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class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/cameron-santoro">Cameron Santoro</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="Breast Cancer Challenges and Promises in Immunotherapy" 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" 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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">Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, discusses new treatments for HR+/HER2- breast cancer and immunotherapy challenges, particularly regarding immune-related adverse events. </p><div class="py-2"><div class="blockText_blockContent__TbCXh"><div class="relative"><div class="brightcove-fluid" autoplay=""></div></div><p class="pb-2">Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, participated in the Denver Regional Institute for Value-Based Medicine<sup class="text-inherit">®</sup> event and contributed to the session on new treatments for hormone receptor–positive (HR+)/HER2- breast cancer.<br/></p><p class="pb-2">Wei spoke with <em>The American Journal of Managed Care</em><sup class="text-inherit">®</sup> to emphasize the impact CDK4/6 inhibitors and antibody-drug conjugates will have on the outcomes of patients with HR+/HER2- breast cancer. She highlights how checkpoint inhibitors like pembrolizumab have shown efficacy in specific settings, while managing immune-related adverse events.<br/></p><p class="pb-2"><em>This transcript was lightly edited for clarity.</em></p><p class="pb-2"><em></em></p><p class="pb-2"><strong><span style="text-decoration:underline">Transcript</span></strong><br/></p><p class="pb-2"><strong>How are new treatments impacting patient outcomes, and what are the long-term implications?</strong></p><p class="pb-2"></p><p class="pb-2">This is very exciting because the ADCs, all of the targeted therapies, I think significantly improve the outcome.</p><p class="pb-2"></p><p class="pb-2">Historically, in the metastatic setting, before the CDK4/6 inhibitor was approved, patients had a much shorter overall survival. However, now with the CDK4/6 inhibitor, the overall survival among all the CDK4/6 inhibitors is about 50 to 60 months, that's about 5 to 6 years on average.</p><p class="pb-2"></p><p class="pb-2">After that, a patient can use ADCs and other chemotherapy, putting all of those together in an [endocrine receptor]–positive metastatic breast cancer. I think we can pretty reasonably bring them to 5, 6, or 7 years of overall survival when putting together [these therapies and] adding on the new ADC benefit. Then in the adjuvant setting, by adding 2 CDK4/6 inhibitors, we don't have the overall survival data yet.</p><p class="pb-2"></p><p class="pb-2">With the <a rel="nofollow noreferrer noopener" target="_blank" href="https://www.clinicaltrials.gov/study/NCT03155997">monarchE</a>, which is using adjuvant abemaciclib, even though the PFS [progression-free survival] is significantly improved compared with the patient that did not receive abemaciclib. The overall survival does not reach a statistical significance, but probably because the follow-up time is not long enough.</p><p class="pb-2"></p><p class="pb-2">The same situation with the ribociclib. Despite the PFS improvement, we haven't seen the overall survival benefit yet, but we hope with longer follow-up time we can kind of see the trend. But we don't have that data yet.<br/></p><p class="pb-2"><strong>What are the implications of immune-related adverse events for the use of immunotherapy in breast cancer?</strong></p><p class="pb-2"></p><p class="pb-2">This is another field where we are way behind from our peers. For the melanoma team, they were already using checkpoint inhibitors many years ago. However, for breast, just recently the checkpoint inhibitor has been approved for the triple-negative metastatic and very locally advanced non-metastatic breast cancer.</p><p class="pb-2"></p><p class="pb-2">We are pretty much only familiar with pembrolizumab, although there's many other checkpoint inhibitors under investigation at this point.</p><p class="pb-2"></p><p class="pb-2">We are still learning how to identify the immune checkpoint inhibitor–associated side effects and how to manage those. But we are learning. We've noticed a very high chance of patients developing hypothyroidism with the pembrolizumab. I would say probably even close to 100% of patients would have hypothyroidism when they receive pembrolizumab, and skin rashes and diarrheas.</p><p class="pb-2"></p><p class="pb-2">We are learning all of those, how to recognize the side effects, and how to manage those side effects.</p></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" 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loading="lazy"/></noscript></span></div><div class="w-full flex-wrap text-center text-sm mt-4 font-light no-underline text-white"></div></a></div></div><div class="relative block sm:hidden"><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/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/10079312e506a633cf4fcc09d893a56878bf8769-3407x2272.jpg?fit=crop&auto=format" alt="Palliative care | Image Credit: Chinnapong - 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/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent">Early Palliative Care Linked to Better End-of-Life Outcomes in Ovarian Cancer</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/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Initiating palliative care more than 3 months before death improves end-of-life outcomes for patients with ovarian cancer, highlighting the need for earlier interventions.</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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080.jpg?fit=crop&auto=format" alt="Don M. Benson, MD, PhD, James Cancer Hospital" 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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent">Balancing Life and Myeloma: A Patient-Centered Approach</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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.</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/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 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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f49fc4ae0c0acf600f9f66fb2d4e59bbf7fec0e1-5000x3033.jpg?fit=crop&auto=format" alt="BMI - Olivier Le Moal" 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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent">Study Finds Obesity May Worsen Multiple Sclerosis: Genetic Analysis Points to Causal Link</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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study aimed at exploring the relationship between obesity and multiple sclerosis severity using genetic data finds that higher BMI and other obesity measures were associated with increased disability progression in patients with MS.</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/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/10079312e506a633cf4fcc09d893a56878bf8769-3407x2272.jpg?fit=crop&auto=format" alt="Palliative care | Image Credit: Chinnapong - 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/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent">Early Palliative Care Linked to Better End-of-Life Outcomes in Ovarian Cancer</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/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/early-palliative-care-linked-to-better-end-of-life-outcomes-in-ovarian-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Initiating palliative care more than 3 months before death improves end-of-life outcomes for patients with ovarian cancer, highlighting the need for earlier interventions.</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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/6c4eacfe9c992d1f7ea48bbb7606ade7b9a0b9cf-1920x1080.jpg?fit=crop&auto=format" alt="Don M. Benson, MD, PhD, James Cancer Hospital" 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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent">Balancing Life and Myeloma: A Patient-Centered Approach</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/balancing-life-and-myeloma-a-patient-centered-approach?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In this second part of our discussion with Don M. Benson, MD, PhD, from our recent Institute for Value-Based Medicine® event in Cleveland, Ohio, he explains how his ultimate goal for his patients is for them to live as long and as well as possible.</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/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 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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/f49fc4ae0c0acf600f9f66fb2d4e59bbf7fec0e1-5000x3033.jpg?fit=crop&auto=format" alt="BMI - Olivier Le Moal" 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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent">Study Finds Obesity May Worsen Multiple Sclerosis: Genetic Analysis Points to Causal Link</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/study-finds-obesity-may-worsen-multiple-sclerosis-genetic-analysis-points-to-causal-link?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">A new study aimed at exploring the relationship between obesity and multiple sclerosis severity using genetic data finds that higher BMI and other obesity measures were associated with increased disability progression in patients with MS.</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":"Breast Cancer Challenges and Promises in Immunotherapy","datePublished":"2024-11-06T15:00:00.000Z","dateModified":"2024-11-01T19:53:34Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/1a4360029594090b3778ebf3cb4b361bbd0dc564-2859x1605.png?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/breast-cancer-challenges-and-promises-in-immunotherapy"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"ADCs,CDK4/6 inhibitors,ribociclib,abemaciclib,pembrolizumab,adverse events","articleBody":"\n\nMei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, participated in the Denver Regional Institute for Value-Based Medicine® event and contributed to the session on new treatments for hormone receptor–positive (HR+)/HER2- breast cancer.\n\n\nWei spoke with The American Journal of Managed Care® to emphasize the impact CDK4/6 inhibitors and antibody-drug conjugates will have on the outcomes of patients with HR+/HER2- breast cancer. She highlights how checkpoint inhibitors like pembrolizumab have shown efficacy in specific settings, while managing immune-related adverse events.\n\n\nThis transcript was lightly edited for clarity.\n\n\n\nTranscript\n\n\nHow are new treatments impacting patient outcomes, and what are the long-term implications?\n\n\n\nThis is very exciting because the ADCs, all of the targeted therapies, I think significantly improve the outcome.\n\n\n\nHistorically, in the metastatic setting, before the CDK4/6 inhibitor was approved, patients had a much shorter overall survival. However, now with the CDK4/6 inhibitor, the overall survival among all the CDK4/6 inhibitors is about 50 to 60 months, that's about 5 to 6 years on average.\n\n\n\nAfter that, a patient can use ADCs and other chemotherapy, putting all of those together in an [endocrine receptor]–positive metastatic breast cancer. I think we can pretty reasonably bring them to 5, 6, or 7 years of overall survival when putting together [these therapies and] adding on the new ADC benefit. Then in the adjuvant setting, by adding 2 CDK4/6 inhibitors, we don't have the overall survival data yet.\n\n\n\nWith the monarchE, which is using adjuvant abemaciclib, even though the PFS [progression-free survival] is significantly improved compared with the patient that did not receive abemaciclib. The overall survival does not reach a statistical significance, but probably because the follow-up time is not long enough.\n\n\n\nThe same situation with the ribociclib. Despite the PFS improvement, we haven't seen the overall survival benefit yet, but we hope with longer follow-up time we can kind of see the trend. But we don't have that data yet.\n\n\nWhat are the implications of immune-related adverse events for the use of immunotherapy in breast cancer?\n\n\n\nThis is another field where we are way behind from our peers. For the melanoma team, they were already using checkpoint inhibitors many years ago. However, for breast, just recently the checkpoint inhibitor has been approved for the triple-negative metastatic and very locally advanced non-metastatic breast cancer.\n\n\n\nWe are pretty much only familiar with pembrolizumab, although there's many other checkpoint inhibitors under investigation at this point.\n\n\n\nWe are still learning how to identify the immune checkpoint inhibitor–associated side effects and how to manage those. But we are learning. We've noticed a very high chance of patients developing hypothyroidism with the pembrolizumab. I would say probably even close to 100% of patients would have hypothyroidism when they receive pembrolizumab, and skin rashes and diarrheas.\n\n\n\nWe are learning all of those, how to recognize the side effects, and how to manage those side effects.","description":"Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, discusses new treatments for HR+/HER2- breast cancer and immunotherapy challenges, particularly regarding immune-related adverse events. 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However, now with the CDK4/6 inhibitor, the overall survival among all the CDK4/6 inhibitors is about 50 to 60 months, that's about 5 to 6 years on average."}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"419fe86f2c13"},{"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"","_key":"3999e820fa930"}],"_type":"block","style":"normal","_key":"01070d5d445a","markDefs":[],"upload_doc":null},{"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"text":"After that, a patient can use ADCs and other chemotherapy, putting all of those together in an [endocrine receptor]–positive metastatic breast cancer. I think we can pretty reasonably bring them to 5, 6, or 7 years of overall survival when putting together [these therapies and] adding on the new ADC benefit. 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Previous studies suggest that increased PC access has not reduced EOL care intensity in this population, and late PC consultations have shown limited impact on EOL quality indicators. 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More specifically, decedents with PC from 3 to 6 months before death were significantly less likely to receive aggressive EOL care (OR, 0.47; 95% CI, 0.37-0.60), be admitted to the ICU in their final 30 days (OR, 0.46; 95% CI, 0.27-0.76), or die in the hospital (OR, 0.54; 95% CI, 0.45-0.65) than those with late PC.","_key":"8c98bed5a39e0"}]},{"markDefs":[],"children":[{"_key":"017f716d70c60","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"1f2e03695990"},{"style":"normal","_key":"e18859042cd9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Only 4298 patients (51.8%) received a specialist PC consultation. Compared with those who received late specialist PC, patients who received specialist PC between 3 to 6 months before death were less likely to receive supportive EOL care (OR, 1.52; 95% CI, 1.23-1.88) and less likely to die in the hospital (OR, 0.66; 95% CI, 0.54-0.79).","_key":"e0f910ebc7480"}],"_type":"block"},{"children":[{"_key":"e9e230a65fd60","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"9bd5016efa45","markDefs":[]},{"children":[{"_key":"83a0341a44c80","_type":"span","marks":[],"text":"Also, only patients who received specialist PC 3 to 6 months before death were significantly less likely to receive late chemotherapy than those who received late specialist PC (OR, 0.46; 95% CI, 0.24-0.88). 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Leaving the complexities aside for a second, the principal goal of induction treatment is to alleviate suffering, get symptoms under control, get the disease in remission. I tell my patients, we're going to play offense, we're going to take the ball. We're playing offense, and the goal is a complete remission. The goal is to get you back to life before you heard those words that you have myeloma.","_key":"98a12fa87f160"}]},{"_key":"b87ccab950ce","markDefs":[],"children":[{"marks":[],"text":"","_key":"e5122cc087dd0","_type":"span"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"We’re blessed. We can achieve that now for the vast majority of people within a few months.The challenge really isn't getting the disease under control nowadays, it's doing it in a way to minimize toxicities, minimize side effects, even down to things like time. How long are you in the clinic? How long are you away from your life? These are things that we never would have thought of 20 years ago. So I think starting with principles and then moving forward, once the disease is in remission.","_key":"903297a2544e0"}],"_type":"block","style":"normal","_key":"4fa1f2e9a11a"},{"markDefs":[],"children":[{"text":"","_key":"d68b2f25f9270","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"350f7d4b1a54"},{"children":[{"_type":"span","marks":[],"text":"We talk a little bit about this shared decision-making model of, we have a panoply of options available. What makes sense for you with your myeloma right now? Realizing that that answer might be different 2 years from now or 5 years from now. But what can we do right now to stay on our true north, that I want you to live as long as possible and as well as possible. And for some people, that's a transplant.For some people, that's maybe a CAR [chimeric antigen receptor] T cell. For some people, that might be stopping treatment and just taking a maintenance drug.","_key":"6f14e254c8760"}],"_type":"block","style":"normal","_key":"0e3a9819924f","markDefs":[]},{"children":[{"_type":"span","marks":[],"text":"","_key":"cb0db495ec3c0"}],"_type":"block","style":"normal","_key":"db2656198b38","markDefs":[]},{"children":[{"_type":"span","marks":["strong"],"text":"What strategies can be implemented to support caregivers and enhance patient engagement throughout this journey?","_key":"e44a4e9608260"}],"_type":"block","style":"normal","_key":"6d35a1abcd26","markDefs":[]},{"style":"normal","_key":"6c3f5f7fe4dd","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"1dce3cf224050"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"I can speak to my perspective at a referral center that the vast majority of people with myeloma are receiving care in community settings. Oftentimes, when we get involved at a referral center, at an academic center, there's potentially a question about transplant eligibility, about eligibility for a BiTE [bispecific T-cell engager] or a CAR T cell. But just as often, these are referrals that are like grassroots referrals, and it's often an adult child who's driving care.It's not the patient who's maybe 75 or 80 years old, it's an adult child who's gotten on the internet, who's going to support groups, who's done his or her homework, and is saying, “Mom, I really think it's worth the drive to this center. Not that we are unhappy with our care, not that we disagree with our care, but this is a rare cancer. Maybe it would make sense to have somebody look at your case and meet you once, who does it for a living, who sees it every day.”","_key":"1350599e72c50"}],"_type":"block","style":"normal","_key":"9a1ed96927d7"},{"_key":"c81bbcef117c","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"87957829728e0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"And I'm all about that. I think that's so important. Myeloma is a rare cancer, and I think the more that—the patient, obviously—but the patient's family, their loved ones, and most often it's the adult children—it's actually usually the oldest daughter for what it's worth, who's taking time off work, who's finding childcare, who's making sacrifices to make sure mom or dad is getting the best care possible. And I see that as a partnership, and I truly see it as a shared decision-making model, because things that we would do for one person… I've had patients come in and say, “I got 400 acres of corn I have to harvest.” And I've had other people come in and say, “We have nonrefundable tickets for a cruise around Greece.”","_key":"9f0e0feae61c0","_type":"span"}],"_type":"block","style":"normal","_key":"4194d4d05490"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"5afcebb5c5d40"}],"_type":"block","style":"normal","_key":"04d18b8da36f"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And so we make it work. 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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":"block","style":"normal"},{"style":"normal","_key":"89b2464fb63f","markDefs":[],"children":[{"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":"span","marks":[]}],"_type":"block"},{"_type":"figure","alt":"Rhonda Henschel | Image: The US Oncology Network","alignment":"left","disableTextWrap":false,"imgcaption":[{"children":[{"_key":"347e5fea5df4","_type":"span","marks":[],"text":"Rhonda Henschel | Image: The US Oncology Network"}],"_type":"block","style":"normal","_key":"d48ae7d46033","markDefs":[]}],"_key":"a1bc02af1bb4","disableLightBox":true,"asset":{"_ref":"image-24cccff952af8c38e2b8b88d388c8e69f7e60bc1-512x512-jpg","_type":"reference"},"widthP":25},{"_key":"5301a22f7d04","markDefs":[],"children":[{"_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","_key":"cfc8a856ed21"},{"_type":"span","marks":["strong"],"text":"The Role of Telemedicine","_key":"f2d10719e25e"},{"_type":"span","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":"block","style":"normal"},{"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":[]}],"_type":"block"},{"_type":"block","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"},{"_type":"span","marks":["superscript"],"text":"1","_key":"f3cc0ed62087"},{"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"}]},{"markDefs":[],"children":[{"_type":"span","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"},{"marks":["em"],"text":"JAMA Network Open","_key":"94af27568272","_type":"span"},{"_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"},{"_type":"span","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":"block","style":"normal","_key":"ccf037264511"},{"_type":"block","style":"normal","_key":"d8fd458d1c20","markDefs":[],"children":[{"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":[]},{"_type":"span","marks":["strong"],"text":"Therapeutic Advances","_key":"3126b432dfd6"},{"text":"\n","_key":"5f3f70057a5a","_type":"span","marks":[]}]},{"alignment":"left","_type":"figure","imgcaption":[{"_key":"15e4bbaf4e85","markDefs":[],"children":[{"text":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers","_key":"02aa1460fade","_type":"span","marks":[]}],"_type":"block","style":"normal"}],"_key":"c2d874e6bb9b","asset":{"_ref":"image-d447adb68e95c40a32b67a3e106204096ded2512-200x200-jpg","_type":"reference"},"widthP":25,"disableTextWrap":false,"disableLightBox":true,"alt":"Amy Sidorski, MS, ANP-C | Image: Rocky Mountain Cancer Centers"},{"children":[{"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"},{"_type":"span","marks":["superscript"],"text":"3","_key":"64db89dd6b36"}],"_type":"block","style":"normal","_key":"716e82860d50","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","markDefs":[]},{"_type":"block","style":"normal","_key":"c87eb11ebe11","markDefs":[],"children":[{"_key":"aa530af5a2f9","_type":"span","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":"1b1e6c212a25","markDefs":[],"children":[{"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":"span"}],"_type":"block","style":"normal"},{"disableTextWrap":false,"alt":"Tejas Patil, MD | Image: University of Colorado","imgcaption":[{"style":"normal","_key":"f0a3f9ae75eb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Tejas Patil, MD | Image: University of Colorado","_key":"1b01259dcaf9"}],"_type":"block"}],"alignment":"left","widthP":25,"asset":{"_ref":"image-53e969cbdbb7ddb733d3e127f4dbea8f818f7170-500x500-jpg","_type":"reference"},"disableLightBox":true,"_type":"figure","_key":"5910fde13802"},{"markDefs":[],"children":[{"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","_type":"span"},{"_type":"span","marks":["superscript"],"text":"4-6","_key":"8a1a82e6db12"}],"_type":"block","style":"normal","_key":"4eaf0b172016"},{"markDefs":[],"children":[{"_type":"span","marks":[],"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"},{"marks":["superscript"],"text":"7","_key":"3d1893568deb","_type":"span"},{"_key":"32fb5a0d994c","_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."}],"_type":"block","style":"normal","_key":"751733a9f193"},{"markDefs":[],"children":[{"_type":"span","marks":[],"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":"block","style":"normal","_key":"afa16ed3c372"},{"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","style":"normal","_key":"382a9b62e3d2","markDefs":[]},{"asset":{"_ref":"image-2d330678dfcdd6731a1750cdad0d1e581842adda-200x200-jpg","_type":"reference"},"_key":"2ec27a02fe1e","disableTextWrap":false,"alt":"Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn","imgcaption":[{"_key":"f80a6e656336","markDefs":[],"children":[{"_type":"span","marks":[],"text":" Zahra Mahmoudjafari, PharmD, MBA, BCOP, FHOPA | Image: LinkedIn","_key":"6f03be26012b"}],"_type":"block","style":"normal"}],"disableLightBox":true,"alignment":"left","widthP":25,"_type":"figure"},{"style":"normal","_key":"0c47fcb50c27","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"},{"markDefs":[],"children":[{"_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.","_key":"bb7f54650c5a"}],"_type":"block","style":"normal","_key":"be73d7e3003d"},{"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":[]},{"markDefs":[],"children":[{"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":[]},{"_type":"span","marks":["strong"],"text":"Takeaways and Next Steps\n","_key":"3cc3820e940c"},{"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":"span","marks":[]}],"_type":"block","style":"normal","_key":"a40bf20eabe2"},{"_key":"f8a886b17e4a","markDefs":[],"children":[{"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"},{"text":"AJMC","_key":"c4fb58bda4c7","_type":"span","marks":["em"]},{"_type":"span","marks":[],"text":". \n\n","_key":"05d76c82066c"},{"_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"},{"_type":"span","marks":[],"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":["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. 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Discussions highlighted the challenges and advancements in rural cancer care, emphasizing the role of decentralized clinical trials and telemedicine. Therapeutic advances, including CAR T-cell therapy and quadruplet therapy for multiple myeloma, were explored. Financial toxicity remains a significant concern, with panelists advocating for cost-effective solutions and patient assistance programs. 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Olivier Le Moal","imgcaption":[{"_key":"dd544f994d59","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"2dcb13b9690a"}],"_type":"block","style":"normal"},{"children":[{"text":"A new study links obesity to an increased severity of multiple sclerosis.","_key":"67c9a7060fa20","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"589313493efb","markDefs":[]},{"_type":"block","style":"normal","_key":"1f73e45b30ac","markDefs":[],"children":[{"text":"Image Credit: BMI - Olivier Le Moal","_key":"f27fa9bac5eb","_type":"span","marks":[]}]}],"alignment":"right","asset":{"_ref":"image-f49fc4ae0c0acf600f9f66fb2d4e59bbf7fec0e1-5000x3033-jpg","_type":"reference"},"widthP":38,"disableTextWrap":false,"disableLightBox":true,"_type":"figure","_key":"c26f294f9424"},{"children":[{"_type":"span","marks":[],"text":"A new study led by researchers at McGill University links ","_key":"457bf82616430"},{"marks":["21f0c132d592"],"text":"obesity","_key":"bf70f4573ad7","_type":"span"},{"_type":"span","marks":[],"text":" to an increased severity of ","_key":"6a83f108b4d1"},{"marks":["712b100b2dce"],"text":"multiple sclerosis (MS)","_key":"a4362bdd5c13","_type":"span"},{"_type":"span","marks":[],"text":". The study, published in ","_key":"07f166e3957e"},{"marks":["em","e477b2c0d4c4"],"text":"Annals of Neurology","_key":"c458f39bee97","_type":"span"},{"_type":"span","marks":[],"text":", aimed to build on findings from the largest genome-wide association study (GWAS) of MS severity to date, which provided extensive data but initially found no confirmed link between body mass index (BMI) and MS severity.","_key":"b97401ee75ae"},{"_key":"987d9c9cf5c2","_type":"span","marks":["superscript"],"text":"1"}],"_type":"block","style":"normal","_key":"3085007ac895","markDefs":[{"_type":"link","href":"https://pubmed.ncbi.nlm.nih.gov/39431322/","_key":"e477b2c0d4c4","nofollow":true,"blank":true},{"_type":"link","href":"https://www.ajmc.com/compendium/multiple-sclerosis","_key":"712b100b2dce","nofollow":false,"blank":true},{"_key":"21f0c132d592","nofollow":false,"blank":true,"_type":"link","href":"https://www.ajmc.com/compendium/obesity"}]},{"_key":"074fbf772265","markDefs":[],"children":[{"_type":"span","marks":["superscript"],"text":"","_key":"905b9da3c19f"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"ba9d2f8d910e0","_type":"span","marks":[],"text":"“Results showed a significant association between higher genetically-determined body mass index and increased MS severity ("},{"marks":["em"],"text":"P","_key":"db363fde6b6f","_type":"span"},{"_type":"span","marks":[],"text":" = .02),” the researchers noted, adding that “The convergence of this genetic evidence with prior observational studies strengthens the association between obesity and adverse long-term disability in MS.”","_key":"fd902474a8e0"}],"_type":"block","style":"normal","_key":"de1be0fc31c0"},{"_key":"13219009bc06","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"144a87d1c301"}],"_type":"block","style":"normal"},{"style":"normal","_key":"85aa5e34ee1b","markDefs":[],"children":[{"_key":"d833443126e10","_type":"span","marks":[],"text":"For this study, researchers updated the statistical power and expanded the analysis of the original GWAS of MS severity data to incorporate a range of obesity measures beyond BMI, providing a more comprehensive view of how different aspects of obesity might impact disease progression in patients with MS ."},{"_type":"span","marks":["superscript"],"text":"2","_key":"d45390949133"}],"_type":"block"},{"_key":"bb2fca8fc541","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c9866c455dd4"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"1d13d0dd6e31","markDefs":[],"children":[{"_type":"span","marks":[],"text":"A larger GWAS with 806,834 participants was used to identify relevant genetic variants associated with obesity traits, which served as proxies for obesity in the analysis.","_key":"d3378c9c38280"},{"_type":"span","marks":["superscript"],"text":"3","_key":"ac7d68546260"},{"marks":[],"text":" “Mendelian randomization (MR), a technique that uses genetic variants as proxies for risk factors, allowed us to overcome confounding factors and reverse causality,” the authors explained. The original GWAS of 12,584 individuals with MS was then examined using MR to determine the effects of various obesity measures, including adipose distribution, on MS severity and progression.","_key":"ac4220049d12","_type":"span"},{"_type":"span","marks":["superscript"],"text":"1","_key":"d1fd4fea426d"}]},{"children":[{"_type":"span","marks":[],"text":"","_key":"5b5df4b8998e"}],"_type":"block","style":"normal","_key":"becdbf145cdc","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"The primary analysis showed that each standard deviation increase in BMI was associated with a 0.08-point increase in MS severity scores (","_key":"8d9a4ed165a60"},{"_type":"span","marks":["em"],"text":"P","_key":"03574fdcb0c7"},{"_key":"191d3608eaef","_type":"span","marks":[],"text":" = .02). This association was measured using the Age-Related Multiple Sclerosis Severity Score (ARMSS). In addition to BMI, other measures of obesity, such as whole-body fat mass (WBF), body fat percentage (BFP), trunk fat percentage (TFP), and trunk fat mass (TFM), showed a positive correlation with MS severity. However, only WBF had a significant association (β = 0.08, "},{"_type":"span","marks":["em"],"text":"P","_key":"7879c5db5fe7"},{"_key":"6c3a4575e85c","_type":"span","marks":[],"text":" = .04). “Similar to BMI, we observed no heterogeneity, a null MR-Egger intercept, and a significant RAPS estimate (β = 0.08, "},{"_type":"span","marks":["em"],"text":"P","_key":"15d80ce6ef6e"},{"_type":"span","marks":[],"text":" = .039),” the authors noted. The study found no significant association between MS severity and measures of fat distribution, such as waist-hip ratio adjusted for BMI and visceral adipose tissue.","_key":"9744730dec94"}],"_type":"block","style":"normal","_key":"b273141ed207"},{"_key":"9f9339e99f50","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"b2164f8e325b"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"While the study offers additional insights into the link between obesity and MS severity, the authors note several limitations. First, despite the robust MR approach, the analysis cannot fully eliminate the risk of pleiotropy, where genetic variants may influence MS severity through pathways other than obesity. Additionally, the genetic associations with MS severity were derived from data that did not stratify participants by sex, limiting the ability to examine potential sex-based differences. 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