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Objective: Relapsed/refractory multiple myeloma (MM) has poor outcomes, especially in heavily pretreated patients. Limited data exists on the use of novel therapies in MM patients with renal dysfunction. This case series describes the successful initiation of teclistamab in four patients with heavily pre-treated MM on hemodialysis (HD). Data Sources: The medical records of four adult MM patients on HD who received teclistamab were retrospectively reviewed. Data Summary: All patients completed teclistamab step-up dosing and received at least one full dose. HD runs were administered irrespective of teclistamab initiation. Patients tolerated therapy well, with only one patient experiencing grade 1 CRS, which was managed with supportive care. Conclusions: Due to the complexity of this patient population, close monitoring and multidisciplinary care are crucial. This approach is essential for effectively managing MM patients with renal dysfunction and for exploring novel treatment options. [ABSTRACT FROM AUTHOR]

Simple Summary: Induction regimens using 4-drugs for patients with newly diagnosed multiple myeloma have shown impressive results in multiple trials. However, trials of 4-drug regimens typically use a 3-drug regimen as their comparator, which limits our ability to determine whether the benefit is from the specific combination of drugs or just the addition of more agents. We performed a meta-analysis to compare all trials that compared 4-drug to 3-drug regimens and found that the addition of an anti-CD38 antibody (daratumumab or isatuximab) resulted in improved responses, while 4-drug regimens without an anti-CD38 antibody performed similarly to 3-drug regimens. While the addition of an anti-CD38 antibody led to increased adverse effects, these were predominantly mild and easily managed. These data suggest that an anti-CD38 antibody should be part of all 4-drug induction regimens for newly diagnosed myeloma patients. The use of 4-drug induction regimens for treatment naïve newly diagnosed multiple myeloma (NDMM) is associated with improved depth of response and progression-free survival (PFS). However, head-to-head trials of 4-drug combinations are lacking, and instead, these regimens are typically compared to 3-drug backbones; limiting the ability to discern whether any additional benefit (or toxicity) is simply additive or represents a synergy (or interaction). We conducted a meta-analysis of phase 2 and phase 3 clinical trials that randomized treatment naïve NDMM patients to either a 4-drug or 3-drug induction regimen. We included 11 trials which represented 6509 unique patients. PFS for all trials in the meta-analysis was 54 months with a 4-drug induction and 8.9 months with a 3-drug induction (HR: 0.49; 95% CI: 0.45; 0.54), but there was no benefit to using a 4-drug induction that did not include an anti-CD38 antibody (PFS 4-drug 8.1 months, PFS 3-drug 8.0 months; HR 0.95; 95% CI 0.86; 1.06). Adverse events were more frequent with the quadruplet regimens but were predominately mild. High-grade (≥3) adverse events (AEs) that were more common with 4-drug regimens were infections (RR: 1.34; 95% CI 1.17; 1.54) and thrombocytopenia (RR: 1.39; 95% CI 1.12; 1.74). This study suggests that 4-drug induction regimens which include an anti-CD38 antibody improve efficacy although with additional toxicity in NDMM patients. [ABSTRACT FROM AUTHOR]

Introduction: Hematology/oncology pharmacists work in various roles in healthcare systems and represent a highly skilled and valuable resource. There remains a significant challenge in the recruitment and retention of these well‐trained pharmacists. We sought to identify key factors and propose solutions to impact the ability to recruit, promote, and retain pharmacists. Methods: An initial survey in 2021 assessed the status of the oncology pharmacist workforce with regard to job satisfaction and attrition risk. Based on the top 5 factors identified in the Initial Survey, a Follow‐Up Survey was conducted in 2022 to further understand top dissatisfiers in the workplace. To address these factors, an in‐person collaborative workshop was conducted in 2023 with a focus on creating action plans around the practice model, professional development, well‐being, and metrics. Results: A total of 392 individuals participated in the Follow‐Up Survey. Most were 31–40 years of age (56%), female (70%), Caucasian (78%), and from academic medical centers (68%). Of the 367 individuals who responded to factors contributing to dissatisfaction at work, 51 of the respondents selected all five factors. The most common factor was the practice model (77%), followed by burnout/well‐being (74%), leadership (62%), professional development (56%), and metrics (32%). At the workshop, teams worked collaboratively to review detailed data, evaluate root causes, define a goal future state, and build recommendations for incremental steps to pursue progress in each of these areas. Discussion: Utilizing key information learned from both the Initial and Follow‐Up Survey, the Oncology Pharmacy Workforce Collaborative demonstrated that the key themes are interconnected and institutional support is essential in modernizing practice models, revamping professional development, creating better measures of direct and indirect patient care activities, and ensuring effective support for well‐being. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pegfilgrastim is a colony-stimulating factor used 24 to 72 hours after myelosuppressive chemotherapy to decrease the incidence of febrile neutropenia. Returning for treatment the day after chemotherapy for this injection is not always feasible or convenient for patients, and therefore, a same-day administration strategy may be preferred. Although there is an on-body injector available, the potential for mechanism failures and the cost of a brand-name drug limit its potential use. Studies examining the same-day administration of pegfilgrastim have varied in their design, and there is minimal evidence for this administration strategy in patients with breast cancer. OBJECTIVE: To compare the outcome of same-day versus next-day administration of pegfilgrastim on a composite of neutropenia-related events (NREs) in patients with breast cancer. METHODS: This retrospective, single-center, matched-cohort chart review included patients with breast cancer who completed at least 1 cycle of curative-intent chemotherapy between January 1, 2019, and October 31, 2020, at The University of Kansas Health System. The patients were matched by chemotherapy regimen and age in a 2:1 ratio for next-day and same-day administration of pegfilgrastim. The primary composite outcome of NREs was defined as having at least 1 of the following events: chemotherapy cycle delayed because of neutropenia, a dose reduction in chemotherapy as a result of neutropenia, the cancellation of planned chemotherapy cycles secondary to neutropenia, and admission to the hospital with a suspected or confirmed diagnosis of febrile neutropenia. RESULTS: A total of 87 patients were included in this study for data analysis and matching, including 58 patients who received the next-day administration of pegfilgrastim and 29 patients who received the same-day administration of pegfilgrastim. There were 6 patients who met the composite outcome in the next-day (10.3%) and same-day (20.7%) pegfilgrastim administration groups (odds ratio, 0.36; 95% confidence interval, 0.08-1.41). In all, 8 separate events occurred in the same-day pegfilgrastim group and 11 separate events occurred in the next-day pegfilgrastim group. The most frequent NRE was hospital admission for suspected or confirmed febrile neutropenia. In all, chemotherapy was cancelled for 2 cycles in the same-day pegfilgrastim cohort versus for 4 cycles in the next-day pegfilgrastim cohort. There were no cases of COVID-19 or treatment-related deaths in either group. CONCLUSION: Although the use of same-day pegfilgrastim did not significantly increase NREs and is not overtly detrimental to the patient, same-day pegfilgrastim cannot be recommended for routine use based on the results of this study. Larger, interventional studies are needed to validate this study's results to expand the use of same-day pegfilgrastim. [ABSTRACT FROM AUTHOR]

BACKGROUND: The landscape for maintenance treatment of ovarian cancer has rapidly changed in the past decade. Poly (ADP-ribose) polymerase (PARP) inhibitors are now approved for use in the first-line and recurrent maintenance settings; however, the approvals vary based on the line of therapy, agent used, and the BRCA or homologous recombination deficiency (HRD) status. Clinical trials for PARP inhibitor maintenance therapy have included very few patients with somatic mutations; therefore, comparisons among patients with germline or somatic HRD and duration of response to PARP inhibitor maintenance therapy are minimal. OBJECTIVE: To determine if germline, somatic, or no known HRD status impacted the duration of response to PARP inhibitor maintenance therapy. METHODS: This single-center, retrospective chart review was conducted to evaluate patients who received PARP inhibitor maintenance therapy from May 1, 2017, to September 1, 2020, at The University of Kansas Health System. The primary end point, time to next treatment (TTNT), was defined as the time from PARP inhibitor initiation to day 1 of subsequent chemotherapy. TTNT was used instead of progression-free survival because the duration of clinical benefit can be assessed without having the date of clinician-reported progression. RESULTS: The Cox proportional hazard model estimated restricted mean TTNT was 13 months for the patients with no known HRD versus 20.7 months for the patients with germline HRD (no known vs germline, hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.07-0.83). The estimated restricted mean TTNT was 19.5 months for the patients with somatic HRD (no known vs somatic, HR, 0.33; 95% CI, 0.12-0.89). The TTNT was not significantly different between the patients with germline HRD and the patients with somatic HRD (germline vs somatic, HR, 0.74; 95% CI, 0.17-.13). CONCLUSIONS: The patients with germline or somatic HRD had a significantly longer TTNT compared with the patients with no known HRD. The TTNT in the patients with somatic HRD was not significantly different from the patients with germline HRD. Based on these findings, patients with somatic or germline HRD who receive PARP inhibitor maintenance therapy can expect similar periods of response. [ABSTRACT FROM AUTHOR]