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Pilot Trial of Streamlined Genetic Education and Traceback Genetic Testing in Prostate Cancer Survivors

Marc D. Schwartz, Beth N. Peshkin, Claudine Isaacs, Christopher Grisham, Nora J. Holmes, Lia J. Sorgen, Sean Collins, Nancy Dawson, Colleen McGuire, Tobechukwu Okobi, Kelsey Newell, Kavitha A. Kolla, and Veronique Weinstein

Background: Germline genetic testing is recommended for men with metastatic or high-risk prostate cancer to inform treatment and risk management for other cancers and inform genetic testing in at-risk relatives. However, relatively few patients with prostate cancer undergo genetic testing. Given the low rate of testing and increasing demands on genetic service providers, strategies are needed that reduce barriers to testing while conserving genetic counseling resources. The primary goal of this study was to determine whether a proactive and streamlined “traceback” approach could yield increased genetic testing participation among prostate cancer survivors. Methods: We randomized 107 survivors of metastatic and high-risk prostate cancer to streamlined testing (ST) versus enhanced usual care (EUC). ST participants were proactively provided with print genetic education materials and the option to proceed to genetic testing without pre-test genetic counseling. EUC participants were sent a letter from their physician advising them of their eligibility for genetic testing and recommending they schedule genetic counseling. The primary outcome was genetic testing participation. Secondary outcomes were distress, knowledge, decision satisfaction, and regret. Results: In the ST group, 41.5% of participants completed genetic testing compared with 27.8% in the EUC group. After adjusting for education and marital status, the odds of testing were more than twice as high for the ST group as for the EUC group (odds ratio, 2.57; 95% CI, 1.05–6.29). The groups did not differ on any of the psychosocial outcomes at the 3-month follow-up. Conclusions: Proactive outreach paired with streamlined genetic testing delivery may be a safe, effective, and resource-efficient approach to facilitate traceback genetic testing in prostate cancer survivors.

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Similar Efficacy Observed for First-Line Immunotherapy in Racial/Ethnic Minority Patients With Metastatic NSCLC

Matthew Lee, Jianyou Liu, Emily Miao, Shuai Wang, Frank Zhang, John Wei, Julie Chung, Xiaonan Xue, Balazs Halmos, H. Dean Hosgood, and Haiying Cheng

Background: Limited data exist on the impact of immunotherapy use in ethnic minority patients with non–small cell lung cancer (NSCLC), because they have been underrepresented in immunotherapy trials. This study aims to evaluate race/ethnicity and other demographic, socioeconomic, and clinical factors of patients with metastatic NSCLC treated with first-line immunotherapy. Methods: A retrospective cohort study of 5,920 patients diagnosed with lung cancer treated at Montefiore Einstein Cancer Center from January 1, 2013, to June 1, 2022, was used to identify patients with metastatic NSCLC without EGFR, ALK, or ROS1 alterations who underwent first-line immunotherapy (n=248). The primary endpoint was overall survival (OS), with secondary endpoints of progression-free survival (PFS) and time to discontinuation (TTD) from the start of immunotherapy. Results: Among the 248 patients, median follow-up time was 12.0 months, median age at start of treatment was 66 years, and 39.1% were non-Hispanic Black, 30.2% were Hispanic, and 30.7% were non-Hispanic White. OS (P=.39), PFS (P=.29), and TTD (P=.98) were similar among racial/ethnic groups. Patients with an ECOG performance status (PS) of <2 at the start of immunotherapy had longer OS compared with those with ECOG PS of ≥2 (P<.0001). PD-L1 expression (<50% vs ≥50%; P=.03) and body mass index (BMI) (P=.01) were also found to be associated with PFS, and ECOG PS (P<.0001) and BMI (P=.02) were associated with TTD. In a multivariate analysis of OS and PFS, ECOG PS was the only variable found to be significant. Conclusions: Our study observed similar benefits of immunotherapy in patients with metastatic NSCLC in different racial and ethnic groups. Furthermore, ECOG PS was associated with OS, and PD-L1 expression and BMI were associated with PFS and TTD. These findings help identify potential factors associated with outcomes and care while patients are undergoing immunotherapy.

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What Constitutes Quality of Life? Perspectives of Adolescents and Young Adults With Advanced Cancer

Jane Hinkle, Lori Wiener, Andrea Altschuler, Katharine E. Brock, Mallory Casperson, Chun R. Chao, Lauren Fisher, Lawrence H. Kushi, Joshua R. Lakin, Anna Lefebvre, Corey M. Schwartz, Dov M. Shalman, Catherine B. Wall, and Jennifer W. Mack

Background: Adolescents and young adults (AYAs) with advanced cancer identify maintaining a good quality of life (QoL) as a central goal of end-of-life care. QoL is a dynamic and subjective overarching concept that refers to an individual’s relative satisfaction with their own life. Despite its importance to AYAs with advanced cancer, a patient-centered definition of QoL is lacking in this population. Patients and Methods: This qualitative secondary analysis of semistructured interviews was conducted across 3 institutions and 1 online support community among AYA patients with advanced cancer, family caregivers, and health care providers who cared for living or recently deceased AYAs. Interviewees were asked about priorities in receipt of care. Interviews were transcribed using NVivo software for primary analysis, and previously coded excerpts were screened for references to QoL. Relevant excerpts were sorted into organizing domains. Results: Participants included 23 AYA patients, 28 family caregivers, and 29 health care providers (including physicians, nurses, nurse practitioners, social workers, and psychologists). Four domains of QoL were identified: psychosocial and physical well-being, dignity, normalcy, and personal and family relationships. Within each domain there was agreement across AYAs, caregivers, and health care providers, with nuanced perspectives provided by AYAs of different ages. Personal and family relationships was the most frequently referenced domain of QoL among all participants. A common feature of each domain was that adaptation to current circumstances impacted perspectives on QoL. Patients valued active participation in the development of a care plan that supported these domains. Conclusions: AYAs with advanced cancer, their caregivers, and health care providers agree on several broad domains of QoL in this population. To provide high-quality, patient-centered care, care plans should integrate these domains to enable AYAs to maximize their QoL throughout their advanced cancer care.

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Words Matter: Unintended Side Effects of “Financial Toxicity”

Eric C. Blackstone and Barbara J. Daly

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Volume 21 (2023): Issue Supplement (Nov 2023): Highlights of the NCCN 2023 Annual Congress: Hematologic Malignancies

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Acute Myeloid Leukemia: Selecting Induction Therapy Based on Biological Disease Factors

Presented by: Rebecca Olin

Greater insight into the role of biologic disease factors in acute myeloid leukemia (AML) has led to more effective and personalized treatment options. Data presented at the NCCN 2023 Annual Congress: Hematologic Malignancies reflected the rapidly evolving treatment landscape, showcasing the significance of combination therapies and precision medicine in managing different AML subtypes. For patients deemed fit for induction with favorable-risk cytogenetics, the standard of care has moved to combining the 7 + 3 regimen with gemtuzumab ozogamicin. Alternatively, for patients with FLT3-mutated disease, a more intensified approach involving the addition of midostaurin or newer therapies, such as quizartinib, to standard induction treatment has shown improved outcomes. For patients with AML who are unfit for standard induction, treatments combining hypomethylating agents with venetoclax, as well as therapies involving IDH1/2 and FLT3 inhibitors for specific genetic subtypes, offer encouraging alternatives in managing the disease.

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Adult Acute Lymphocytic Leukemia: Strategies for Selection of Consolidation Therapy

Presented by: Aaron C. Logan

The 2 primary treatment options for adult acute lymphoblastic leukemia (ALL) are pediatric-inspired Berlin-Frankfurt-Münster protocols and the hyper-CVAD (cyclophosphamide, vincristine, doxorubicin, and dexamethasone) regimen—these treatment strategies are now being augmented with novel agents. Current strategies also emphasize measurable residual disease (MRD) quantification as a critical tool for determining the treatment course. For patients with MRD-positive ALL, the standard of care has shifted toward blinatumomab, resulting in improved outcomes and survival rates. Another novel agent, inotuzumab ozogamicin, is also being explored for the treatment of earlier stages of disease in patients with ALL. For Philadelphia chromosome (Ph)–negative ALL, the NCCN Guidelines recommend treatment with blinatumomab followed by allogeneic transplants for patients remaining MRD-positive after initial therapy. For patients achieving MRD negativity at the level of 10-4, blinatumomab is now recommended as consolidation, with or without subsequent allotransplant, depending on patient disease risk features. For Ph-positive ALL, the use of tyrosine kinase inhibitors in combination with blinatumomab has demonstrated excellent efficacy, indicating the growing importance of combination targeted therapies to improve outcomes and decrease the toxicity of therapy in adults with ALL.

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Advances in the Management of Classical Hodgkin Lymphoma

Presented by: Ryan C. Lynch

The development of brentuximab vedotin, nivolumab, and pembrolizumab has revolutionized the treatment of classical Hodgkin lymphoma. Continuous efforts are underway to improve the established early-line treatment regimens, incorporating these novel systemic therapies as either replacements for or additions to conventional agents. Although brentuximab vedotin, nivolumab, and pembrolizumab have demonstrated efficacy both as monotherapies and in combinations, critical questions remain regarding the sequencing of these agents, as well as the role of radiation therapy and interim PET scans.

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Chronic Myeloid Leukemia/Myelofibrosis: TKI Therapy and Toxicity Management

Presented by: Gabriela S. Hobbs and Christopher Bell

Recent advances in the understanding of the molecular basis of chronic myeloid leukemia (CML) and myelofibrosis have led to more effective treatment options, with survival now close to that of age-matched controls in CML. The latest updates to the NCCN Guidelines for CML reflect the rapidly evolving treatment landscape, emphasizing the increasing importance of personalized medicine and various targeted therapies. For patients with CML, standard of care involves tyrosine kinase inhibitors such as imatinib, dasatinib, bosutinib, nilotinib, ponatinib, and asciminib, tailored to patient-specific factors and the severity of adverse events. In patients with myelofibrosis, the Janus kinase inhibitors ruxolitinib, pacritinib, and fedratinib have yielded improved outcomes. Critical strategies for managing treatment-related adverse events to optimize the quality of life for patients with these hematologic malignancies were also highlighted.

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Incorporating Immunotherapeutic Strategies in the Management of Relapsed/Refractory Multiple Myeloma

Presented by: Shaji K. Kumar

The emergence of immunotherapy has changed the treatment strategy for multiple myeloma, both in the early disease setting and in relapsed/refractory disease. Although daratumumab has been routinely incorporated into various combination regimens, T-cell–redirecting approaches, such as bispecific T-cell engagers and CAR T-cell therapy, are emerging. In patients with highly refractory disease, these approaches have robustly impacted both progression-free and overall survival. Most of these agents target the B-cell maturation antigen. Drugs with new targets are also in development, which will further extend the value of immunotherapeutic strategies in myeloma.