentration at steady-state of subcutaneous nivolumab vs IV nivolumab. A key secondary end point of the trial was ORR.

The study met its coprimary pharmacokinetic end points and key secondary end point of ORR with subcutaneous nivolumab in this patient population.

 Subcutaneous nivolumab was noninferior in regard to time-averaged nivolumab serum concentration over 28 days and steady-state trough serum concentration vs treatment with IV nivolumab. Additionally, subcutaneous nivolumab also demonstrated a noninferior ORR compared with IV nivolumab.

1. U.S. Food and Drug Administration accepts Bristol Myers Squibb’s application for subcutaneous nivolumab (nivolumab and hyaluronidase). News release. Bristol Myers Squibb. May 6, 2024. Accessed May 6, 2024. 

2. Phase 3 Check-Mate -67T trial of subcutaneous nivolumab (nivolumab and hyaluranisade) meets co-primary end points in advanced or metastatic clear cell renal cell carcinoma. News release. Bristol Myers Squibb. October 19, 2024. Accessed May 6, 2024. 

3. A study of subcutaneous nivolumab versus intravenous nivolumab in participants with previously treated clear cell renal cell carcinoma that is advanced or has spread (CheckMate-67T). ClinicalTrials.gov. Updated October 12, 2023. Accessed May 6, 2024. 

https://www.clinicaltrials.gov/study/NCT04810078

The FDA is considering a subcutaneous nivolumab formulation for various solid tumors based on promising data from the phase 3 CheckMate -67T trial. A target action date has been set for December 29, 2024.

Clinical

FDA Accepts BLA for Subcutaneous Nivolumab Across Various Solid Tumors

Future Implications for CAR T in Early RRMM and Treatment Sequencing

Video content above is prompted by the following:

What is the future treatment landscape for early relapsed/refractory multiple myeloma (R/R MM)? 

What are the future implications for a patient’s access to care and the role of community providers in the future landscape?

How do the emerging data impact your approach to treatment sequencing for the next lines of therapy in R/R MM?

Panelists discuss the future treatment landscape for early relapsed/refractory multiple myeloma, emphasizing the evolving role of community providers, the implications for patient access to care, and how emerging data will influence treatment sequencing in subsequent lines of therapy.

Video Series

Case Based Peer Perspectives

Alternative Clinical Approaches and Data for Patients not Suitable for 2L CAR T

For patients not suitable to receive chimeric antigen receptor T-cell therapy in the second line, what current/emerging treatments would you consider?

How do you approach selecting a new proteasome inhibitor and/or immune-mediated immunomodulatory drug vs recycling a combination regimen?

Briefly comment on recent data in combination regimens that support their use:

APOLLO trial, DPd vs Pd in patients with relapsed/refractory multiple myeloma (R/R MM) 

IKEMA trial, Isa-Kd vs Kd in patients with R/R MM

Panelists discuss treatment options for patients ineligible for chimeric antigen receptor T-cell therapy in the second-line setting, focusing on the selection of new proteasome inhibitors and/or immune-mediated immunomodulatory drugs vs recycling combination regimens, and reviewing recent data from the APOLLO and IKEMA trials that support the use of combination therapies in relapsed/refractory multiple myeloma.

Navigating Early versus Late Toxicities with CAR T in Myeloma

For patients receiving chimeric antigen receptor T-cell (CAR T) in early relapsed/refractory multiple myeloma, how do toxicities (ie, early, late) correlate to those observed in practice? 

What are your perceptions of the latest International Myeloma Working Group Consensus Guidelines surrounding the response/management of CAR T, specifically adverse events?

Panelists discuss the correlation between early and late toxicities observed in clinical practice for patients receiving chimeric antigen receptor T-cell (CAR T) therapy in early relapsed/refractory multiple myeloma and their perceptions of the latest International Myeloma Working Group Consensus Guidelines on response assessment and management of CAR T–related adverse events.

CARTITUDE-4: Latest Data of Cilta-Cel for Early R/R MM

Please briefly discuss the latest efficacy outcomes from the CARTITUDE-4 trial, evaluating ciltacabtagene autoleucel in patients with relapsed refractory multiple myeloma (R/R MM). 

How have the latest findings informed your approach to patient selection and referral for chimeric antigen receptor T-cell therapy in early R/R MM?

Aimee Merino, MD, discusses how the latest efficacy outcomes from the CARTITUDE-4 trial, evaluating ciltacabtagene autoleucel (cilta-cel) in relapsed/refractory multiple myeloma, have influenced her approach to patient selection and referral for chimeric antigen receptor T-cell therapy in early relapse cases.

Yelena Ginzburg, MD

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