Seminars in oncology最新文献

{"title":"Practical guidance for new multiple myeloma treatment regimens: A nursing perspective","authors":"Monica Epstein ,&nbsp;Candis Morrison","doi":"10.1053/j.seminoncol.2022.01.010","DOIUrl":"10.1053/j.seminoncol.2022.01.010","url":null,"abstract":"<div><p><span>As is the case for solid tumors<span>, treatment paradigms have shifted from non-specific chemotherapeutic agents towards novel targeted </span></span>drugs<span> in the treatment of patients with multiple myeloma<span><span><span> (MM). Currently, multiple targeted therapies are available to treat patients augmenting the arsenal of modalities which also includes chemotherapy, </span>immunotherapy, radiation therapy, </span>hematopoietic stem cell transplantation (HSCST) and chimeric antigen T-cell therapy (CAR-T). These novel, targeted agents have dramatically increased optimism for patients, who may now be treated over many years with successive regimens. As fortunate as we are to have these new therapies available for our patients, this advantage is juxtaposed with the challenges involved with delivering them safely. While each class of agents has demonstrated efficacy, in terms of response rates and survival, they also exert class effects which pose risks for toxicity. In addition, newer generation agents within the classes often have slightly different toxicity profiles than did their predecessors. These factors must be addressed, and their risks mitigated by the multidisciplinary team. This review presents a summary of the evolution of drug development for MM. For each targeted agent, the efficacy data from pivotal trials and highlights of the risks that were demonstrated in trials, as well as during post-marketing surveillance, are presented. Specific risks associated with agents within the classes, that are not shared with all new class members, are described. A table presenting these potential risks, with recommended nursing actions to mitigate toxicity, is provided as a quick reference that nurses may use during the planning, and provision, of patient care.</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10677355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining genomic events involved in the evolutionary trajectories of myeloma and its precursor conditions","authors":"Monika Chojnacka ,&nbsp;Benjamin Diamond ,&nbsp;Ola Landgren ,&nbsp;Francesco Maura","doi":"10.1053/j.seminoncol.2022.01.006","DOIUrl":"10.1053/j.seminoncol.2022.01.006","url":null,"abstract":"<div><p>All patients with a diagnosis of multiple myeloma<span><span> (MM) have a preceding, asymptomatic expansion of clonal plasma cells, clinically recognized as monoclonal gammopathy of undetermined significance or smoldering multiple </span>myeloma<span> (SMM). While most patients with monoclonal gammopathy of undetermined significance have a very small rate of progression, SMM is a widely heterogeneous condition where a fraction of patients will progress to symptomatic MM rather quickly, while others will experience an indolent clinical course. The differentiation between progressive and stable precursor condition thus represents one of the most important unmet clinical needs in the MM community. The ability to identify patients at high-risk of progression before major clonal expansion and onset of end-organ damage would enable strategies for early prevention and perhaps more effective intervention. All proposed criteria to predict the progression of myeloma precursor conditions are built around indirect markers of disease burden and, therefore, are generally able to accurately identify only a small fraction of patients in whom progression to MM is already occurring. Leveraging whole genome and exome sequencing, it has been shown that patients with stable myeloma precursor conditions are characterized by either absence or lower prevalence of distinct genomic events that are detectable in progressive precursor condition years before the progression. In this review, we discuss evolving genomic concepts and tools; and their ability to differentiate myeloma precursor conditions into two distinct entities: one benign (monoclonal gammopathy of benign significance) and another malignant (asymptomatic multiple myeloma).</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10588800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOC","authors":"","doi":"10.1053/S0093-7754(22)00018-5","DOIUrl":"https://doi.org/10.1053/S0093-7754(22)00018-5","url":null,"abstract":"","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0093775422000185/pdfft?md5=7b91ad8d484ec113df505b63dc6b5aee&pid=1-s2.0-S0093775422000185-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136458851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing natural killer cells for the treatment of multiple myeloma","authors":"Joseph A. Clara,&nbsp;Richard W. Childs","doi":"10.1053/j.seminoncol.2022.01.004","DOIUrl":"10.1053/j.seminoncol.2022.01.004","url":null,"abstract":"<div><p>Multiple myeloma (MM) is hematologic malignancy that is associated with profound immune alterations. Myeloma cells are susceptible to killing by natural killer (NK) cells but acquire the ability to elude NK cell surveillance by avoiding recognition and suppressing NK cell function. Major advances in the treatment of multiple myeloma have been achieved by effective new drugs that redirect NK cells and enhance their function. Despite significant progress, myeloma remains incurable and novel treatment approaches are required. Strategies to take advantage of the intrinsic antitumor properties of NK cells to treat MM represent a novel immunotherapeutic approach. One such strategy is adoptive NK cell therapy that consist of infusions of NK cells that have been propagated ex vivo. Adoptive NK cell therapy encompasses contemporary genetic engineering strategies such as chimeric antigen receptor (CAR)-engineered NK cells. An alternative approach involves the use of pharmacologic agents to enhance NK cell activity against myeloma. NK cell-modulating therapies can be used to bolster the function of endogenous NK cells or to enhance the efficacy of adoptively infused NK cells. Here, we review the mechanistic complexities influencing NK cell activity in MM and highlight a variety of innovative NK cell-based strategies being developed for the treatment of MM.</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0093775422000057/pdfft?md5=238aee36cdb90f95b5fe550e80d3bbda&pid=1-s2.0-S0093775422000057-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39769766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current perspectives, guiding lights to the future, and transforming care for patients with multiple myeloma","authors":"Dickran Kazandjian MD","doi":"10.1053/j.seminoncol.2022.03.004","DOIUrl":"10.1053/j.seminoncol.2022.03.004","url":null,"abstract":"","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49050222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Off-the-shelf” immunotherapies for multiple myeloma","authors":"Turab Mohammed ,&nbsp;Sham Mailankody","doi":"10.1053/j.seminoncol.2022.01.001","DOIUrl":"10.1053/j.seminoncol.2022.01.001","url":null,"abstract":"<div><p>Over the past couple of decades, the life expectancy of patients with multiple myeloma<span> (MM) has progressively increased, however, the disease per se remains incurable. This has resulted in a subset of the patient population who have progressed despite multiple standard treatment<span> options but remain amenable for novel therapies to achieve durable remission. With the discovery of the role of B-Cell Maturation Antigen (BCMA) in the pathogenesis of MM, strategies targeting the BCMA have been the focus of many treatment modalities in development. Although autologous CAR-T cell therapy has shown an overall efficacy of &gt;80% across various phases of studies, it has its own set of limitations and challenges. There is now an increasing focus on identifying novel therapeutic targets for multiple myeloma and developing “off-the-shelf” immunotherapeutic approaches for treatment of MM. This review discusses and highlights the emerging data from various ongoing trials on “off-the-shelf” approaches like antibody-drug conjugates, bispecific antibodies, and allogeneic cellular therapies demonstrating feasibility, acceptable safety, and promising preliminary efficacy. Ongoing and future efforts will need to focus on comparative effectiveness of these different approaches, possible combination strategies, and ensuring equitable and affordable access to these therapies globally.</span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39892006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The knowns and unknowns of disparities, biology, and clinical outcomes in Hispanic and Latinx multiple myeloma patients in the U.S.","authors":"Lauren C. Peres ,&nbsp;Doris K. Hansen ,&nbsp;Francesco Maura ,&nbsp;Dickran Kazandjian","doi":"10.1053/j.seminoncol.2022.01.011","DOIUrl":"10.1053/j.seminoncol.2022.01.011","url":null,"abstract":"<div><p><span>Multiple myeloma<span> (MM) is a plasma cell malignancy that accounts for approximately a tenth of all </span></span>blood cancers<span><span><span>. The last two decades, have witnessed considerable improvement in survival rates driven by a better understanding of the biology of MM and the development of novel therapies to treat MM. Despite these advancements, MM remains an incurable disease. Marked disparities exist by race and ethnicity for MM, particularly a higher incidence and an earlier age of onset of MM among Non-Hispanic Black and Hispanic and Latinx individuals compared to Non-Hispanic Whites. Inequities in receipt and time to utilization of novel therapies and </span>stem cell transplantation as well as participation in </span>clinical trials<span> have also been observed for Non-Hispanic Black and Hispanic and Latinx patients with a diagnosis of MM compared to Non-Hispanic White patients, yet Non-Hispanic Black patients have slightly better survival rates compared to Non-Hispanic White and Hispanic patients with MM. Most of the ongoing work to characterize and elucidate causes of these racial and ethnic disparities in MM etiology, outcomes, and treatment response compares Black and Non-Hispanic White individuals, with the Hispanic and Latinx population vastly understudied. Here, we provide an overview of the current state of knowledge on racial and ethnic differences in the epidemiology<span>, biology, and clinical outcomes of patients with MM, with a special emphasis on Hispanic and Latinx individuals. We additionally discuss potential opportunities to consider for disparities research that includes Hispanic and Latinx patients with MM. Despite the encouraging progress in the study of health disparities in MM thus far, our review highlights the critical gaps that still remain to better understand MM in diverse populations and to develop more effective tools and approaches to provide all patients diagnosed with MM meaningful and transformative care.</span></span></span></p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46066975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining health related quality of life outcomes in multiple myeloma: Past and future perspectives","authors":"Gil Hevroni ,&nbsp;Neha Korde","doi":"10.1053/j.seminoncol.2022.01.002","DOIUrl":"10.1053/j.seminoncol.2022.01.002","url":null,"abstract":"<div><p><span><span>Multiple myeloma<span> (MM) is a complex hematological malignancy. Advances in therapy over the last decade have resulted in significant improvement in overall survival for patients with a diagnosis of MM, leading to a substantial number of older people living with the disease. However, patients continue to suffer from a multitude of debilitating symptoms that can significantly affect their </span></span>quality of life<span><span>, a problem that especially can impact patients with MM considered in the geriatric age group. In the first part of our review, we reflect on traditional measurement tools that are used to assess health related quality of life </span>in patients<span> living with MM, as they undergo different types of treatment regimens. In the second part, we discuss the potential role of the Internet of Medical Things in tracking and actively enhancing health related quality of life in patients with a diagnosis of MM. We conceptualize models of passive and active digital </span></span></span>health technology platforms that are posed to transform the patient-physician relationship in the new era of advanced care.</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39777037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The emerging importance and evolving understanding of clonal hematopoiesis in multiple myeloma","authors":"Christin B. DeStefano ,&nbsp;Steven J. Gibson ,&nbsp;Adam S. Sperling ,&nbsp;Paul G. Richardson ,&nbsp;Irene Ghobrial ,&nbsp;Clifton C. Mo","doi":"10.1053/j.seminoncol.2022.01.009","DOIUrl":"10.1053/j.seminoncol.2022.01.009","url":null,"abstract":"<div><p>Multiple myeloma (MM) is the second most common hematologic malignancy diagnosed in the United States. With a growing arsenal of novel therapies, patients are living longer and hence are at increased risk of secondary cancers such as myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). While MDS-associated cytogenetic abnormalities have been described in patients with a diagnosis of for decades, clonal hematopoiesis (CH) has been described only recently. CH has been shown to correlate with inferior survival in MM due to increased risk of disease progression in patients who are treated with high-dose melphalan without lenalidomide maintenance. When involving specific high-risk genes, multiple genes, or when present at high variant allelic frequencies, CH could also potentially elevate the risk of secondary MDS and/or AML, cardiovascular events, and venous thromboembolic events. Despite growing knowledge about CH in patients with MM, many questions remain unanswered. Further studies are needed to better understand the prognostic and therapeutic significance of CH in MM and its precursor conditions, as well as the effect of specific treatments on long-term outcome.</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0093775422000094/pdfft?md5=7ddefe685d3d9f0fd3587c07d07286f1&pid=1-s2.0-S0093775422000094-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39580105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Daratumumab: A review of current indications and future directions","authors":"Elizabeth Hill MD ,&nbsp;Candis Morrison CNP, PhD ,&nbsp;Dickran Kazandjian MD","doi":"10.1053/j.seminoncol.2022.01.008","DOIUrl":"10.1053/j.seminoncol.2022.01.008","url":null,"abstract":"<div><p><span><span><span>Daratumumab<span>, a human IgG1 kappa </span></span>monoclonal antibody<span> targeting CD38<span> has transformed the treatment paradigm of </span></span></span>multiple myeloma<span> (MM). With the identification of CD38 as a crucial receptor involved in immune system function, it became an ideal target for monoclonal antibody (mAb) </span></span>drug development in MM. Daratumumab's unique multifaceted mechanism of action has led to great success in the treatment of relapsed refractory multiple myeloma (RRMM) as well as newly diagnosed multiple myeloma (NDMM) patients. Along with its efficacy comes a low toxicity profile, improved further with the introduction of subcutaneous daratumumab. With such success within MM, daratumumab is now being explored in other disease states. This article will review daratumumab's drug development, practical use, and future potential indications.</p></div>","PeriodicalId":21750,"journal":{"name":"Seminars in oncology","volume":null,"pages":null},"PeriodicalIF":4.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39938443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}