Patrick M. Brunner, MD, associate professor, dermatology, director, Cutaneous Lymphoma Clinic, The Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai, discusses how collaboration between dermatologists and oncologists is critical for both accurate diagnosis and selection of effective treatment approaches for patients with blastic plasmacytoid dendritic cell neoplasm (BPDCN). Brunner also shares how future research on the characterization of tumor cells may help further clarify and improve the treatment of patients with this rare disease.

Brunner on the Role of the Dermatologist in BPDCN Diagnosis and Treatment

BPDCN is typically characterized as a rare and aggressive hematologic malignancy and is known to affect other organs such as the skin, Brunner begins. Accordingly, a majority of patients with BPDCN often display variable skin involvement, including bruise-like or tumor-like lesions. Dermatologists are often responsible for initial diagnosis when patients first present with these symptoms in the clinic, Brunner states. If a dermatologist suspects a patient has BPDCN, they will request that they undergo a skin biopsy, Brunner adds. After this diagnosis is confirmed using histopathology, the patient will continue on to treatment under the guidance of a hematologic oncologist, he says. 

Brunner on Unmet Needs and Future Areas of Investigation in BPDCN

When considering the future treatment of patients with rare malignancies like BPDCN, it is important to increase clinicians’ knowledge of disease biology and characterization through research, Brunner says. Although this may not directly affect the treatment of current patients with BPDCN, increasing such knowledge of the disease may inform and clarify treatment for future patients. Moreover, enrolling patients in clinical trials will not only help maximize the efficacy of currently available treatment options, but aid in the development of novel treatment approaches, Brunner concludes.

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Patrick M. Brunner, MD, discusses how collaboration between dermatologists and oncologists is critical for both accurate diagnosis and the selection of effective treatment approaches for patients with blastic plasmacytoid dendritic cell neoplasm.

Dr Brunner on the Role of the Dermatologist in BPDCN Diagnosis and Treatment

Matthew Brunner, MD, assistant professor, hematologic specialist, medical oncology, and palliative care, Department of Medicine, University of Wisconsin Carbone Cancer Center, discusses how the phase 2 BMT CTN 1902 trial (NCT05032820) of anti-BCMA CAR T-cell therapy will attempt to address an area of unmet need in multiple myeloma.

In the field of multiple myeloma, there is significant interest in investigating novel strategies for the management of patients who do not respond to initial therapy, Brunner begins. Previous research has shown that the use of maintenance therapy in patients who respond to first-line induction therapy and autologous stem cell transplant (ASCT) can sustain remission for several years, Brunner states. However, patients who do not achieve remission with this approach lack sufficient alternatives, Brunner says.

The multicenter, single-arm, BMT CTN 1902 trial was designed to address this unmet need by evaluating the use of consolidative CAR T-cell therapy in patients who achieve very good partial responses or worse within 12 months of standard ASCT and lenalidomide (Revlimid) maintenance therapy, Brunner introduces. Patients included in the study are between 18 and 71 years of age and should have not experienced disease progression after initial systemic therapy was administered. 

As this population has not been previously treated with an intensive approach, investigators hope to achieve deeper, more durable responses after up-front ASCT with more robust lymphocytes, Brunner explains.

The trial’s primary objective is to determine the efficacy of BCMA-directed CAR T-cell therapy in this population, Brunner states. 

Additionally, there are long-term toxicities associated with CAR T-cell therapy that can affect a patient’s response to treatment, Brunner adds. Therefore, the trial will also assess the frequency and severity of treatment-related adverse effects, including cytokine release syndrome, immune cytopenias, and neurotoxicity, Brunner concludes. The trial is currently open to enrollment.

Matthew Brunner, MD, discusses how the phase 2 BMT CTN 1902 trial of anti-BCMA CAR T-cell therapy will attempt to address an area of unmet need in multiple myeloma.

Dr. Brunner on the Use of CAR T-cell Therapy to Improve Post-ASCT Responses in Multiple Myeloma  

Matthew Brunner, MD, assistant professor, hematologic specialist, medical oncology, and palliative care, Department of Medicine, University of Wisconsin Carbone Cancer Center, discusses how to best approach the navigation of advanced imaging modalities in relapsed/refractory multiple myeloma.

The increasing use of advanced imaging techniques has expanded treatment selection in relapsed/refractory multiple myeloma, Brunner begins. Several studies have investigated the comparative utility of novel vs standard techniques in this space, including the phase 3 IMAJEM trial (NCT01309334), Brunner details. This prospective trial compared the efficacy of MRI imaging vs [18F]Fluorodeoxyglucose PET computed tomography (CT) scans with respect to their detection of bone lesions at diagnosis, as well as their ability to predict patient response to subsequent maintenance therapy. There was no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI, indicating that both options are effective and comparable, Brunner states. However, PET-CT was shown to have substantial prognostic value.

PET-CT imaging is the current imaging standard of care (SOC) for patients with relapsed/refractory multiple myeloma due to its ability to detect extramedullary disease and PET-avid disease, Brunner continues. Both features are highly prevalent in this disease space, he notes. Additionally, PET-CTimaging can be utilized as a marker of patient responses during treatment. Tracking improvements in imaging can add to or supplement other common indicators of response such as serologic markers, biomarkers, and decreased anemia, Brunner says.

Conversely, MRI functional imaging has evolved to utilize diffusion weighting, and novel PET-MRI scans are also an option, Brunner states. This modality is more sensitive in certain applications and can provide a better anatomic picture, he explains. Patients who may have structural issues and need radiation or surgery are more easily identified with this technique, Brunner adds.

In terms of prognostic value, PET-CT scans can predict a patient's likelihood of late-line relapse, Brunner says. Moreover, PET-CT scans can help identify key patient characteristics that are associated with benefit from a given treatment, in turn, informing treatment selection, he states. This includes factors such as a high-risk, asymptomatic lesion, which would require immediate radiation or surgical fixation before treatment could be initiated, Brunner concludes.

Matthew Brunner, MD, discusses how to best approach the navigation of advanced imaging modalities in relapsed/refractory multiple myeloma.
 

Patrick M. Brunner, MD

Articles

Dr Brunner on the Role of the Dermatologist in BPDCN Diagnosis and Treatment

Dr. Brunner on the Use of CAR T-cell Therapy to Improve Post-ASCT Responses in Multiple Myeloma

Dr. Brunner on the Utilization of Advanced Imaging Modalities in R/R Multiple Myeloma