ASH News Daily 2016 - Issue 1 - A-3

Saturday, December 3, 2016

ASH News Daily

Page A-3
®

M U LT I P L E M Y E L O M A

Breaking Waves In California: Novel Immunotherapy for Myeloma
By R. Frank Cornell, MD, MS

early every clinic day, one of
my patients will ask "what's
the status of immunotherapy for myeloma?" It seems that patients intuitively know that the next
pillar of multiple myeloma (MM)
therapy will be unlocking and harnessing the power of the immune
system. The scientific session entitled "New and Emerging ImmuneBased Approaches" sponsored by
the Scientific Committee on Plasma
Cell Neoplasia, which will take place
today at 2:00 p.m. in Ballroom 20AB
and Sunday at 9:30 a.m. in Room 29,
of the San Diego Convention Center
will provide the answers your patients are looking for. This session
will highlight several methods by
which the immune system is empowered to attack myeloma cells.
This approach has the potential to
radically change the treatment options for myeloma in coming years.
This session will cover three important immunotherapy modalities.
First, Dr. Ivan Borrello will discuss
vaccine therapy and adoptive cell
therapy: the process of removing a
patient's immune cells, engineering
them in the lab, and then reinfusing
back into the patient to fight myeloma. Next, Dr. Fabio Malavasi will
review the basic science of anti-CD38

therapy. Finally, Dr. James Kochenderfer will discuss the status of chimeric
antigen receptors/genetically modified T-cells (CAR T-cell therapy) in
the fight against myeloma.
Many may recall the headlines of
mega-doses of measles vaccine being
used to treat myeloma, a treatment
known as oncolytic virotherapy. Dr.
Borrello's research will provide keen
insight into how dramatically antimyeloma therapy has evolved over
the past several decades. His presentation will discuss the potential integration of immune-based therapies
for myeloma management. Some
potential vaccine therapeutic approaches include fusion of dendritic
cells, which serve as the most effective antigen presenting cells, with
patient specific myeloma cells. Another potential approach is vaccines
using cancer testis antigens (CTAs).
CTAs have low expression in normal tissue but are highly expressed
in cancer making them an ideal target. Finally, the ability to produce
sufficient quantities of vaccine has
hampered mainstream use of vaccine-based therapy. However, the
GM-CSF-based vaccine Myeloma
GVAX is one method to potentially
overcome this obstacle. It will be
of interest to learn about this, other
potential barriers to routine implementation of vaccine-based therapy,

and some potential solutions to these
barriers.
Dr. Malavasi has been studying the
biology of CD38 since long before it
became a therapy target for myeloma.
Anti-CD38 therapy is now approved
by the U.S. Food and Drug Administration for treatment of myeloma. One
interesting biological feature is that
this treatment has multiple mechanisms of action, at least some of which
involve the immune system. Attendees can look forward to learning more
about these mechanisms and how
they have resulted in an exciting and
promising therapy for the treatment
of MM. Understanding the immune

system components that become engaged to target myeloma will be of
importance. It will also be interesting
to hear about how myeloma cells can
become resistant to this form of therapy. Understanding these mechanisms
can serve as a platform and rationale
for developing combination therapies to further augment response and
overcome resistance. The session will
cover the mechanisms of anti-CD38
therapy rather than providing clinical trial updates. To learn more about
some exciting clinical updates, plan
to attend session #653 Monday at
»» IMMUNOTHERAPY Page A-22

Attendees participate in a discussion during Friday's Training Program
Directors Workshop.

H E A LT H - C A R E Q U A L I T Y

HIT Me with Your Best Shot
By Aaron T. Gerds, MD, MS

hile for some of us attending the ASH annual meeting, the acronym "HIT"
conjures up memories of the inpatient consultative service and the
4Ts score. For others, it represents an
increasingly cited source of stress in
everyday practice: Health Information Technology. Death by a thousand clicks, right? Whether friend or
foe, information technologies hold
enormous potential for transforming
the health-care delivery system. Except how can the potential of this real
tough cookie be realized?
Medicine remained largely untouched by the revolution that swept
nearly every other aspect of modern
life. However, in 2001, a key finding
of an Institute of Medicine report,
"Crossing the Quality Chasm: A
New Health System for the 21st Century," shined a spotlight on this opportunity. Since then, HIT has been a
key component of subsequent legislation, notably the American Recovery and Reinvestment Act of 2009,
as well as the Affordable Care Act.

The result has been a widespread
implementation of HIT into clinical practice. Nonetheless, this effort
has not been without its challenges.
First, healthcare is incredibly complex compared with other industries
and sectors of the economy. Moreover, widespread adoption of many
information technology applications
also requires behavioral adaptation
by clinicians, organizations, and patients.
When we focus too heavily on
the "trees" that are shooting up with
implementing HIT into practice, it
is sometimes difficult to see if the
"forest" is forming as originally intended. While it is intuitive that HIT
can improve knowledge, communication, and efficiency (and therefore
the overall quality of healthcare) the
evidence that HIT improves important health-related outcomes is limited. This afternoon, during the Special Symposium on Quality, "Quality
of Care in the Era of Health Information Technology," (2:00 p.m., Room
33, San Diego Convention Center),
Dr. Hardeep Singh will lead off
the discussion by trying to answer

that question. Then Dr. Douglas W.
Blayney will show us how we can
use HIT already employed at our
institutions, effectively in quality
outcomes research. Lastly, Dr. Doris
Howell will outline strategies to use
HIT to improve patient experience.
Both session co-chairs, Drs. Vishal
Kukreti and Anita Rajasekhar, were
all too thrilled to weigh in on future implications for paper systems.
"Once you have moved in this direction," noted Dr. Kukreti, "I don't
think anyone would be willing to go
back to a completely paper system."
Dr. Rajasekhar agrees and also
urges us to remain realistic. "The
conversation needs to begin with
how our old paper systems have
hindered providing quality care and
what electronic heath records can do
to improve that. Electronic health
records will not be a panacea either.
The human aspect of assimilating
health information and delivering
health care will always be critical,"
she says, adding, "We know that
patient noncompliance to treatment
plans is partly due to disengagement. By getting patients intimately

involved in their own healthcare, I
hope this will stimulate better communication
between
providers
and patients, and ultimately, better
health-care outcomes."
Increased patient involvement is
one of the more exciting facets of HIT
now being developed. As Dr. Kukreti explains, "This is an area that patients are actively participating in,
they are using wearable devices,
willing to share their data, want full
access to health records, and there is
a growing value to patient generated
data."
"Hit me with your best shot!" is
an exclamation of self-confidence in
the face of all manner of difficulty.
And despite the difficulties of incorporating HIT into our everyday
practices, the Special Session on
Quality tomorrow promise to looks
to not only examine how HIT can be
used to improve health care quality,
but also to enhance patient-provider
shared decision-making, and facilitate efforts in quality research.
Dr. Gerds indicated no relevant conflicts of interest.

Table of Contents for the Digital Edition of ASH News Daily 2016 - Issue 1