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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">Commentary</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-08-30T12:00:00.000">August 30, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Triple-Target CAR T Cells: Benefits and Challenges</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Triple-Target CAR T Cells: Benefits and Challenges" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" fill="white"></path></svg></button><button aria-label="twitter" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg fill="#DC7633" xmlns="http://www.w3.org/2000/svg" width="32" zoomAndPan="magnify" viewBox="0 0 375 374.9999" height="32" preserveAspectRatio="xMidYMid meet" version="1.0"><defs><path d="M 7.09375 7.09375 L 367.84375 7.09375 L 367.84375 367.84375 L 7.09375 367.84375 Z M 7.09375 7.09375 " fill="#000000"></path></defs><g><path d="M 187.46875 7.09375 C 87.851562 7.09375 7.09375 87.851562 7.09375 187.46875 C 7.09375 287.085938 87.851562 367.84375 187.46875 367.84375 C 287.085938 367.84375 367.84375 287.085938 367.84375 187.46875 C 367.84375 87.851562 287.085938 7.09375 187.46875 7.09375 " fill-opacity="1" fill-rule="nonzero" fill="#000000"></path></g><g transform="translate(85, 75)"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 24 24" version="1.1" height="215" width="215"><path d="M18.244 2.25h3.308l-7.227 8.26 8.502 11.24H16.17l-5.214-6.817L4.99 21.75H1.68l7.73-8.835L1.254 2.25H8.08l4.713 6.231zm-1.161 17.52h1.833L7.084 4.126H5.117z" fill="#ffffff"></path></svg> </g></svg></button><button aria-label="linkedin" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#007fb1"></circle><path d="M20.4,44h5.4V26.6h-5.4V44z M23.1,18c-1.7,0-3.1,1.4-3.1,3.1c0,1.7,1.4,3.1,3.1,3.1 c1.7,0,3.1-1.4,3.1-3.1C26.2,19.4,24.8,18,23.1,18z M39.5,26.2c-2.6,0-4.4,1.4-5.1,2.8h-0.1v-2.4h-5.2V44h5.4v-8.6 c0-2.3,0.4-4.5,3.2-4.5c2.8,0,2.8,2.6,2.8,4.6V44H46v-9.5C46,29.8,45,26.2,39.5,26.2z" fill="white"></path></svg></button><button title="Triple-Target CAR T Cells: Benefits and Challenges" aria-label="pinterest" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#cb2128"></circle><path d="M32,16c-8.8,0-16,7.2-16,16c0,6.6,3.9,12.2,9.6,14.7c0-1.1,0-2.5,0.3-3.7 c0.3-1.3,2.1-8.7,2.1-8.7s-0.5-1-0.5-2.5c0-2.4,1.4-4.1,3.1-4.1c1.5,0,2.2,1.1,2.2,2.4c0,1.5-0.9,3.7-1.4,5.7 c-0.4,1.7,0.9,3.1,2.5,3.1c3,0,5.1-3.9,5.1-8.5c0-3.5-2.4-6.1-6.7-6.1c-4.9,0-7.9,3.6-7.9,7.7c0,1.4,0.4,2.4,1.1,3.1 c0.3,0.3,0.3,0.5,0.2,0.9c-0.1,0.3-0.3,1-0.3,1.3c-0.1,0.4-0.4,0.6-0.8,0.4c-2.2-0.9-3.3-3.4-3.3-6.1c0-4.5,3.8-10,11.4-10 c6.1,0,10.1,4.4,10.1,9.2c0,6.3-3.5,11-8.6,11c-1.7,0-3.4-0.9-3.9-2c0,0-0.9,3.7-1.1,4.4c-0.3,1.2-1,2.5-1.6,3.4 c1.4,0.4,3,0.7,4.5,0.7c8.8,0,16-7.2,16-16C48,23.2,40.8,16,32,16z" fill="white"></path></svg></button><button aria-label="email" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#7f7f7f"></circle><path d="M17,22v20h30V22H17z M41.1,25L32,32.1L22.9,25H41.1z M20,39V26.6l12,9.3l12-9.3V39H20z" fill="white"></path></svg></button><a class="print-wrap flex justify-center items-center cursor-pointer"><svg id="print" xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="print bi bi-printer" viewBox="0 0 16 16"> <path d="M2.5 8a.5.5 0 1 0 0-1 .5.5 0 0 0 0 1z"></path> <path d="M5 1a2 2 0 0 0-2 2v2H2a2 2 0 0 0-2 2v3a2 2 0 0 0 2 2h1v1a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2v-1h1a2 2 0 0 0 2-2V7a2 2 0 0 0-2-2h-1V3a2 2 0 0 0-2-2H5zM4 3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1v2H4V3zm1 5a2 2 0 0 0-2 2v1H2a1 1 0 0 1-1-1V7a1 1 0 0 1 1-1h12a1 1 0 0 1 1 1v3a1 1 0 0 1-1 1h-1v-1a2 2 0 0 0-2-2H5zm7 2v3a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1v-3a1 1 0 0 1 1-1h6a1 1 0 0 1 1 1z"></path></svg></a></div><style> .print-wrap { width: 32px; height: 32px; background: #7F7F7F; border-radius: 100%; } .print { background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div></div></div></div><div class=" lg:w-full flex flex-col lg:flex-row lg:items-center lg:justify-end"></div><p class="py-2 mb-2 text-sm italic text-gray-600">In part 1 of our interview with Leland Metheny, MD, he explained how a new triple-target chimeric antigen receptor (CAR) T-cell therapy works in multiple myeloma.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">In <a target="_blank" href="https://www.ajmc.com/view/new-car-t-trial-in-mm-aims-for-triple-receptor-targeting">part 1</a> of our interview with Leland Metheny, MD, lead investigator for the phase 1 BAFF CAR T clinical trial, hematologist-oncologist at University Hospitals Seidman Cancer Center, and assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, he explained how a new triple-target chimeric antigen receptor (CAR) T-cell therapy works in multiple myeloma and what are the primary and secondary outcomes of the trial investigating this potential therapeutic approach. Here he continues the discussion by telling us of the benefits and challenges this treatment poses and how electroporation, its method of delivery, may be superior to lentiviral vectors, which are most commonly used to deliver CAR Ts to patient cells.</p><p class="pb-2"></p><p class="pb-2"><em>This transcript has been lightly edited for clarity</em>.</p><p class="pb-2"></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong></p><p class="pb-2"><strong>What are the potential benefits and challenges of targeting 3 receptors vs conventional CAR T therapies?</strong></p><p class="pb-2"></p><p class="pb-2">So with conventional CAR Ts, there's often 1 type of receptor that's recognized, CD19, in certain lymphomas, and BCMA [B-cell maturation antigen] in myeloma. What we have found, as a community of practitioners, is that one of the ways that cancer escapes or relapses after CAR T is that the cancer cells themselves downregulate or eliminate that target from their surface. So, for certain types of lymphomas after CD19 CAR T-cell therapy, when they relapse, the lymphoma cells lack CD19. And for a certain percentage of patients with multiple myeloma, when their myeloma relapses after BCMA CAR T-cell therapy, BCMA is not on the surface or very highly downregulated, as we say. So that's a mechanism of relapse that's well characterized for CAR T-cell [therapy]. So when you have 3 targets on a cell surface, it's a lot harder genetically for cancer cells to downregulate all 3 receptors at once, and so therefore there's less chance of that immune escape, or target escape, from cancer cells with these types of therapies.</p><p class="pb-2"></p><p class="pb-2"><strong>How does electroporation improve on lentiviral vector delivery for CAR T therapy?</strong></p><p class="pb-2"></p><p class="pb-2">For many years, the way to integrate DNA into a cell was lentiviral transfection—using a virus itself as a kind of Trojan horse to get DNA into the cell. Over the years, it's become more refined and more safe and more effective. One of the things is that when foreign DNA is integrated into the DNA of a cell with viral transfection, oftentimes it's integrated in places in the DNA that are important and transcribed. Meaning that sometimes the DNA is inserted into a necessary gene, and so there's a higher chance that when you're using viral transfection, that that DNA that you're trying to insert into the DNA of a healthy cell might actually get into a place that causes problems. So that's number one. Number 2, it can be fairly expensive in that regard. The manufacturing of these viruses is highly regulated, as you might understand when you're dealing with viruses being transcribed into living human cells. So those are the 2 issues that kind of have been identified with viral transfection</p><p class="pb-2"></p><p class="pb-2">This electroporation uses nonviral techniques. And so what in general happens is these cells are put in kind of a bath with the DNA, that's kind of protected in that bath, and then electricity is kind of flowed through that bath. What happens is the cells, the T cells that you want to transfect, develop little pores due to that electromagnetic charge, and just by the fact that the DNA is negatively charged and the interior of the cells is positively charged, that DNA is then brought into the cell—and so you don't need a virus to kind of get the DNA into the cell. Then, you use certain types of enzymes to integrate that DNA into the healthy human T cell, and that integration is random. So that integration occurs in places that are transcribed and nontranscribed, and so the potential is that there's less of a chance for integration of that DNA into important parts or necessary parts of the DNA.</p><p class="pb-2"></p><p class="pb-2">Those are some of the benefits of electroporation vs viral transcription into human DNA.</p><p class="pb-2"></p><p class="pb-2">As you might think, viruses are really, really good at integrating DNA into the human cell, and so the efficiency of viral transfection is really, really good. We kind of use nature's natural strengths to integrate DNA into the human cells. The electroporation doesn't have kind of that Trojan horse, and so the efficiency of integrating DNA into the cell is less than—or at least has been in the past—viral transduction. So you get less efficiency of inserting the DNA into those cells. That's okay. 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class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a7faacd2fa8e7c7c69fd4060f3c1a5f5d28f148c-5369x3558.jpg?fit=crop&auto=format" alt="Blood testing - angellodeco - stok.adobe.com.jpg" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent">A Case for Iron Deficiency as a Marker of Inequality in Care Access and Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Iron deficiency represents more than a medical condition; it is a reflection of persistent health disparities, according to an editorial published in The Lancet Haematology.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e16c42f428ff1dae499535cfedd861067c30dce4-4096x4096.jpg?fit=crop&auto=format" alt="Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent">COVID-19 Infection Raises Myasthenia Gravis Exacerbation Risk, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kimberly-rath-pharmd">Kimberly Rath, PharmD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study shows that COVID-19 infection significantly increases the risk of exacerbation in patients with myasthenia gravis (MG). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/54f2a4431fd4ea73ec6c2ec625fd0d107129c22d-285x121.png?fit=crop&auto=format" alt="Collaborating for Cancer Care Equity: Community and Academic Insights" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent">Collaborating for Cancer Care Equity: Community and Academic Insights</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the recent Institute for Value-Based Medicine event with NYU Langone Health.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a7faacd2fa8e7c7c69fd4060f3c1a5f5d28f148c-5369x3558.jpg?fit=crop&auto=format" alt="Blood testing - angellodeco - stok.adobe.com.jpg" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent">A Case for Iron Deficiency as a Marker of Inequality in Care Access and Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/a-case-for-iron-deficiency-as-a-marker-of-inequality-in-care-access-and-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Iron deficiency represents more than a medical condition; it is a reflection of persistent health disparities, according to an editorial published in The Lancet Haematology.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/a1728e6a06fccde8af20d2308f860344f9776b8f-800x400.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent">Frameworks for Advancing Health Equity: Wellness Way</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/frameworks-for-advancing-health-equity-wellness-way?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">The Wellness Way facility was designed to improve access to comprehensive outpatient care and address social determinants of health for a diverse patient population.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/e16c42f428ff1dae499535cfedd861067c30dce4-4096x4096.jpg?fit=crop&auto=format" alt="Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Cutie - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 22nd 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent">COVID-19 Infection Raises Myasthenia Gravis Exacerbation Risk, Study Finds</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/kimberly-rath-pharmd">Kimberly Rath, PharmD</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/covid-19-infection-raises-myasthenia-gravis-exacerbation-risk-study-finds?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study shows that COVID-19 infection significantly increases the risk of exacerbation in patients with myasthenia gravis (MG). </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/4d74ae04b0508977864936ec08f2aaa199758e5c-1000x563.jpg?fit=crop&auto=format" alt="Managed Care Cast" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 29th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent">Breaking the Cycle: The Importance of Early Intervention in Hidradenitis Suppurativa</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/giuliana-grossi">Giuliana Grossi</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/breaking-the-cycle-the-importance-of-early-intervention-in-hidradenitis-suppurativa?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Prompt care supports mental well-being, as hidradenitis suppurativa is often associated with depression and anxiety due to its physical and social challenges.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/54f2a4431fd4ea73ec6c2ec625fd0d107129c22d-285x121.png?fit=crop&auto=format" alt="Collaborating for Cancer Care Equity: Community and Academic Insights" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent">Collaborating for Cancer Care Equity: Community and Academic Insights</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/collaborating-for-cancer-care-equity-community-and-academic-insights?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the recent Institute for Value-Based Medicine event with NYU Langone Health.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645.png?fit=crop&auto=format" alt="Elevating Value in Cancer Care With Innovations, Accessibility, Equity" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent">Elevating Value in Cancer Care With Innovations, Accessibility, Equity</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/elevating-value-in-cancer-care-with-innovations-accessibility-equity?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Coverage from the IVBM Regional event in Denver, Colorado.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Triple-Target CAR T Cells: Benefits and Challenges","datePublished":"2024-08-30T12:00:00.000Z","dateModified":"2024-08-27T20:36:57Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/cda4a66773ecad35c99e0b776bda873d8dda6f50-1200x675.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/triple-target-car-t-cells-benefits-and-challenges"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"Leland Metheny, MD,phase 1 BAFF CAR T clinical trial,multiple myeloma","articleBody":"\n\nIn part 1 of our interview with Leland Metheny, MD, lead investigator for the phase 1 BAFF CAR T clinical trial, hematologist-oncologist at University Hospitals Seidman Cancer Center, and assistant professor of medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, he explained how a new triple-target chimeric antigen receptor (CAR) T-cell therapy works in multiple myeloma and what are the primary and secondary outcomes of the trial investigating this potential therapeutic approach. Here he continues the discussion by telling us of the benefits and challenges this treatment poses and how electroporation, its method of delivery, may be superior to lentiviral vectors, which are most commonly used to deliver CAR Ts to patient cells.\n\n\n\nThis transcript has been lightly edited for clarity.\n\n\n\nTranscript\n\nWhat are the potential benefits and challenges of targeting 3 receptors vs conventional CAR T therapies?\n\n\n\nSo with conventional CAR Ts, there's often 1 type of receptor that's recognized, CD19, in certain lymphomas, and BCMA [B-cell maturation antigen] in myeloma. What we have found, as a community of practitioners, is that one of the ways that cancer escapes or relapses after CAR T is that the cancer cells themselves downregulate or eliminate that target from their surface. So, for certain types of lymphomas after CD19 CAR T-cell therapy, when they relapse, the lymphoma cells lack CD19. And for a certain percentage of patients with multiple myeloma, when their myeloma relapses after BCMA CAR T-cell therapy, BCMA is not on the surface or very highly downregulated, as we say. So that's a mechanism of relapse that's well characterized for CAR T-cell [therapy]. So when you have 3 targets on a cell surface, it's a lot harder genetically for cancer cells to downregulate all 3 receptors at once, and so therefore there's less chance of that immune escape, or target escape, from cancer cells with these types of therapies.\n\n\n\nHow does electroporation improve on lentiviral vector delivery for CAR T therapy?\n\n\n\nFor many years, the way to integrate DNA into a cell was lentiviral transfection—using a virus itself as a kind of Trojan horse to get DNA into the cell. Over the years, it's become more refined and more safe and more effective. One of the things is that when foreign DNA is integrated into the DNA of a cell with viral transfection, oftentimes it's integrated in places in the DNA that are important and transcribed. Meaning that sometimes the DNA is inserted into a necessary gene, and so there's a higher chance that when you're using viral transfection, that that DNA that you're trying to insert into the DNA of a healthy cell might actually get into a place that causes problems. So that's number one. Number 2, it can be fairly expensive in that regard. The manufacturing of these viruses is highly regulated, as you might understand when you're dealing with viruses being transcribed into living human cells. So those are the 2 issues that kind of have been identified with viral transfection\n\n\n\nThis electroporation uses nonviral techniques. And so what in general happens is these cells are put in kind of a bath with the DNA, that's kind of protected in that bath, and then electricity is kind of flowed through that bath. What happens is the cells, the T cells that you want to transfect, develop little pores due to that electromagnetic charge, and just by the fact that the DNA is negatively charged and the interior of the cells is positively charged, that DNA is then brought into the cell—and so you don't need a virus to kind of get the DNA into the cell. Then, you use certain types of enzymes to integrate that DNA into the healthy human T cell, and that integration is random. So that integration occurs in places that are transcribed and nontranscribed, and so the potential is that there's less of a chance for integration of that DNA into important parts or necessary parts of the DNA.\n\n\n\nThose are some of the benefits of electroporation vs viral transcription into human DNA.\n\n\n\nAs you might think, viruses are really, really good at integrating DNA into the human cell, and so the efficiency of viral transfection is really, really good. We kind of use nature's natural strengths to integrate DNA into the human cells. The electroporation doesn't have kind of that Trojan horse, and so the efficiency of integrating DNA into the cell is less than—or at least has been in the past—viral transduction. So you get less efficiency of inserting the DNA into those cells. That's okay. We can still generate the appropriate number of cells, but the efficiency is a little less there.","description":"In part 1 of our interview with Leland Metheny, MD, he explained how a new triple-target chimeric antigen receptor (CAR) T-cell therapy works in multiple myeloma.","author":[{"@type":"Person","name":"Maggie L. Shaw"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] ml-auto"><div><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span 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Here he continues the discussion by telling us of the benefits and challenges this treatment poses and how electroporation, its method of delivery, may be superior to lentiviral vectors, which are most commonly used to deliver CAR Ts to patient cells.","_key":"4efcc834ccf72","_type":"span"}],"upload_doc":null,"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"5ad439becd5c"},{"medias":null,"_type":"block","style":"normal","_key":"d954c5a818bc","markDefs":[],"children":[{"marks":[],"text":"","_key":"4bbdf2745eaf0","_type":"span"}],"upload_doc":null,"uploadAudio":null},{"medias":null,"_key":"0c64fc941dd5","markDefs":[],"children":[{"_type":"span","marks":["em"],"text":"This transcript has been lightly edited for clarity","_key":"16ee5f14363c0"},{"_type":"span","marks":[],"text":".","_key":"16ee5f14363c1"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null},{"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"6ccfed7d37ca","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7be1dac50c620"}]},{"uploadAudio":null,"medias":null,"style":"normal","_key":"4d2371e1194d","markDefs":[],"children":[{"_type":"span","marks":["strong","underline"],"text":"Transcript","_key":"ee597e1b2b6f0"}],"_type":"block","upload_doc":null},{"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"4293cf8ebe3b","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"What are the potential benefits and challenges of targeting 3 receptors vs conventional CAR T therapies?","_key":"2a2036a13fc30"}]},{"uploadAudio":null,"medias":null,"_key":"3a4a2a717d40","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"eba2d63019da0"}],"_type":"block","style":"normal","upload_doc":null},{"style":"normal","_key":"f5dc6927417a","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_key":"dc6dbfb382470","_type":"span","marks":[],"text":"So with conventional CAR Ts, there's often 1 type of receptor that's recognized, CD19, in certain lymphomas, and BCMA [B-cell maturation antigen] in myeloma. What we have found, as a community of practitioners, is that one of the ways that cancer escapes or relapses after CAR T is that the cancer cells themselves downregulate or eliminate that target from their surface. So, for certain types of lymphomas after CD19 CAR T-cell therapy, when they relapse, the lymphoma cells lack CD19. And for a certain percentage of patients with multiple myeloma, when their myeloma relapses after BCMA CAR T-cell therapy, BCMA is not on the surface or very highly downregulated, as we say. So that's a mechanism of relapse that's well characterized for CAR T-cell [therapy]. So when you have 3 targets on a cell surface, it's a lot harder genetically for cancer cells to downregulate all 3 receptors at once, and so therefore there's less chance of that immune escape, or target escape, from cancer cells with these types of therapies."}],"_type":"block"},{"children":[{"text":"","_key":"fb878753c1c40","_type":"span","marks":[]}],"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"d2b8005a0bfb","markDefs":[]},{"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"a4d81eac5d7a","markDefs":[],"children":[{"_key":"b8180c5e2b820","_type":"span","marks":["strong"],"text":"How does electroporation improve on lentiviral vector delivery for CAR T therapy?"}]},{"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"debd615a2ce4","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"85281ef1da9c0"}],"upload_doc":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"2f7dd61e567c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"For many years, the way to integrate DNA into a cell was lentiviral transfection—using a virus itself as a kind of Trojan horse to get DNA into the cell. Over the years, it's become more refined and more safe and more effective. One of the things is that when foreign DNA is integrated into the DNA of a cell with viral transfection, oftentimes it's integrated in places in the DNA that are important and transcribed. Meaning that sometimes the DNA is inserted into a necessary gene, and so there's a higher chance that when you're using viral transfection, that that DNA that you're trying to insert into the DNA of a healthy cell might actually get into a place that causes problems. So that's number one. Number 2, it can be fairly expensive in that regard. The manufacturing of these viruses is highly regulated, as you might understand when you're dealing with viruses being transcribed into living human cells. So those are the 2 issues that kind of have been identified with viral transfection","_key":"cd7e396beb790"}],"_type":"block"},{"_key":"f185ef2b0f22","upload_doc":null,"uploadAudio":null,"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"655f847309e80"}],"_type":"block","style":"normal"},{"uploadAudio":null,"medias":null,"_type":"block","style":"normal","_key":"dca65cdccf3c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"This electroporation uses nonviral techniques. And so what in general happens is these cells are put in kind of a bath with the DNA, that's kind of protected in that bath, and then electricity is kind of flowed through that bath. What happens is the cells, the T cells that you want to transfect, develop little pores due to that electromagnetic charge, and just by the fact that the DNA is negatively charged and the interior of the cells is positively charged, that DNA is then brought into the cell—and so you don't need a virus to kind of get the DNA into the cell. Then, you use certain types of enzymes to integrate that DNA into the healthy human T cell, and that integration is random. So that integration occurs in places that are transcribed and nontranscribed, and so the potential is that there's less of a chance for integration of that DNA into important parts or necessary parts of the DNA.","_key":"3c941b3559fd0"}],"upload_doc":null},{"medias":null,"_type":"block","style":"normal","_key":"ae617b024ca2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"84bb44fd4a660"}],"upload_doc":null,"uploadAudio":null},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Those are some of the benefits of electroporation vs viral transcription into human DNA.","_key":"703bd60941bd0"}],"_type":"block","style":"normal","_key":"db06fd6f3413","upload_doc":null,"uploadAudio":null,"medias":null},{"medias":null,"style":"normal","_key":"1912c9ee3e60","markDefs":[],"children":[{"text":"","_key":"6d23dca1171d0","_type":"span","marks":[]}],"_type":"block","upload_doc":null,"uploadAudio":null},{"_type":"block","style":"normal","_key":"76f683c83bd9","markDefs":[],"children":[{"text":"As you might think, viruses are really, really good at integrating DNA into the human cell, and so the efficiency of viral transfection is really, really good. 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With continued momentum, the article stated the burden of iron deficiency can be reduced, enhancing the quality of life for millions worldwide.","_key":"a4ec0c3d7a90","_type":"span"}],"_type":"block","style":"normal","_key":"4cfea19cf600","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(24)00318-1/fulltext","_key":"ef693db9ff8f"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2d0b2a3ad81e"}],"_type":"block","style":"normal","_key":"bf3fbdc13f53"},{"markDefs":[],"children":[{"text":"Non-anemic iron deficiency is a common yet often overlooked condition that predominantly affects women, girls, and individuals in low- and middle-income countries (LMICs). While anemia impacts nearly a quarter of the world's population, the prevalence of iron deficiency may be twice as high, highlighting the severity of this public health concern.","_key":"b285e730f1b30","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"2a4b908ae6b5"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7df921a4510e"}],"_type":"block","style":"normal","_key":"1cc0884281f0"},{"markDefs":[],"children":[{"text":"Diagnosis and Treatment Challenges","_key":"a972be8b207a0","_type":"span","marks":["strong"]}],"_type":"block","style":"h3","_key":"f4a3df4488ae"},{"_key":"cc4b29bc8cbb","markDefs":[],"children":[{"marks":[],"text":"Iron deficiency often goes undiagnosed or inadequately treated due to challenges in defining and managing the condition. A recent study published in ","_key":"a09cfc1c8a140","_type":"span"},{"_type":"span","marks":["em"],"text":"Blood Advances","_key":"a09cfc1c8a141"},{"text":" analyzed data from 13,084 patients in the United States with laboratory-confirmed iron deficiency.","_key":"a09cfc1c8a142","_type":"span","marks":[]},{"_key":"828b516e1a0d","_type":"span","marks":["superscript"],"text":"2"},{"_key":"bd46393f6d9a","_type":"span","marks":[],"text":" It was found that 58% of patients did not resolve their deficiency within 3 years of diagnosis, even with repeated ferritin testing. For those who did see improvement, the median time to resolution was nearly 2 years."}],"_type":"block","style":"normal"},{"style":"normal","_key":"2f990b646e2b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"aba3a485c4ce"}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"Understanding the effects of iron deficiency separate from anemia can be complex.","_key":"e1d472ec43750","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"0372013b0f93"},{"_key":"1c3fc5b6e5f7","_type":"span","marks":[],"text":" However, those with iron deficiency often experience symptoms like fatigue, weakness, intolerance to exercise, and cognitive difficulties. The implications are even more significant for pregnant individuals, as iron deficiency has been associated with adverse neurodevelopmental outcomes in infants."}],"_type":"block","style":"normal","_key":"2d55ba5b754c"},{"_type":"block","style":"normal","_key":"cea5fa013bf4","markDefs":[],"children":[{"text":"","_key":"b084d12699350","_type":"span","marks":[]}]},{"style":"normal","_key":"43e8892b332a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The quality-of-life impact is significant, yet historical diagnostic practices often fail to capture the condition. Current evidence suggests that a ferritin level of 30 µg/L or less is sensitive and specific for diagnosing absolute iron deficiency. However, some experts advocate using a threshold of 50 µg/L to better identify affected individuals, the article acknowledged. Functional iron deficiency, marked by an inability to utilize stored iron due to underlying inflammatory conditions such as chronic kidney disease, requires different diagnostic approaches, including measuring transferrin saturation.","_key":"5a6918b5ce960"}],"_type":"block"},{"style":"normal","_key":"c00da1714f6f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"d4f247c6d13e"}],"_type":"block"},{"style":"h3","_key":"1894f045d6c0","markDefs":[],"children":[{"text":"Disproportionate Burden and Barriers to Treatment","_key":"7cd19df54a6e","_type":"span","marks":["strong"]}],"_type":"block"},{"_type":"block","style":"normal","_key":"0d9a723e1fe5","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Recent data highlight significant disparities in the prevalence of iron deficiency. A study conducted in September 2024 estimated that 14% of adults in the US experience absolute iron deficiency, while 15% are affected by functional iron deficiency. Among women aged 18 to 50 years, the prevalence of absolute iron deficiency is particularly concerning, reaching 34% (95% CI, 31-37), whereas functional iron deficiency is more commonly observed in older women and men across all age groups. 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This can limit the scope of treatments for women who generally have higher hormone levels, Margaret Ragni, MD, MPH, professor of medicine and clinical and translational research in the Division of Hematology/Oncology at the University of Pittsburgh, director of the Hemophilia Center of Western Pennsylvania, and American Society of Hematology expert, explained in an ","_key":"c4c6f6599c970"},{"_key":"c35a7d5f340a","_type":"span","marks":["c872f66ace7b"],"text":"interview"},{"_key":"876c6f31e367","_type":"span","marks":[],"text":" with "},{"_key":"82161bfe24ab","_type":"span","marks":["em"],"text":"The American Journal of Managed Care"},{"_type":"span","marks":["superscript"],"text":"®","_key":"810d503ed657"},{"_type":"span","marks":[],"text":" (","_key":"f2d59db9a89f"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"89b670cb5cbb"},{"_type":"span","marks":["superscript"],"text":"®","_key":"6fda27a29344"},{"marks":[],"text":") ","_key":"91cbaa029bde","_type":"span"},{"marks":["814d08b08247"],"text":"Center on Health Equity \u0026 Access","_key":"69ca8d14d9eb","_type":"span"},{"_type":"span","marks":[],"text":".","_key":"d110dd1c7716"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7bf94255f494"}],"_type":"block","style":"normal","_key":"697d9159a4e2"},{"_key":"2d2cd28492dd","markDefs":[],"children":[{"_key":"3ee38737c65e0","_type":"span","marks":[],"text":"Treatment options for iron deficiency include oral iron supplements and intravenous iron therapy."},{"_type":"span","marks":["superscript"],"text":"1","_key":"95ad879425b1"},{"_type":"span","marks":[],"text":" Oral iron is generally cost-effective; however, gastrointestinal adverse effects can limit its use for some patients. Alternatively, intravenous iron is safe and effective but may be difficult to access due to logistical or financial barriers.","_key":"d92df4950774"}],"_type":"block","style":"normal"},{"_key":"0def125fc7c4","markDefs":[],"children":[{"marks":[],"text":"","_key":"316c3f70b3630","_type":"span"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"e9c1b33e76d7","markDefs":[],"children":[{"_key":"853955daff7d0","_type":"span","marks":[],"text":"Functional iron deficiency typically requires treatment of the underlying inflammatory condition, adding another layer of complexity to its management. In LMICs, additional challenges exacerbate the issue. Food insecurity, untreated heavy menstrual bleeding, and increasing inflammatory conditions, such as obesity, contribute to the prevalence of iron deficiency. This condition often reflects broader health inequities and serves as an indicator of unmet nutritional and health care needs."}]},{"markDefs":[],"children":[{"_key":"dac55da0cb25","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"39136b2b7afe"},{"style":"h3","_key":"ee96250f8f97","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Iron Deficiency: A Marker of Inequality","_key":"271c4f3a3e20"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Increased research has highlighted the widespread issue of iron deficiency, especially among women, and the difficulties in diagnosing and treating it. This increasing awareness should now lead to significant changes in health care to enable timely and effective diagnosis and management.","_key":"ab02d4c9e26f0"}],"_type":"block","style":"normal","_key":"5d31a61a3186"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"780bb2f62de2"}],"_type":"block","style":"normal","_key":"3edc48e54eba"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"\"Iron deficiency itself can serve as a marker of inequality and unmet health needs since it emerges when nutrition is not optimal or when a related condition or disease is not being adequately managed,\" the article stated. \"Numerous barriers to the recognition of non-[anemic] iron deficiency as a substantial health burden still exist.\"","_key":"de30c4510d680"}],"_type":"block","style":"normal","_key":"343ce342c237"},{"_type":"block","style":"normal","_key":"b40f1e922351","markDefs":[],"children":[{"text":"","_key":"e762316edc5e","_type":"span","marks":[]}]},{"_key":"d0c89769f599","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The need for improved diagnostic criteria, such as raising ferritin cutoff levels and incorporating measures for functional iron deficiency, was further emphasized. 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Published in "},{"text":"Brain and Behavior","_key":"9536ae64a5fc3","_type":"span","marks":["b1f6be191129","em"]},{"_type":"span","marks":[],"text":", the study adds to the growing body of evidence that infections can significantly impact the risk of exacerbations in patients with autoimmune disorders like MG.","_key":"9536ae64a5fc4"},{"_type":"span","marks":["superscript"],"text":"1","_key":"6bd3648f26f9"}],"_type":"block","style":"normal"},{"disableTextWrap":false,"alt":"Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Vibu design gallery - stock.adobe.com","alignment":"left","widthP":30,"disableLightBox":true,"_key":"65a7462537bd","_type":"figure","imgcaption":[{"style":"normal","_key":"03397da8be52","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Respiratory infections like COVID-19 are known to exacerbate MG | image credit: Vibu design gallery - stock.adobe.com","_key":"a92c989c06860"}],"_type":"block"}],"asset":{"_ref":"image-ab621c3c59b3aa8a2f04ea44e2fe654215288eb7-5376x3584-jpg","_type":"reference"}},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The observational study collected information on COVID-19 infections and exacerbations of 289 patients with MG during China’s widespread Omicron wave between December 2022 and early 2023. Patients in this cohort were predominantly female (60%), with an average age of 46. According to the study, 234 (80.9%) participants contracted COVID-19. The course of infection was generally mild, with 88% of COVID-19 cases classified as low severity (stages 1-3). Common symptoms included respiratory issues in 50% of infected patients and systemic symptoms like fatigue and headache in 74.4%.","_key":"61c8cc59c5cd0"}],"_type":"block","style":"normal","_key":"7cc4c947f259"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"e349e86acd060"}],"_type":"block","style":"normal","_key":"5e6739d41d1b"},{"style":"normal","_key":"ec6fb8e1e90a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“MG patients with COVID-19 infection exhibited a higher likelihood of exacerbation, compared to those without COVID-19 infection,” the study finds, with exacerbation rates recorded at 18.8% among infected patients versus 7.3% in the non-infected group (P = .039). After adjusting for confounding factors, the hazard ratio for exacerbation in patients with MG post-infection was found to be 3.38 (95% CI, 1.20–9.53; ","_key":"c90bbaee49bc0"},{"_type":"span","marks":["em"],"text":"P","_key":"bb20553304a6"},{"_type":"span","marks":[],"text":" = .021).","_key":"62e0a5fbf3c2"}],"_type":"block"},{"_type":"block","style":"normal","_key":"63a5e40371ec","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1801749c00270"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In infected patients, MG exacerbations developed quickly after contracting COVID-19, with a median onset time of just 14 days post-infection (interquartile range, 3-24 days). Exacerbations were evaluated based on changes in the Myasthenia Gravis Activities of Daily Living (MG-ADL) scale, with a worsening of at least 2 points considered an exacerbation. Exacerbations were found to be more severe among patients with MG who had comorbidities and those receiving immunosuppressive therapy, such as corticosteroids.","_key":"a230552b05790"}],"_type":"block","style":"normal","_key":"ed433cadbb3f"},{"_key":"88f945190704","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"523a2b7424580"}],"_type":"block","style":"normal"},{"children":[{"text":"Most COVID-19 infections were primarily managed at home, but a few cases required hospitalization. Eight patients with COVID-19 infection (3.4%) developed respiratory failure that required mechanical ventilation, and 3 patients were admitted to the ICU. No deaths were reported within this cohort. However, 14.9% of patients experienced prolonged symptoms of fatigue, tiredness, and shortness of breath.","_key":"a8247d692e3d0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"e821e7210a86","markDefs":[]},{"_key":"4772327b8df1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"7b39509e0dd00"}],"_type":"block","style":"normal"},{"style":"normal","_key":"94f7576911ed","markDefs":[],"children":[{"_type":"span","marks":[],"text":"To further investigate the impact of COVID-19 on patients with MG, the researchers conducted a survival analysis comparing MG exacerbations in 2 time periods: December 1, 2022 to March 10, 2023 (DTM23), covering the Omicron wave, and January 2021 to April 2021 (JTA21), an earlier period without COVID-19 exposure. The comparison indicated an increase in exacerbations during the Omicron outbreak, with a recorded exacerbation rate of 17.2% in DTM23 compared to 4.4% in JTA21 (","_key":"fc23a17ba5bb0"},{"_type":"span","marks":["em"],"text":"P","_key":"565d292c2521"},{"_type":"span","marks":[],"text":" \u003c .001).","_key":"36719ee858e2"}],"_type":"block"},{"style":"normal","_key":"89066828d77a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"62f5bb72dfb70"}],"_type":"block"},{"markDefs":[],"children":[{"text":"No statistically significant differences in COVID-19 vaccination rates were observed between infected and non-infected patients. Although COVID-19 vaccines effectively reduce severe illness, they may offer limited protection against infection with COVID-19 due to the development of unique variants.","_key":"a0d36c7301920","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"9f68fc8008a2"},{"children":[{"_key":"1fadcdc5e1b20","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"2ef57ee9e298","markDefs":[]},{"_key":"b40369efdd6d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Infection, particularly respiratory infections, has long been known as a trigger for MG exacerbation. This is supported by previous studies showing that viral infections like influenza can similarly increase exacerbation risk.","_key":"effcf725c4820"},{"_key":"1b77d53b9173","_type":"span","marks":["superscript"],"text":"2,3"},{"text":" The results of this study align with recent data from the COVID-19 Associated Risks and Effects in Myasthenia Gravis (CARE-MG) registry that suggests patients with MG infected with COVID-19 are more frequently hospitalized, experience increased disease exacerbations, and have higher mortality rates compared to the general COVID-19 population.","_key":"2574bcdecaaa","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"4","_key":"98650c5589f8"},{"text":" ","_key":"d8664363b173","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_key":"555bffcfee43","markDefs":[],"children":[{"text":"","_key":"f4ecd16e57150","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"b387cb476159","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It should be noted that in this study, COVID-19 diagnosis was not based strictly on laboratory tests but rather on typical COVID-19 symptoms. 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Lahoud, MD | Image: NYU Langone Health","_key":"023e638c57ca"}],"_type":"block","style":"normal","_key":"103cb9e141a8"}],"_key":"4d34ff79b9bb","widthP":20,"disableTextWrap":false,"_type":"figure"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Their data-driven discussions examined how to bridge the chasm between community-led cancer care and research that seeks to optimize patient outcomes and strengthen program support Emeline Aviki, MD, MBA, FACOG, medical director of network integration and strategy for NYU Langone Health Perlmutter Cancer Center, cochaired the meeting with Oscar B. Lahoud, MD, section chief of hematology at NYU Langone Hospital-Brooklyn and director for strategy and network operations in the Division of Hematology and Oncology at Perlmutter Cancer Center. Featured panelists were:","_key":"b2d6f6696f6c"}],"_type":"block","style":"normal","_key":"3cf2345e8dcc"},{"style":"normal","_key":"416e657de6b0","listItem":"bullet","markDefs":[],"children":[{"_key":"7ce95fc096ba","_type":"span","marks":[],"text":"Samyukta Mullangi, MD, MBA, medical director of oncology of Thyme Care and medical oncologist at Tennessee Oncology in Nashville;"}],"level":1,"_type":"block"},{"_key":"f1fbca10c6be","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Mario Lacouture, MD, chief of the Division of Dermatology at NYU Grossman Long Island School of Medicine, and medical director of the Symptom Management Program at Perlmutter Cancer Center of NYU Langone Hospital–Long Island; and","_key":"36ea118e137e"}],"level":1,"_type":"block","style":"normal"},{"level":1,"_type":"block","style":"normal","_key":"284ab500cf5c","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Brita Roy, MD, MPH, clinical associate professor of population health and director of Community Health and Clinical Outcomes at NYU Langone Health.\n","_key":"4781e2125bc4"}]},{"markDefs":[],"children":[{"marks":[],"text":"Their presentations emphasized how policies and political decisions help to shape cancer care, especially in community settings that often face financial and regulatory challenges. The academic-community partnerships at the center of these talks offer transformative initiatives; the speakers discussed multidisciplinary collaboration, data sharing, and patient support that focused on addressing social determinants of health and improving health equity through equitable access, clinical trial diversity, and technology.","_key":"95dd10c9e3d0","_type":"span"}],"_type":"block","style":"normal","_key":"d442582340f8"},{"markDefs":[],"children":[{"marks":[],"text":"“There’s just no question that delivering care closer to home has tremendous benefits. The obstacle is, how do you do that in a way that ensures the highest level of quality and a consistent level of quality across very diverse settings?” Aviki said. “What are the different ways that you can navigate these diverse settings to ensure that patients are receiving the same world-class quality of care no matter where they’re being treated?”\n\n","_key":"ebf363ae3f48","_type":"span"},{"_type":"span","marks":["strong"],"text":"Policy Updates in Cancer Care","_key":"015a2db8f33d"},{"marks":[],"text":"\n","_key":"c97d9bcb2520","_type":"span"}],"_type":"block","style":"normal","_key":"78d2acb8d7fd"},{"widthP":20,"crop":{"left":0.04444458007812498,"bottom":0.22407404581705737,"_type":"sanity.imageCrop","right":0.07111083984375,"top":0.05740737915039065},"_type":"figure","alt":"Samyukta Mullangi, MD, MBA | Image: Tennessee Oncology","_key":"1ccd3046b0e4","imgcaption":[{"_key":"517378d2c64d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Samyukta Mullangi, MD, MBA | Image: Tennessee Oncology","_key":"7fe58f0eab9d"}],"_type":"block","style":"normal"}],"hotspot":{"y":0.41666666666666663,"height":0.718518575032552,"_type":"sanity.imageHotspot","width":0.884444580078125,"x":0.48666687011718746},"asset":{"_type":"reference","_ref":"image-bd0765070700f2d20a2bafedfbb7619f454ca265-300x360-jpg"},"alignment":"left","disableTextWrap":false,"disableLightBox":true},{"style":"normal","_key":"86f8297f6580","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In this election year, potential shifts in health care policies are front and center, and they likely depend on what changes come with the return of Donald Trump as the 47th president of the United States.","_key":"21506b3f1c72"},{"_key":"009025bf96f2","_type":"span","marks":["superscript"],"text":"1 "},{"_type":"span","marks":[],"text":"Mullangi highlighted those of maximum interest, including the use of existing vehicles of law and policy, drug pricing, pharmacy benefit manager (PBM) reform, reinterpretation of the Stark Law on physician self-referrals","_key":"69ba8ffc3fb4"},{"_type":"span","marks":["superscript"],"text":"2","_key":"a54b0a8e0e5a"},{"marks":[],"text":" and older patients’ access to critical medications,","_key":"1ade9f2ffc05","_type":"span"},{"_type":"span","marks":["superscript"],"text":"3","_key":"ef5ba7047426"},{"text":" physician fee schedules, average sales price (ASP) cuts, 340B reform, and the extension of telemedicine provisions.","_key":"0d4a3bd949e5","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"“Paying attention is important,” she emphasized. “These policies will have a direct impact on things like consolidation, access, investments, innovation, and how we deliver care to the patients that we serve.”","_key":"be08abd03790"}],"_type":"block","style":"normal","_key":"2eb4a604ae45","markDefs":[]},{"_key":"a57fb1f7e525","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The future of the Affordable Care Act (ACA) is in question, Mullangi said at the time; with Republicans poised to control both the White House and the Congress at press time, expectations are that the ACA may not be fully overturned but changes are likely. Republicans have historically aimed to limit the ACA’s reach—with research from 2018 showing that most Americans (56% overall; of those polled, 80% were Democrats, 54% Independents, 28% Republicans) think a Trump administration could cause the ACA to fail.","_key":"ac8a04f06961"},{"_type":"span","marks":["superscript"],"text":"4","_key":"8752b7a8854a"},{"_key":"10db435dc965","_type":"span","marks":[],"text":" Mullangi also presented policy options in drug pricing and reproductive health for Trump and for Vice President Kamala Harris, as the event took place before the November 5, 2024, election."},{"_key":"eeae84f3745b","_type":"span","marks":["superscript"],"text":"5"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"bf95509dca0b","markDefs":[],"children":[{"_key":"84e20cb9eee3","_type":"span","marks":[],"text":"Another top-of-mind issue is the financial pressure that community oncology practices continue to face through insufficient reimbursement structures, ASP erosion, and drug affordability. In the past, Trump has focused on price transparency and international drug price comparisons. He has not, however, taken a firm stance on Medicare reimbursement or National Institutes of Health funding cuts, knowing that regulatory changes affect community oncologists’ abilities to maintain independent practices."}]},{"_type":"block","style":"normal","_key":"303dd5f68d0d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"In contrast, areas of bipartisan support that could advance regardless of the election outcome are PBM reform and Stark. For the former, this could mean requiring greater transparency of rebates and fees regarding drug list prices, and for the latter, continuing to try to strike down the Medicare FAQ provisions that restrict physician delivery of medications via mail order—with the unfortunate consequence of contributing to care disparities for patients who live in rural areas or are disabled.","_key":"7a0b079dbf67"}]},{"markDefs":[],"children":[{"_key":"9f60f14cb4e7","_type":"span","marks":[],"text":"“To continue to survive and thrive as community oncologists, we need to educate our leaders,” she concluded, “and advocate for responsible choices that continue to drive research innovation and access to improve cancer care.”\n"},{"_type":"span","marks":["strong"],"text":"\nBridging Gaps in Specialty Care","_key":"ef5b47e9ab8e"},{"_type":"span","marks":[],"text":"\n","_key":"28c5133a1602"}],"_type":"block","style":"normal","_key":"454c93185e1c"},{"asset":{"_ref":"image-4d7f16f2aa7c59f43a233a9292595288ead0f626-600x800-jpg","_type":"reference"},"hotspot":{"height":0.6218699741695817,"_type":"sanity.imageHotspot","width":0.8536583239193162,"x":0.5406503710597235,"y":0.31093498708479084},"disableLightBox":true,"alt":"Mario Lacouture, MD | Image: NYU Grossman","alignment":"left","disableTextWrap":false,"_type":"figure","imgcaption":[{"_type":"block","style":"normal","_key":"32051c7d5656","markDefs":[],"children":[{"_key":"f15bfe8c3dee","_type":"span","marks":[],"text":"Mario Lacouture, MD | Image: NYU Grossman"}]}],"_key":"88a5ab90c3f0","crop":{"bottom":0.3781300258304183,"_type":"sanity.imageCrop","right":0.0325204669806185,"top":0,"left":0.11382120910006534},"widthP":20},{"_key":"c6b5b993b2b2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Lahoud then introduced Lacouture as a pioneer for helping to transform the field of onco-dermatology, “now formally recognized as a specialty around the world, including with the American Academy of Dermatology and the International Society of Dermatopathology.” Lacouture started his presentation with the necessity of promoting interdisciplinary care within oncology by both highlighting misconceptions about the field from those on the outside looking in and fulfillment from seeing patients battle what is very often a debilitating disease.","_key":"5e2d1cc44e6d"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"“We see this struggle that people face, and we see the courage that people show us on a daily basis as they fight the disease,” Lacouture said, “and they allow us to participate in their care.”","_key":"cb2e54882aa4"}],"_type":"block","style":"normal","_key":"d1fe6ac3e80f","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, cancer care is becoming increasingly complex. Principal modes of treatment include surgery, radiotherapy, cytotoxic chemotherapy, molecularly targeted therapy, and immunotherapy; survivorship is skyrocketing, both in total survivors and those still alive 25 years or more after their initial diagnosis; and more patients are now living with comorbidities that come with age due to the increased survivorship (eg, diabetes, renal disease, obesity, cardiovascular disease, and neurological disorders).","_key":"a0d65d2b108d"},{"_type":"span","marks":["superscript"],"text":"6-8","_key":"bdcc956144cd"}],"_type":"block","style":"normal","_key":"fef55d45dbb7"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The price these patients pay for their survival, in terms of mild to moderate or severe treatment-related adverse events and symptom management, impact on quality of life, financial burden, and challenges with long-term adherence demonstrate mean that multidisciplinary collaboration among research and community centers and between oncology and other disciplines—the sharing of knowledge—is fast becoming necessary for care to advance and to keep up with the ever-growing patient base.","_key":"0a35ab54decb"}],"_type":"block","style":"normal","_key":"430f2c4c59cc"},{"_type":"block","style":"normal","_key":"385de0d5a943","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Specialist access is easier wished for than done, however, Lacouture pointed out, which makes it all the more important to create and implement standard guidelines for patient referrals and management “to ensure consistency in care delivery across different providers and settings and to reduce variability and potential errors in symptom management.” His suggestions include being preoccupied with failure, or actively surveilling for adverse events to manage them sooner; taking a proactive approach to reduce the incidence of adverse effects; deferring to the other care specialists on the team who may have more knowledge on how to best manage a certain adverse effect; making real-time adjustments to treatment based on observed symptoms; and always learning through ongoing research and clinical trials.","_key":"696f0533b14b"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"These tools of efficiency are at the heart of Perlmutter’s Symptom Management Program and its focus on driving excellence through specialty care, he explained. The programs 3 pillars are as follows:\nOptimizing specialist referrals and making that process more straightforward can reduce care fragmentation and increase care coordination and referral tracking, which in turn helps to prioritize urgent cases and shorten appointment wait time.","_key":"db4d62c9e730"}],"_type":"block","style":"normal","_key":"a9db0e67b987"},{"style":"normal","_key":"c439905002cc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Providing point-of-care decision support gives oncologists and other interdisciplinary care team specialists the critical data they need to support timely interventions.","_key":"34510ce82256"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Utilizing digital patient monitoring improves communication efficiency with interprofessional consultations so patients can get timely input from specialists without needing to be at appointments in person.","_key":"d3db7531e2ce"}],"_type":"block","style":"normal","_key":"5c4b58294bf0"},{"style":"normal","_key":"823cc64e0bd7","markDefs":[],"children":[{"_type":"span","marks":[],"text":"“It’s possible to transform oncology practices through these optimized symptom care pathways if a concerted effort is made to include specialists,” he explained. “It’s important to equip all oncology teams with these data-driven tools to really revolutionize the management of symptoms so that they are an integral component of cancer care.”","_key":"f7d1c8f732cf"}],"_type":"block"},{"children":[{"text":" ","_key":"5a4437b881d0","_type":"span","marks":[]},{"_type":"span","marks":["strong"],"text":"\nImproving Cancer Health Outcomes Through Community-Clinical Partnerships","_key":"e92f110764a7"},{"_type":"span","marks":[],"text":"\n","_key":"bd29049d639b"}],"_type":"block","style":"normal","_key":"70aecf97dd59","markDefs":[]},{"widthP":24,"crop":{"left":0.29198322537579113,"bottom":0.4356539020779764,"_type":"sanity.imageCrop","right":0.2683550484572783,"top":0.027881829949873912},"_type":"figure","disableLightBox":true,"alignment":"left","asset":{"_type":"reference","_ref":"image-5383d5661750df50b5003e5523c1de4c2128125f-413x400-jpg"},"hotspot":{"y":0.2961139639359488,"height":0.5364642679721497,"_type":"sanity.imageHotspot","width":0.43966172616693056,"x":0.5118140884592564},"imgcaption":[{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Brita Roy, MD, MPH | Image: NYU Langone","_key":"98e33fbd926b"}],"_type":"block","style":"normal","_key":"91967eac49fb"}],"_key":"6965e796dee7","disableTextWrap":false},{"style":"normal","_key":"23c11725b7bb","markDefs":[],"children":[{"marks":[],"text":"Roy brought the evening’s presentations to a close with an exploration of the profound impact of community-clinical partnerships on improving cancer care outcomes and recognizing and addressing how health and social factors are interconnected and impact medical care.","_key":"dd80581d5aaa","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Did you know that your zip code can be more important than your genetic code when it comes to morbidity and mortality, especially in the United States, and that really profound health disparities exist depending on where you live?” she asked. For example, in New York City, she explained, just 6 subway stops separate Murray Hill from East Harlem, but there is a 9-year difference in life expectancy, at 85 years vs 76 years.","_key":"c5ef1a25f53f"}],"_type":"block","style":"normal","_key":"3b35900c2bac"},{"_key":"be3ea2797ac2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A staunch advocate for stronger integration of community resources and clinical care, Roy addressed how place-based health disparities can affect cancer risk and outcomes and how within this there are influences from 2 principal pathways. She explained that both the physical environment (eg, walkability, access to green spaces, nutritious food, educational opportunities, stable housing) and psychosocial stressors (eg, structural racism, low social support, exposure to violence, trauma, chronic stress, lack of safety) can create pronounced health disparities, as well as influence cancer screening rates and prevalence of chronic illness.","_key":"ab22d75893a3"}],"_type":"block","style":"normal"},{"children":[{"text":"This is where community involvement and community-clinical partnerships become integral to fostering holistic support for people with cancer within their communities and augmenting existing clinical strategies to improve health equity by addressing social and clinical needs. Such collaborations can make progress in providing comprehensive care in several ways, she noted.","_key":"96c76a20551c","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"b101e85348a3","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Getting out into the communities is a necessity, as are utilizing community health workers who are diverse and reflect the neighborhoods. They are better able to provide outreach and education, address concerns, and answer questions about cancer screening, she said. It is also pertinent that health care providers, community organizations, and community health workers operate as a single entity, knowing that closer collaboration improves care outcomes and enhances the ability to provide the comprehensive care that is needed. ","_key":"5ecde7ec7dd6"}],"_type":"block","style":"normal","_key":"e63ffb15162a"},{"_key":"7dd2222791cd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, to be effective in this regard, they must not only network effectively but coordinate, cooperate, and collaborate. Doing these things within the communities facilitates information exchange, the sharing of resources, and more effective patient support; improves health literacy; and serves to address social needs, she added.","_key":"dac00e86cd80"}],"_type":"block","style":"normal"},{"style":"normal","_key":"39871dcda096","markDefs":[],"children":[{"marks":[],"text":"Community-clinical partnerships play crucial roles in addressing the complex challenges of cancer care, Roy concluded, and by focusing on social determinants of health and fostering interdisciplinary collaboration, “by forging strong partnerships between clinics and the neighborhoods they serve, we can create lasting change and ensure equitable access to the care and resources everyone deserves. The health of the community is the foundation upon which we must build.” \n","_key":"8d3f8d427012","_type":"span"},{"_type":"span","marks":["strong"],"text":"\nReferences","_key":"f17ebacc2136"},{"_type":"span","marks":[],"text":"\n1. Steinzor P. The 2024 presidential election: implications for health care policy. AJMC. October 18, 2024. Accessed October 31, 2024. https://www.ajmc.com/view/the-2024-presidential-election-implications-for-health-care-policy\n2. AJMC staff. COA supports bills to ensure access to cancer medications. Am J Manag Care. 2024;29(suppl 8):SP722.\n3. McCormick B. House unanimously passes seniors’ access to Critical Medications Act. AJMC. September 25, 2024. Accessed October 31, 2024. https://www.ajmc.com/view/house-unanimously-passes-seniors-access-to-critical-medications-act. ","_key":"1ef1493551ee"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"4. A majority of Americans say the Trump administration is trying to make the Affordable Care Act fail. KFF. July 26, 2018. Accessed October 31, 2024. https://www.kff.org/affordable-care-act/slide/a-majority-of-americans-say-the-trump-administration-is-trying-to-make-the-affordable-care-act-fail/\n5. Steinzor P. Biden-Harris administration proposes new rule to expand affordable contraception coverage. AJMC. October 23, 2024. Accessed October 31, 2024. https://www.ajmc.com/view/biden-harris-administration-proposes-new-rule-to-expand-affordable-contraception-coverage\n6. Panigrahi G, Ambs S. How comorbidities shape cancer biology and survival. Trends Cancer. 2021;7(6):488-495. doi:10.1016/j.trecan.2020.12.010\n7. Gallicchio L, Devasia TP, Tonorezos E, Mollica MA, Mariotto AB. Estimation of the number of individuals living with metastatic cancer in the United States. J Natl Cancer Inst. 2022;114(11):1476-1483. doi:10.1093/jnci/djac158\n8. Tonorezos E, Devasia TP, Mariotto AB, et al. Prevalence of cancer survivors in the United States. J Natl Cancer Inst. Published online July 13, 2024. doi:10.1093/jnci/djae135","_key":"262a4f33cba2"}],"_type":"block","style":"normal","_key":"f5159ca88d3a"}],"contentCategory":{"_id":"3f4b3ced-7c9d-4fc4-967f-fe993087cce2","_updatedAt":"2023-09-29T14:32:27Z","_createdAt":"2020-04-03T20:03:53Z","_rev":"Q2ZL7ihdIB33NiMMcGccmh","_type":"contentCategory","name":"Articles"},"ExcludeFromPubMedXML":false,"is_visible":true,"taxonomyMapping":[{"perKeywordMapping":["Dermatology","Health Equity Diversity \u0026 Inclusion"],"_createdAt":"2021-11-30T14:11:09Z","name":"Dermatology","_id":"b3842fbc-a157-4b94-beaf-1e9def3f3485","pixelTrackingCode":null,"cmeType":"per","summary":[{"style":"normal","_key":"dcea5143ecb1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The ","_key":"0b9e7b1e1924"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"efe193fe9384"},{"_type":"span","marks":["superscript"],"text":"®","_key":"46cb1dcc0a32"},{"_type":"span","marks":[],"text":" Dermatology compendium is a comprehensive resource for clinical news and expert insights for diseases related to the skin, hair, and nails.","_key":"ae7ed02215e2"}],"_type":"block"}],"parent":{"_id":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_updatedAt":"2024-04-09T09:14:18Z","isMainTopic":true,"_createdAt":"2020-03-30T18:16:46Z","_rev":"oruil6rlosjyltJbhrNMGF","identifier":"compendium","_type":"taxonomy","name":"Compendium","parent":null},"_type":"taxonomy","_rev":"rs7eCk0lrr8LMiZP9GBgQM","_updatedAt":"2023-11-03T18:13:07Z","identifier":"dermatology"},{"_rev":"N7mKycgLbGtEq6btkPHYvR","name":"Center on Health Equity \u0026 Access","_type":"taxonomy","usedForRecommendations":false,"identifier":"center-on-health-equity-and-access","parent":{"_updatedAt":"2021-10-21T10:15:35Z","identifier":"topic","isMainTopic":true,"_createdAt":"2020-03-31T14:24:50Z","_rev":"SpZIJtjiAn4ebHE4u6sWYc","_type":"taxonomy","name":"Topic","_id":"15012229-f713-4f0a-8f82-7667530bb382","parent":null},"_id":"4ee49086-e720-4a65-883e-4efc24de53bb","_updatedAt":"2024-06-12T13:58:15Z","summary":[{"asset":{"_ref":"image-5f5a1d7609b5e2167e8398bb48c8734b1ba7aca8-800x212-jpg","_type":"reference"},"widthP":70,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","_key":"3b7c1e2bf551","alignment":"left"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The mission of the Center on Health Equity \u0026 Access is to support improvement of health care delivery and health outcomes due to health disparities by maintaining a content platform focused on education, training, frontline perspectives, and practical application of evidence-based methodologies.","_key":"cdef2f34ef460"}],"_type":"block","style":"normal","_key":"973bcb0dcce4"}],"_createdAt":"2022-11-16T22:15:20Z","thumbnail":{"_type":"mainImage","alt":"Logo for the Center on Health Equity \u0026 Access","asset":{"_ref":"image-5f5a1d7609b5e2167e8398bb48c8734b1ba7aca8-800x212-jpg","_type":"reference"}},"pixelTrackingCode":null},{"_type":"taxonomy","name":"Technology","_id":"topic_technology","_rev":"GQ2iWOdzjKwgYpKUFVt5oL","pixelTrackingCode":null,"_updatedAt":"2020-07-30T14:47:46Z","identifier":"technology","parent":{"identifier":"topic","_type":"taxonomy","name":"Topic","_id":"15012229-f713-4f0a-8f82-7667530bb382","_updatedAt":"2021-10-21T10:15:35Z","isMainTopic":true,"parent":null,"_createdAt":"2020-03-31T14:24:50Z","_rev":"SpZIJtjiAn4ebHE4u6sWYc"},"_createdAt":"2020-05-04T23:46:13Z"}],"gptTakeaways":"• Strategic partnerships between academic and community cancer programs can optimize patient outcomes and address health disparities through interdisciplinary collaboration and data sharing.\n\n• Policy changes, including drug pricing and telemedicine provisions, significantly impact cancer care delivery, requiring attention to ensure access and innovation.\n\n• Multidisciplinary collaboration is essential for managing complex cancer care, emphasizing the need for standard guidelines and proactive symptom management.\n\n• Community-clinical partnerships are crucial for addressing social determinants of health, improving health equity, and fostering comprehensive cancer care.","gptSummary":"Experts from leading cancer centers and venture capital convened to discuss enhancing community cancer programs through academic partnerships. The event highlighted the importance of bridging gaps between community-led cancer care and research to optimize patient outcomes. Key discussions included the impact of policies on cancer care, the necessity of interdisciplinary collaboration, and the role of community-clinical partnerships in addressing health disparities. Emphasis was placed on the need for data-driven tools, equitable access to care, and the integration of community resources to improve cancer health outcomes and ensure consistent quality of care.","issueSection":{"_ref":"cc663f4a-abe3-4db7-a6a8-502b2c7a6f4b","_type":"reference"},"drugMentions":"{\"drug_mentions\": []}","url":"collaborating-for-cancer-care-equity-community-and-academic-insights","_rev":"qMZkEXqBAV3IRERLM4LFwv","issueGroup":{"_ref":"477f9888-ea5b-4621-bb40-41487563b322","_type":"reference"},"_type":"article","seoTag":["dermatology","strategic partnerships","NYU Langone","Emeline Aviki","obstetrics","technology","data science","social determinants of health","SDOH","digital health"],"_updatedAt":"2024-11-21T19:18:34Z","_createdAt":"2024-11-21T18:33:04Z","summary":"Coverage from the recent Institute for Value-Based Medicine event with NYU Langone Health.","documentGroup":null,"thumbnail":{"_type":"mainImage","asset":{"_ref":"image-54f2a4431fd4ea73ec6c2ec625fd0d107129c22d-285x121-png","_type":"reference"}},"articleType":"Publication","authorMapping":[{"biography":[{"_type":"block","style":"normal","_key":"643be033259e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Maggie is an editor for The American Journal of Managed Care® (AJMC®) and produces written, video, and podcast content covering several disease states. 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Myeloma","_updatedAt":"2023-11-03T18:19:22Z","identifier":"multiple-myeloma","parent":{"name":"Compendium","_updatedAt":"2024-04-09T09:14:18Z","identifier":"compendium","_createdAt":"2020-03-30T18:16:46Z","_rev":"oruil6rlosjyltJbhrNMGF","parent":null,"_type":"taxonomy","isMainTopic":true,"_id":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a"},"_rev":"J9E0v654gKdSlGLhTDCsAu","cmeType":"per","_createdAt":"2021-11-30T14:08:52Z","_type":"taxonomy","pixelTrackingCode":null},{"_updatedAt":"2020-04-14T19:37:19Z","parent":{"identifier":"stakeholders","_createdAt":"2020-04-14T19:35:35Z","_rev":"OP7H2echeMthIUyBlewe80","parent":null,"_type":"taxonomy","name":"Stakeholders","_id":"5aa8e7d5-8a2d-44dd-99fc-fc43f03e2bed","_updatedAt":"2022-02-18T12:19:28Z"},"_rev":"sBk7YzjWMuBuhiatU3dlrp","_id":"e6d00060-6fac-4bf6-9b44-4be71a23cb38","name":"Providers","identifier":"providers","_createdAt":"2020-04-14T19:37:19Z","pixelTrackingCode":null,"_type":"taxonomy"},{"parent":{"parent":null,"_rev":"OP7H2echeMthIUyBlewe80","_type":"taxonomy","name":"Stakeholders","_id":"5aa8e7d5-8a2d-44dd-99fc-fc43f03e2bed","_updatedAt":"2022-02-18T12:19:28Z","identifier":"stakeholders","_createdAt":"2020-04-14T19:35:35Z"},"_createdAt":"2020-04-14T19:37:02Z","_type":"taxonomy","_updatedAt":"2020-04-14T19:37:02Z","identifier":"payers","_rev":"Wa44PLk8JzTa4XEWdp4v2C","name":"Payers","_id":"d58c9cdc-7922-468a-8ec2-654846edc983","pixelTrackingCode":null},{"_rev":"OU32WOWh4YetHW0RkWbkso","parent":null,"name":"News","_id":"39be7351-bd4c-4e98-82b3-0d675ae4671b","identifier":"news","pixelTrackingCode":null,"_updatedAt":"2022-01-19T10:20:16Z","_createdAt":"2020-03-30T18:05:45Z","_type":"taxonomy"},{"_createdAt":"2020-04-14T15:02:13Z","_type":"taxonomy","_id":"compendium_hematology","identifier":"hematology","parent":{"isMainTopic":true,"_createdAt":"2020-03-30T18:16:46Z","_type":"taxonomy","name":"Compendium","_id":"297fa3d1-5216-46eb-bf51-66c5f77c3c8a","_updatedAt":"2024-04-09T09:14:18Z","identifier":"compendium","_rev":"oruil6rlosjyltJbhrNMGF","parent":null},"pixelTrackingCode":null,"_rev":"GeM6ny2T6Y1Qp0cm9jBxeg","name":"Hematology","_updatedAt":"2020-07-30T14:48:10Z"}],"title":"Elevating Value in Cancer Care With Innovations, Accessibility, Equity","thumbnail":{"_type":"mainImage","asset":{"_ref":"image-c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645-png","_type":"reference"}},"_rev":"HwE5PzPdkhb4dxbtVFC5If","issueGroup":{"_ref":"477f9888-ea5b-4621-bb40-41487563b322","_type":"reference"},"factCheckAuthors":null,"body":[{"children":[{"_key":"b179e226d6880","_type":"span","marks":[],"text":"Innovations, accessibility, and equity within the treatment landscape, with a focus on evaluating value in cancer, were highlights of an Institute for Value-Based Medicine (IVBM) event held in Denver, Colorado, on October 10, 2024. Panelists discussed advances in treatment methods, technology, and immunotherapy across disease states, with some innovations destined to become best practices."}],"_type":"block","style":"normal","_key":"3f9907b43edb","markDefs":[]},{"widthP":25,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","_key":"b7c46eb7eef7","alignment":"left","asset":{"_ref":"image-c93bf646d31467af3bf1146ded1ddb1b32755d08-2022x645-png","_type":"reference"}},{"style":"normal","_key":"1c6e5fbc7136","markDefs":[],"children":[{"text":"Glenn Balasky, executive director of Rocky Mountain Cancer Centers in Colorado, moderated the session “Implementing New Technology and Innovations in Cancer Care in Rural Communities.” The session featured Ken Cohen, MD, executive director of translational research at Optum Care, and Rhonda Henschel, MBA, senior vice president of payer and care transformation at The US Oncology Network.\n\n","_key":"bb7bfad5ce10","_type":"span","marks":[]},{"_type":"span","marks":["strong"],"text":"Innovative Methods Within Rural Cancer Care","_key":"e2379f23b82d"},{"_type":"span","marks":[],"text":"\n","_key":"2e02e89255b1"}],"_type":"block"},{"alignment":"left","disableLightBox":true,"widthP":25,"_type":"figure","imgcaption":[{"markDefs":[],"children":[{"text":"Glenn Balasky | Image: Rocky Mountain Cancer Centers","_key":"37ec4350efc4","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"5960bb8926b4"}],"_key":"ee325aa09d48","asset":{"_ref":"image-e9f57485f9ad536c4310c5d28ab219d09a86e10d-225x225-jpg","_type":"reference"},"disableTextWrap":false,"alt":"Glenn Balasky | Image: Rocky Mountain Cancer Centers"},{"_type":"block","style":"normal","_key":"2c822fd6283e","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Balasky began the session by asking Cohen and Henschel for their perspectives on rural cancer care. Cohen explained that therapeutic complications may occur in patients who live near a rural hospital that lacks experience in managing these adverse events. Henschel noted that financial means and transportation needs are huge factors that can determine who has access to care in rural areas.","_key":"082a017f5008"}]},{"alignment":"left","widthP":25,"disableTextWrap":false,"asset":{"_ref":"image-5c85b4966d84d5615aff74d9a12be85688f3da54-220x229-jpg","_type":"reference"},"disableLightBox":true,"_key":"45a02a2b111d","_type":"figure","imgcaption":[{"style":"normal","_key":"e9f4af73026f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Ken Cohen, MD | Image: Optum","_key":"1cc85b223efc"}],"_type":"block"}],"alt":"Ken Cohen, MD | Image: Optum"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“One important thing brought up a couple of times this evening is the concept of decentralized clinical trials, which was a nonstarter before the [COVID-19] pandemic,” Cohen said. “I’ve been a trialist for 30 years, and the FDA wouldn’t let you draw a laboratory [test] outside of a clinical research center, but everything changed at the beginning of the pandemic.”","_key":"7ba105328e60"}],"_type":"block","style":"normal","_key":"aefedb549541"},{"children":[{"_type":"span","marks":[],"text":"Henschel said her greatest concern is the significant lack of oncology providers for patients with cancer who live in rural areas. This compounds financial toxicity for these patients and their caregivers, who often take off work to travel to treatment facilities. Henschel suggested a multistakeholder strategy that focuses heavily on small, rural communities to close these accessibility gaps.","_key":"cf6d34a42722"}],"_type":"block","style":"normal","_key":"e2eef6e8a0b8","markDefs":[]},{"children":[{"marks":[],"text":"“I think where we start to see concerns is in access to clinical trials in some of these rural areas,” Henschel said. With cellular therapy, for example, “I think we’ve seen a lot of information, especially as we partner with the Leukemia \u0026 Lymphoma Society, on the lack of access of cellular therapies, new and novel treatments, and getting those penetrated into rural areas,” she said.","_key":"9e55892f95f5","_type":"span"}],"_type":"block","style":"normal","_key":"5129dea8716c","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"Balasky asked the panelists whether they believe patients with cancer “are already filtered out based on their social determinants of health.” Primary care physicians often give patients a diagnosis based on laboratory results, and those in rural areas may be referred to specialist surgeons in metropolitan centers due to limited local options.","_key":"67d4282bd8b5"}],"_type":"block","style":"normal","_key":"89b2464fb63f","markDefs":[]},{"disableTextWrap":false,"_type":"figure","disableLightBox":true,"asset":{"_ref":"image-24cccff952af8c38e2b8b88d388c8e69f7e60bc1-512x512-jpg","_type":"reference"},"widthP":25,"alignment":"left","_key":"a1bc02af1bb4","alt":"Rhonda Henschel | Image: The US Oncology Network","imgcaption":[{"markDefs":[],"children":[{"text":"Rhonda Henschel | Image: The US Oncology Network","_key":"347e5fea5df4","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"d48ae7d46033"}]},{"markDefs":[],"children":[{"_key":"cfc8a856ed21","_type":"span","marks":[],"text":"Henschel addressed a project she is working on in Texas to secure state funding from Medicaid coverage plans to help with increased screening rates. She believes that after this is achieved, communities and hospitals can form partnerships to offer patients the care they need.\n\n"},{"_type":"span","marks":["strong"],"text":"The Role of Telemedicine","_key":"f2d10719e25e"},{"marks":[],"text":"\nThe discussion shifted to technology as a potential solution for filling knowledge gaps, accessibility, and financial toxicity in rural cancer care. Telemedicine was suggested as a solution to provide widespread care to various regions. Cohen explained that although telemedicine is not the end-all, be-all solution, there are helpful models that utilize technology in a relevant manner.","_key":"68031455ab8b","_type":"span"}],"_type":"block","style":"normal","_key":"5301a22f7d04"},{"_type":"block","style":"normal","_key":"4beae0f8c85e","markDefs":[],"children":[{"text":"He provided examples such as “grandpads,” which are similar to an iPad tablet but instead have large font sizes, limited icons, and connect only to primary care offices through a virtual video call. They allow medical providers to establish and maintain relationships to ensure adequate access to medications and food.","_key":"78283bfebe21","_type":"span","marks":[]}]},{"style":"normal","_key":"cb13304af149","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Another model, still in testing, began at The Everett Clinic, now Optum Care Washington, which operates as a precancer clinic with oncologists using relevant patient data to come to a definitive diagnosis, expediting the overall process. Lastly, Cohen mentioned the WISDOM trial (NCT02620852), a new trial looking at different ways to review breast cancer.","_key":"8bb61a98b14a"},{"marks":["superscript"],"text":"1","_key":"f3cc0ed62087","_type":"span"},{"marks":[],"text":" Prior to a mammography, breast screening practices can include polygenetic testing, and obtaining a detailed family and personal history. Once a person reaches screening age, mammogram assessments of breast density can be uploaded. A team then works to define a personal screening regimen based on these characteristics, which is completed remotely.","_key":"d48e62960003","_type":"span"}],"_type":"block"},{"children":[{"marks":[],"text":"Cohen emphasized that implementing these telemedicine methods within rural areas is largely dependent on state mandates. He acknowledged there are areas in the US where geographic proximity to a high-functioning system doesn’t exist and better mechanisms are necessary. Cohen referenced a study published in ","_key":"cbbad77b7f32","_type":"span"},{"text":"JAMA Network Open","_key":"94af27568272","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":" that conducted screenings for colorectal, cervical, and breast cancers in rural Indiana and Ohio by taking a mobile screening van into communities.","_key":"8a0cd86d7038"},{"_type":"span","marks":["superscript"],"text":"2","_key":"8ac2dacd09ce"},{"marks":[],"text":" Results found the screening rates doubled in these rural regions, but the study still only reached 50% of the population.","_key":"b29f2fd1ed17","_type":"span"}],"_type":"block","style":"normal","_key":"ccf037264511","markDefs":[]},{"_type":"block","style":"normal","_key":"d8fd458d1c20","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The discussion focused on how technology, particularly screening methods, can enhance cancer care. Cohen noted that the pandemic accelerated the shift toward remote patient monitoring, which has potential applications in oncology. However, both he and Henschel acknowledged that this technology is still in its developmental stages and hasn’t realized its full potential.\n\n","_key":"11079cb00bba"},{"_type":"span","marks":["strong"],"text":"Therapeutic Advances","_key":"3126b432dfd6"},{"_type":"span","marks":[],"text":"\n","_key":"5f3f70057a5a"}]},{"disableLightBox":true,"imgcaption":[{"markDefs":[],"children":[{"text":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers","_key":"02aa1460fade","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"15e4bbaf4e85"}],"_type":"figure","_key":"c2d874e6bb9b","alignment":"left","asset":{"_ref":"image-d447adb68e95c40a32b67a3e106204096ded2512-200x200-jpg","_type":"reference"},"widthP":25,"disableTextWrap":false,"alt":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers"},{"_type":"block","style":"normal","_key":"716e82860d50","markDefs":[],"children":[{"_type":"span","marks":[],"text":"All IVBM sessions explore newer treatment methods that consider cost-effectiveness in cancer care. Amy Sidorski, MS, ANP-C, advanced practice provider for oncology and hematology at Rocky Mountain Cancer Centers, explained the evolution of multiple myeloma treatment within their practice over the past several years through the introduction of quadruplet therapy based on the phase 3 PERSEUS trial, which has altered first-line treatment for patients. Results from PERSEUS (NCT03710603), presented in December 2023 at the American Society of Hematology Annual Meeting and Exposition, showed that patients who received daratumumab (Darzalex), bortezomib (Velcade), lenalidomide (Revlimid), dexamethasone (D-VRd) induction/consolidation followed by daratumumab plus lenalidomide maintenance had lower risk of disease progression or death than the VRd group, and improved minimal residual disease negativity.","_key":"7375da5a57e8"},{"_type":"span","marks":["superscript"],"text":"3","_key":"64db89dd6b36"}]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"In addition, Sidorksi said, having chimeric antigen receptor (CAR) T-cell therapy and bispecific T-cell engagers for use in second-line treatment has changed her practices’ operations.","_key":"23b660d7cdd5"}],"_type":"block","style":"normal","_key":"81de327a6fd5"},{"_key":"c87eb11ebe11","markDefs":[],"children":[{"marks":[],"text":"“It’s an amazing time to be a myeloma doctor,” Jorge Monge, MD, assistant professor of medicine and hematology at the University of Colorado School of Medicine in Aurora, said. Monge emphasized advancements made in multiple myeloma treatment from 1985 to 2024, emphasizing that a key area of evolution has been in the patient’s quality of life.","_key":"aa530af5a2f9","_type":"span"}],"_type":"block","style":"normal"},{"children":[{"_type":"span","marks":[],"text":"Lida Bighash, PharmD, BCOP, clinical pharmacy specialist in oncology at Denver Health, reviewed the past decade of advances in non–small cell lung cancer (NSCLC) treatment. As recently as a decade ago, there were no approved agents for use in NSCLC. Currently, there are several options for patients among all areas of NSCLC in neoadjuvant, adjuvant, and perioperative settings.","_key":"81e0b6b4e77a"}],"_type":"block","style":"normal","_key":"1b1e6c212a25","markDefs":[]},{"disableLightBox":true,"alt":"Tejas Patil, MD | Image: University of Colorado","imgcaption":[{"markDefs":[],"children":[{"_key":"1b01259dcaf9","_type":"span","marks":[],"text":"Tejas Patil, MD | Image: University of Colorado"}],"_type":"block","style":"normal","_key":"f0a3f9ae75eb"}],"alignment":"left","asset":{"_ref":"image-53e969cbdbb7ddb733d3e127f4dbea8f818f7170-500x500-jpg","_type":"reference"},"_key":"5910fde13802","disableTextWrap":false,"_type":"figure","widthP":25},{"_type":"block","style":"normal","_key":"4eaf0b172016","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Tejas Patil, MD, oncologist and assistant professor at the University of Colorado Cancer Center agreed with Bighash on the focal areas of development, referring to CHECKMATE-816, KEYNOTE-671, CHECKMATE-77T, as well as other clinical trials that led to improvements in patients’ pathologic complete response.","_key":"68781585f8c9"},{"_key":"8a1a82e6db12","_type":"span","marks":["superscript"],"text":"4-6"}]},{"markDefs":[],"children":[{"text":"Virginia Borges, MD, professor of medicine and medical oncology at the University of Colorado, discussed the significance of ribociclib (Kisqali) in early breast cancer treatment based on results from the phase 3. NATALEE trial (NCT03701334).","_key":"8e6f5ff384a6","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"7","_key":"3d1893568deb"},{"_type":"span","marks":[],"text":" Borges explained patients with early-stage HR+/HER2-negative breast cancer have a pair of CDK4/6 inhibitor options for treatment: abemaciclib (Verzenio) or ribociclib, although she noted that some patients are unable to tolerate either therapy.","_key":"32fb5a0d994c"}],"_type":"block","style":"normal","_key":"751733a9f193"},{"_type":"block","style":"normal","_key":"afa16ed3c372","markDefs":[],"children":[{"text":"Financial toxicity was a theme mentioned across all panels because the best therapies can have high out-of-pocket costs. “The main factor that alters a woman’s life and drives the financial cost of treating breast cancer through the roof is a metastatic diagnosis,” Borges said.","_key":"0f5fc89c2441","_type":"span","marks":[]}]},{"style":"normal","_key":"382a9b62e3d2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"She explained that a metastatic diagnosis includes higher-cost medications used for longer durations and in routine procedures, whereas a diagnosis of early-stage breast cancer is significantly less expensive. Borges referred to public support programs for patients who are uninsured or underinsured. Overall, she highlighted the cost-effectiveness of preventing metastatic breast cancer compared with treating it.","_key":"0911b1e95b11"}],"_type":"block"},{"alt":"Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn","asset":{"_ref":"image-2d330678dfcdd6731a1750cdad0d1e581842adda-200x200-jpg","_type":"reference"},"imgcaption":[{"style":"normal","_key":"f80a6e656336","markDefs":[],"children":[{"_key":"6f03be26012b","_type":"span","marks":[],"text":" Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn"}],"_type":"block"}],"alignment":"left","widthP":25,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","_key":"2ec27a02fe1e"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The moderator for the multiple myeloma panel, Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA, clinical pharmacy manager in the Division of Hematologic Malignancies and Cellular Therapeutics at the University of Kansas Health System, asked Sidorski and Monge about the cost-effectiveness of CAR T-cell therapies. Sidorski stressed the importance of affordable CAR T-cell therapies for patients with myeloma but agreed that access has not been easy. She hypothesized that CAR T-cell therapies may be a more cost-effective option that will allow patients to move forward from previous therapy, potentially saving money down the line.","_key":"70e023a00d29"}],"_type":"block","style":"normal","_key":"0c47fcb50c27"},{"style":"normal","_key":"be73d7e3003d","markDefs":[],"children":[{"_key":"bb7f54650c5a","_type":"span","marks":[],"text":"Monge explained why it is important to determine the duration of treatment on bispecific therapies, because starting treatment earlier for patients who remain on therapy the same length as patients starting later will result in similar financial toxicities. Transparent communication with appropriate stakeholders was suggested to develop models of cost ineffectiveness, which included fixed durations of therapy or minimal residual disease–adapted therapy."}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Both Patil and Bighash emphasized the importance in considering financial toxicity within NSCLC treatment, acknowledging how one affects the other. They suggested patient assistance programs created by drug manufacturers as proposed solutions to lower the high costs of immunotherapies.\n“There are a lot of trials that are looking at this question of de-escalation, which goes hand-in-hand with financial toxicity,” Patil said.","_key":"fabb7d1ae072"}],"_type":"block","style":"normal","_key":"b8b0f9679ce0"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Bighash noted that if the institutions, insurance companies, or patients cannot pay out-of-pocket expenses for adequate care medications, then the patients are not receiving the best quality treatment from health care providers.\n\n","_key":"ddb9daa905ee"},{"_type":"span","marks":["strong"],"text":"Takeaways and Next Steps\n","_key":"3cc3820e940c"},{"_type":"span","marks":[],"text":"Moving forward, the cancer care community must continue to focus on developing innovative treatments, improving access to care, and addressing financial toxicity for patients. By working together, we can create a more equitable and effective cancer care system for all, panelists agreed.","_key":"d0562f193c8d"}],"_type":"block","style":"normal","_key":"a40bf20eabe2"},{"children":[{"_type":"span","marks":[],"text":"“My best idea would be that we bridge the connection with people and then they make trips into the big city for what they need or [find] ways to get them to the city. Transportation [issues] can be overcome, but you can’t just bring very sophisticated care out everywhere. It’s just not economically feasible,” Balasky said in an interview with ","_key":"a06512dba397"},{"_type":"span","marks":["em"],"text":"AJMC","_key":"c4fb58bda4c7"},{"marks":[],"text":". \n\n","_key":"05d76c82066c","_type":"span"},{"_type":"span","marks":["strong"],"text":"References","_key":"fc937ebfb1f8"},{"_type":"span","marks":[],"text":"\n1. Eklund M, Broglio K, Yau C, Connor JT, Stover Fiscalini A, Esserman LJ. The WISDOM personalized breast cancer screening trial: simulation study to assess potential bias and analytic approaches. ","_key":"3ad47b83c420"},{"_type":"span","marks":["em"],"text":"JNCI Cancer Spectr","_key":"d4c09311b118"},{"text":". 2019;2(4):1-7. doi:10.1093/jncics/pky067\n2. Champion VL, Paskett ED, Stump TE, et al. Comparative effectiveness of 2 interventions to increase breast, cervical, and colorectal cancer screening among women in the rural US: a randomized clinical trial. ","_key":"b4cdaa20724d","_type":"span","marks":[]},{"_type":"span","marks":["em"],"text":"JAMA Netw Open.","_key":"a7cb766f16b0"},{"_type":"span","marks":[],"text":" 2023;6(4):e2311004. doi:10.1001/jamanetworkopen.2023.11004\n3. Sonneveld P, Dimopoulos M A, Boccadoro M, et al; PERSEUS Trial Investigators. Daratumumab, bortezomib, lenalidomide, and dexamethasone for multiple myeloma. N Engl J Med. 2023;390(4):301-313. doi:10.1056/nejmoa2312054\n4. A neoadjuvant study of nivolumab plus ipilimumab or nivolumab plus chemotherapy versus chemotherapy alone in early stage non-small cell lung cancer (NSCLC) (CheckMate 816). Clinicaltrials.gov. October 16, 2023. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT02998528\n5. Efficacy and safety of pembrolizumab (MK-3475) with platinum doublet chemotherapy as neoadjuvant/adjuvant therapy for participants with resectable stage III, IIIA, and resectable IIIB (T3-4N2) non-small cell lung cancer (MK-3475-671/KEYNOTE-671). Clinicaltrials.gov. September 19, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT03425643\n6. A study of neoadjuvant chemotherapy plus nivolumab versus neoadjuvant chemotherapy plus placebo, followed by surgical removal and adjuvant treatment with nivolumab or placebo for participants with surgically removeable early stage non-small cell lung cancer. Clinicaltrials.gov. July 23, 2024. Accessed October 22, 2024. https://clinicaltrials.gov/study/NCT04025879\n7. A trial to evaluate efficacy and safety of ribociclib with endocrine therapy as adjuvant treatment in patients with HR+/HER2-early breast cancer (NATALEE). Clinicaltrials.gov. October 10, 2024. Accessed October 23, 2024. https://clinicaltrials.gov/study/NCT03701334","_key":"ab84ec6ac1a5"}],"_type":"block","style":"normal","_key":"f8a886b17e4a","markDefs":[]}],"published":"2024-11-21T17:23:00.000Z","targeting":{"content_placement":["compendium/multiple-myeloma","stakeholders/providers","stakeholders/payers","news","compendium/hematology"],"document_url":["elevating-value-in-cancer-care-with-innovations-accessibility-equity"],"document_group":null,"rootDocumentGroup":[],"issue_url":"","publication_url":""},"relatedArticles":[{"title":"FDA Accepts Resubmitted NDA for Ataluren in Nonsense Duchenne Muscular Dystrophy","url":{"_type":"slug","current":"fda-accepts-resubmitted-nda-for-ataluren-in-nonsense-duchenne-muscular-dystrophy"},"thumbnail":{"_type":"mainImage","alt":"FDA website | Image Credit: © Postmodern Studio - 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