Jennifer Gershman, PharmD, CPh

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 (MCL) is a rare B-cell non-Hodgkin lymphoma blood cancer that can be fast or slow growing, and about 

 individuals are diagnosed with the condition each year. Tumor cells originally come from the “mantle zone” of the lymph node, and MCL is usually diagnosed as a late-stage disease that has spread to the gastrointestinal tract and bone marrow. Here are three updates you should know about MCL.

Investigational novel drug class may help treat MCL

 revealed that small molecule inhibitors of the SOX11 oncogene are toxic to MCL tumor development in human cells studied outside the body.“The SOX11 protein, which is expressed in up to 90% of mantle cell lymphoma patients, is an attractive target for therapy,” study author Samir Parekh, MD, professor of medicine, Icahn School of Medicine at Mount Sinai, said in a 

Real-world data show bendamustine-rituximab (BR) is the most commonly used first-line treatment in patients with MCL treated in community-based U.S. practices.

, Peter Martin, MD, of Weill Cornell Medicine presented the results from a retrospective real-world study from a cohort of 3,455 patients using data from a nationwide electronic health record database to identify first-line treatment patterns and outcomes. The study included data from adult MCL patients diagnosed between January 2011 and November 2020, and 85.3% were from a community oncology setting. The 

 standard of care in younger patients with advanced MCL is chemoimmunotherapy with or without autologous stem-cell transplantation (SCT). BR, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) are recommended for older patients. The retrospective study revealed that BR was the most commonly used first-line treatment and SCT was not commonly used even in patients under 65 years. Older age and high-risk disease features were indicative of worse health outcomes. “Real-world treatment patterns did not necessarily mimic recommendations based on clinical trials,” said Martin in a 

.It is important to keep in mind that retrospective studies show associations but are not designed to prove causation like prospective clinical trials.

Updated NCCN patient guidelines for MCL published

 for MCL, which are written in consumer friendly language for patients. The guidelines include expanded information on the pathology and development of MCL, updated details on diagnostic tests, revised chapters on early and advanced MCL, and a new section on clinical trials. These guidelines provide MCL patients with a useful tool for shared decision making.

Articles

New research and updated treatment guidelines add to knowledge base on this rare blood cancer. 

3 Updates on Mantle Cell Lymphoma 

The American Urological Association (AUA) recently published a 

 supporting the use of Advanced Practice Providers (APPs) in caring for patients with genitourinary disease to improve access to care. There is a workforce shortage of 65,000 physicians projected for primary care and specialty medicine by 2025, and APPs could meet up to 70% of patient needs in clinical practice. Additionally, the supply of physician assistants (PAs) and advanced practice registered nurses (APRNs) are expected to continue increasing.

According to the AUA Census, 72.5% of urologists used an APP in their practice and these healthcare providers performed a variety of procedures such as a cystoscopy (procedure examining bladder lining), which assists in the diagnosis of bladder cancer. Evidence shows that patients have demonstrated a growing acceptance of APPs in urology practice settings.

The white paper discusses that most APPs usually work in general urology, and APRNs are more likely than PAs to practice in urology specialty areas such as oncology. Collaborative models involve an APP working with one or more physicians to deliver healthcare services that are supported by jointly developed protocols and practice guidelines. This partnership can also aid in improving workflow and enhancing patient care. The AUA Education Council identified urologic oncology as one of the 6 topic areas to develop training modules for APPs.

APP compensation is also discussed in the white paper through the following 4 payment methods to consider:

Annual base salary: payment based on job description of clinical role

Annual base salary plus productivity bonus: guaranteed salary plus additional payment based on agreed upon calculated amount

Percentage of net receipts: payment based on amount billed minus accounts received minus overhead

Hourly rate: payment based solely on hours worked

APPs can also play an important role in patient care through telehealth through virtual visits after an initial consultation with the urologist. Additionally, telesurgical streaming can enable APPs to virtually scrub in for surgeries for patients they will be providing postoperative care. This also provides valuable training experience for APPs and critical information for the patient’s recovery process.

According to the American Urological Association, 72.5% of urologists used Advanced Practice Providers in their practice and these healthcare providers performed a variety of procedures such as a cystoscopy (procedure examining bladder lining), which assists in the diagnosis of bladder cancer. Evidence shows patients have demonstrated a growing acceptance of APPs in urology practice settings.

Integrating Advanced Practice Providers into Oncology Settings for Managing Urothelial Cancer

The Leukemia & Lymphoma Society (LLS) recently launched an innovative 

Influential Medicine Providing Access to Clinical Trials (IMPACT)

 research grants program to increase access to clinical trials for underserved patients with blood cancers.

“To get the full benefit of cancer research, we need clinical trials to reflect the diversity of the U.S. population. But this is also about health equity, which is central to the LLS mission. Blood cancer does not discriminate, and people of every age, gender, ethnicity, and socioeconomic status are affected and deserve the same choices in their care,” said Lee Greenberger, Ph.D., LLS chief scientific officer in a 

The IMPACT research grants award funding as a $3.75 million five-year program to establish a “hub and spoke” infrastructure with clinical trial sites in local community-based hospitals and clinics with underserved populations. Mayo Clinic in the upper Midwest, Vanderbilt University Medical Center in the rural south, and Weill Cornell Medicine in New York City will receive the first round of funding for blood cancer research.

The Mayo Clinic Center program will address major barriers to clinical trial enrollment for minority patients with blood cancer and focus on economically disadvantaged minorities in urban areas. Vanderbilt University Medical Center will offer the option to enroll in 10 clinical trials across seven blood cancer types. In addition to expanding clinical trial access, Weill Cornell Medicine will provide education and training for community physicians and oncologists.

, healthy equity is defined as “the attainment of the highest level of health for all people.” LLS has played an integral role through multiple advocacy efforts toward health equity for all blood cancer patients. 

 is a community-based outreach and education program for African American communities that provides free myeloma information and support to enhance access to care and the latest treatment options. Black Americans have twice the incidence of myeloma as white Americans. Additionally, Black Americans are less likely to receive the latest therapies and more likely to experience delays in treatment, which ultimately leads to worse health outcomes.

LLS staff and volunteers in 13 Black communities across the United States provide free resources to enhance patient care. More than 30,000 individuals have received care through more than 250 educational programs as part of Myeloma Link. Outreach is provided through partnerships with a variety of community and faith-based organizations such as churches, senior centers, and libraries. Healthcare provider-led patient education programs focus on resources for patients, families, and caregivers, and individuals are connected to specialists.

The Leukemia & Lymphoma Society is providing grants to increase trial enrollment of ethnic and racial minorities.

Increasing Access to Blood Cancer Clinical Trials

Healthy People 2030 defines health disparities as “a particular type of health difference that is closely linked with social, economic and/or environmental disadvantage.” Reducing disparities has come into particular focus because of the COVID-19 pandemic and its disproportionate effects.

Shaakir Hasan, DO, and his colleagues recently conducted a study that evaluated social disparities in the diagnosis and management of bladder cancer using the National Cancer Database to stratify cases of urothelial carcinoma by the National Comprehensive Cancer Network guidelines. They presented their results as the American Society of Clinical Oncology’s 2021 Genitourinary Cancers Symposium. There were 331,714 (76.3%) early, 72,154 (16.6%) muscle invasive, 15,579 (3.6%) locally advanced, and 15,161 (3.5%) metastatic cases identified. The study revealed that the two strongest predictors of diagnosis made at later stages were being Black and of the female gender

Additionally, Black patients and individuals of the female gender also had reduced survival rates. Other factors that predicted later diagnosis included older age, Medicaid insurance and residing in lower-income/less educated/ more rural areas. It is critical to take an interdisciplinary team approach to managing patients with urothelial cancer that includes physicians, nurses, pharmacists, and social workers. This approach should be integrated with a patient-centered model of care that involves shared decision-making to ensure that individuals are empowered to be involved in their disease management. 

The Institute of Medicine (IOM) evaluated the differences in the types and quality of healthcare received by U.S. racial and ethnic minorities and nonminorities. The IOM report revealed that there are racial and ethnic disparities in healthcare, and they are associated with worse health outcomes. It is important to eliminate these disparities through an interdisciplinary approach that involves increasing awareness among the public, healthcare providers and other key stakeholders. 

Other recommendations include promoting consistent and equitable care using evidence-based clinical practice guidelines, structure payment systems to ensure there is an adequate supply of services to minority patients, support the use of interpretation services, and implement patient education programs to enhance knowledge of how to access care and participate in treatment decisions.

Researchers identified being Black and of the female gender as the strongest predictors of late-stage diagnosis.

Jennifer Gershman, PharmD, CPh

Articles

3 Updates on Mantle Cell Lymphoma

Integrating Advanced Practice Providers into Oncology Settings for Managing Urothelial Cancer

Increasing Access to Blood Cancer Clinical Trials

Tackling Healthcare Disparities for Urothelial Cancer