Perlmutter Cancer Center at NYU Langone

Shella Saint Fleur-Lominy, MD, PhD, an assistant professor in the Department of Medicine at NYU Langone Health’s Perlmutter Cancer Center, discusses targeted pathways in myeloproliferative neoplasms (MPNs).

Some pathways are being targeted in the realm of MPNs, says Fleur-Lominy. More JAK1/2 inhibitors that are proving to be more selective, as was observed with fedratinib (Inrebic); however, others are also being tested. Epigenetic modulators are also available for these patients. Many pathways dependent or independent of STAT downstream are being targeted with therapies that are showing promising results, as well, adds Fleur-Lominy. Some of these therapies are being tested as single agents and others are being tested in combination with ruxolitinib (Jakafi), concludes Fleur-Lominy.

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Shella Saint Fleur-Lominy, MD, PhD, discusses targeted pathways in myeloproliferative neoplasms.

Dr. Fleur-Lominy on Targeted Pathways in MPNs

Faith E. Davies, MD, a professor in the Department of Medicine and director of the Clinical Myeloma Program at NYU Langone Health’s Perlmutter Cancer Center, shares advice on how to best treat patients with relapsed/refractory multiple myeloma.

Patients with relapsed/refractory multiple myeloma should be monitored closely, says Davies. It is also important to be proactive when patients relapse, to remember that a wrong answer does not exist, and that each patient is different, adds Davies. Knowing what treatment patients have received before, what adverse events they had from that treatment, and what problems they have now will allow for personalized therapy for each individual patient; this will ensure that patients are given the best treatment possible at that particular point in their treatment journey, concludes Davies.

Faith E. Davies, MD, shares advice on how to best treat patients with relapsed/refractory multiple myeloma.

Dr. Davies on Personalizing Treatment in Relapsed/Refractory Myeloma

Mohammad Maher Abdul-Hay, MD, an assistant professor in the Department of Medicine, director of the Clinical Leukemia Program in NYU Langone Health’s Perlmutter Cancer Center, and associate director for research in the Bellevue Cancer Center, discusses the use of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to guide transplant eligibility in acute lymphoblastic leukemia (ALL).

The HCT-CI is a comorbidity index, which is made up of 17 points, says Abdul-Hay. Points can be assigned to a patient based on pulmonary function test, history, diabetes status, kidney disease, and more. The lower the total score, the less likelihood the patient has of developing transplant-associated complications or mortality, says Abdul-Hay. A patient who has a low HCT-CI score and is deemed eligible for transplant should undergo transplant, adds Abdul-Hay.

In the era of graft-versus-host disease (GVHD), prevention treatment posttransplant, such as cyclophosphamide-based regimens, have decreased the incidence of GVHD, leading to an increased success rate with transplant.

Mohammad Maher Abdul-Hay, MD, discusses the use of the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to guide transplant eligibility in acute lymphoblastic leukemia (ALL).

Dr. Abdul-Hay on the Use of HCT-CI to Guide Transplant Eligibility in ALL

Diane M. Simeone, MD, Laura and Issac Perlmutter Professor of Surgery in the Department of Surgery; professor in the Department of Pathology; associate director of Translational Research at Perlmutter Cancer Center; professor in the Department of Pathology at NYU Grossman School of Medicine; and director of the Pancreatic Cancer Center of NYU Langone Health, discusses the importance of germline testing in pancreatic cancer.

All patients with pancreatic cancer should receive germline testing, says Simeone. Germline testing helps physicians to identify family members who might be at risk and help said family members undergo the screening they need. Patients should know whether they have family members or parents with pancreatic cancer, or whether they have a family history of pancreatic cancer—especially if it is associated with other cancer types. These patients should seek out a genetic counselor to determine whether or not they should get germline testing and screening done, says Simeone.

For those identified as high risk for pancreatic cancer, annual screening is recommended, along with a pancreatic MRI or magnetic resonance cholangiopancreatography, alternating with an endoscopic ultrasound. That should be done in the setting of a high-risk clinic, where there is a genetic counselor and a team of physicians involved in the patient’s care, concludes Simeone.

Diane M. Simeone, MD, discusses the importance of germline testing in pancreatic cancer.

Dr. Simeone on the Importance of Germline Testing in Pancreatic Cancer

Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses reclassifying patients with prostate cancer by utilizing the 17-gene Oncotype DX Genomic Prostate Score (GPS).

In a study, investigators utilized the 17-gene RT-PCR Prostate Assay to look at the clinical experience of 33,000 patients with clinically low-risk prostate cancer in the United States, says Katz. In this research, investigators were able to redefine the risk assessment in these patients.

Results showed was that men who were defined to be low- and intermediate-risk via the National Comprehensive Cancer Center guidelines were recategorized based upon the new genomic score. Those in the low-risk group were reclassified in 62% of cases and those in the intermediate-risk group were reclassified in 34% of cases, says Katz.

It is important to understand that some of the patients who are considered to be low risk may actually harbor more aggressive disease, concludes Katz.

Aaron E. Katz, MD, FACS, discusses re-classifying low-risk prostate scores with the 17-gene Oncotype DX Genomic Prostate Score.

Dr. Katz on Redefining Risk Assessment in Prostate Cancer With 17-Gene Oncotype DX GPS

Aaron E. Katz, MD, FACS, professor, Department of Urology, NYU Long Island School of Medicine, chairman, Department of Urology, Winthrop Hospital, NYU Langone Health’s Perlmutter Cancer Center, discusses strategies for determining low-risk prostate cancer.

Patients with low-risk prostate cancer can be monitored with active surveillance rather than receive up-front treatment.

Patients who do not have multi-core or primary pattern 4 biopsies may have low-risk disease, says Katz.

Additionally, biochemical assays may factor into risk stratification as patients with a prostate-specific antigen (PSA) of less than 10 are eligible for active surveillance, explains Katz.

Some patients with PSA scores of greater than 10 can receive active surveillance because risk is also stratified by prostate volume, says Katz. MRI can often identify lesions in the prostate based on PI-RADS [Prostate Imaging Reporting & Data System] score and the volume of prostate.

From there, a patient’s PSA density can further stratify their disease. Patients with lower PSA density are more likely to derive a favorable response from active surveillance, concludes Katz.

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Aaron E. Katz, MD, FACS, discusses strategies for determining low-risk prostate cancer.

Dr. Katz on Determining Low-Risk Disease in Prostate Cancer

Gareth J. Morgan, MD, PhD, a professor in the Department of Medicine and director of Multiple Myeloma Research at NYU Langone Health’s Perlmutter Cancer Center, provides insight on treatment selection for patients with multiple myeloma.

In both the up-front and relapsed/refractory settings, treatment should be selected with the goal of maximizing patient responses, says Morgan.

Patients with heavily pretreated relapsed/refractory multiple myeloma could be considered for the novel XPO1 inhibitor selinexor (Xpovio), which received an accelerated approval from the FDA on July 3, 2019 for use in combination with dexamethasone for the treatment of patients with relapsed/refractory myeloma who have received at least 4 prior therapies and whose disease is refractory to at least 2 proteasome inhibitors, at least 2 immunomodulatory agents, and an anti-CD38 monoclonal antibody.

Additionally, patients who harbor a translocation(11;14) should be considered for venetoclax (Venclexta), says Morgan.

Finally, enrolling patients on clinical trials remains an option as CAR T-cell therapy and bispecific monoclonal antibodies remain investigational, concludes Morgan.

Gareth J. Morgan, MD, PhD, provides insight on determining treatment selection for patients with multiple myeloma.

Dr. Morgan on Treatment Selection in Multiple Myeloma

Michael L. Grossbard, MD, professor in the Department of Medicine, chief of the Hematology and Medical Oncology Inpatient Service at Tisch Hospital, and section chief of Hematology at NYU Langone Health’s Perlmutter Cancer Center, discusses the role of maintenance rituximab (Rituxan) in follicular lymphoma.

It is easy to get patients with follicular lymphoma into remission with all the new therapies that are available, says Grossbard. However, frontline therapy is not curative. Although maintenance rituximab can be used to prolong remissions, it may not impact long-term survival. Nonetheless, it is important for patients to be able to live free of disease and maintain their quality of life while on treatment, explains Grossbard.

The phase 3 PRIMA trial evaluated maintenance rituximab following induction chemotherapy with or without rituximab. Patients were treated until remission and then were randomized to receive no additional therapy or maintenance rituximab. Patients who had maintenance rituximab had longer remissions than those who did not receive maintenance therapy, concludes Grossbard.

Michael L. Grossbard, MD, discusses the role of maintenance rituximab (Rituxan) in follicular lymphoma.

Dr. Grossbard on the Role of Maintenance Rituximab in Follicular Lymphoma

Michael L. Grossbard, MD, professor in the Department of Medicine, chief of the Hematology and Medical Oncology Inpatient Service at Tisch Hospital, and section chief of Hematology at NYU Langone Health’s Perlmutter Cancer Center, discusses the role of maintenance rituximab (Rituxan) in follicular lymphoma.

It is easy to get patients with follicular lymphoma into remission with all the new therapies that are available, says Grossbard. However, frontline therapy is not curative. Although maintenance rituximab can be used to prolong remissions, it may not impact long-term survival. Nonetheless, it is important for patients to be able to live free of disease and maintain their quality of life while on treatment, explains Grossbard.

The phase 3 PRIMA trial evaluated maintenance rituximab following induction chemotherapy with or without rituximab. Patients were treated until remission and then were randomized to receive no additional therapy or maintenance rituximab. Patients who had maintenance rituximab had longer remissions than those who did not receive maintenance therapy, concludes Grossbard.

Marc J. Braunstein, MD, PhD, assistant professor in the Department of Medicine at NYU Long Island School of Medicine; course co-director of the Hematology-Oncology System and co-director of the Autologous Stem Cell Transplant Program, NYU Winthrop Hospital of NYU Langone Health’s Perlmutter Cancer Center, discusses updated results from the GRIFFIN trial in multiple myeloma.

The phase 2 GRIFFIN study evaluated the addition of daratumumab (Darzalex) to lenalidomide (Revlimid), bortezomib (Velcade), and dexamethasone (RVd) versus the standard triplet regimen of RVd in transplant-eligible patients with myeloma. The results showed an improvement in progression-free survival with the quadruplet. Additionally, the primary endpoint, which was stringent complete response (sCR), was superior at every evaluable timepoint in the quadruplet arm compared with the triplet arm.

The quadruplet could become the new standard of care for transplant-eligible patients, says Braunstein. However, longer-term follow-up data are needed in order to see which patient benefits the most from this treatment, concludes Braunstein.

Marc J. Braunstein, MD, PhD, discusses updated results from the GRIFFIN trial in multiple myeloma.

Perlmutter Cancer Center at NYU Langone

Dr. Fleur-Lominy on Targeted Pathways in MPNs

Dr. Davies on Personalizing Treatment in Relapsed/Refractory Myeloma

Dr. Abdul-Hay on the Use of HCT-CI to Guide Transplant Eligibility in ALL

Dr. Simeone on the Importance of Germline Testing in Pancreatic Cancer

Dr. Katz on Redefining Risk Assessment in Prostate Cancer With 17-Gene Oncotype DX GPS

Dr. Katz on Determining Low-Risk Disease in Prostate Cancer

Dr. Morgan on Treatment Selection in Multiple Myeloma

Dr. Grossbard on the Role of Maintenance Rituximab in Follicular Lymphoma

Dr. Grossbard on the Role of Maintenance Rituximab in Follicular Lymphoma

Dr. Braunstein on Updated Results of the GRIFFIN Trial in Multiple Myeloma