Providers

There are shortcomings in the ways we have approached value assessment to date, writes the executive director of the Innovation and Value Initiative.

Ibrutinib quickly became the de fact standard of care to treat chronic lymphocytic leukemia, but the high price presents a problem for the US healthcare system, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Patients had never been particularly enthusiastic about using opioids to treat their pain related to sickle cell disease, but they are more cautious now, especially as they are often meet with suspicion of addiction, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

Managing people with sickle cell disease and complex chronic pain is difficult and requires some trial and error, said C. Patrick Carroll, MD, director of psychiatric services, Sickle Cell Center for Adults, associate professor of psychiatry, Johns Hopkins Medicine.

As new therapies come to market for pediatric acute myeloid leukemia, there will be a lot of questions to answer regarding dosing and where these drugs are used in the patient journey, said Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia.

Patients with myelofibrosis can see their quality of life impacted in a range of ways with various symptoms, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Minimal residual disease (MRD) may be prevalent in clinical trials and discussed at conferences, but it is not really used widely in practice, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

While ibrutinib is a major breakthrough in treating chronic lymphocytic leukemia, it is associated with financial burdens and medical concerns for the older patients being treated, said Adam Olszewski, MD, associate professor of medicine at The Warren Alpert Medical School of Brown University.

Research has shown that fedratinib favorably impacts health-related quality of life for patients with myelofibrosis across the board, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Financial barriers and perceived implicit biases were both barriers that families of children with acute leukemia raised regarding access to care issues that might have delayed diagnosis, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia, highlights the coming advances in pediatric acute myeloid leukemia (AML) that she is the most excited for.

While minimal residual disease (MRD) has been a topic of research for at least a decade, right now it is more top of mind than ever before for people treating cancer, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Providers have an inefficient business model that’s become so deeply ingrained, they simply can’t fathom how else to do business as the industry shifts to value-based care.

Quality of life is an important end point in clinical trials, and it is important to discuss that with regulatory agencies, said Ruben Mesa, MD, director of UT Health San Antonio MD Anderson Cancer Center.

Since there are aspects of care in clinical trials that might not be mandated, research is being done to see whether there are socioeconomic disparities for things like supportive care for children with cancer, said Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco.

In research presented at the 61st American Society of Hematology Annual Meeting and Exposition, Abby Statler, PhD, MPH, MA, research associate, Cleveland Clinic, and her colleagues found that African Americans with acute myeloid leukemia (AML) may be excluded from clinical trials due to renal dysfunction, despite it having no impact on AML outcomes.

So far, minimal residual disease (MRD) has not been used much outside of clinical trials, but researchers are testing how it might be used to guide decisions in clinical practice, said Lindsey Roeker, MD, clinical fellow at Memorial Sloan Kettering Cancer Center.

The next era in treating mantle cell lymphoma will use precision medicine to target therapies in a personalized way, said Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at MD Anderson.

The terminology for smoldering myeloma has been around for decades, but more discussion over what it means and who it really applies to is needed, said C. Ola Landgren, MD, PhD, professor of medicine and chief of the Myeloma Service at Memorial Sloan Kettering Cancer.

Lena Winestone, MD, assistant professor of pediatrics at the University of California, San Francisco, explains how her research into disparities in pediatric acute myeloid leukemia (AML) may help identify the cause of those disparities and how best to intervene in order to improve outcomes for these patients.

The introduction of novel agents has really revolutionized the care of patients with chronic lymphocytic leukemia to the point where chemotherapy is rarely used, said Lindsey Roeker, MD, clinical fellow at Memorial Sloan Kettering Cancer Center.

A new sponsor will award a Massachusetts-based organization up to $25,000.

One of the challenges with treating children with acute myeloid leukemia is that many of the novel drugs are not available in children. Current treatment with chemotherapy really requires balancing increasing doses with the short-term and long-term toxicities, said Sarah Tasian, MD, attending physician in the Division of Oncology at Children’s Hospital of Philadelphia.

To avoid the toxicities associated with use of chemotherapy, there has been progress in developing and utilizing chemotherapy-free therapies to treat mantle cell lymphoma, said Michael Wang, MD, professor in the Department of Lymphoma and Myeloma at MD Anderson.

Although the pembrolizumab 8 arm of I-SPY2 did not have strong enough results to continue onto phase 3, it does provide some insights and highlights the need for precision medicine to tailor approaches to treatment, said Rita Nanda, MD, associate professor, medicine, The University of Chicago Medicine.