Influence of Continuing Medical Education On the Utilization of Combined Proteasome Inhibitor/Immunomodulatory Agent Induction Therapy and Cytogenetic Information for Multiple Myeloma by US Healthcare Professionals
Authors: Fagerlie Sara , Heintz Alison , Haas Maureen , Stacy Tina B 
Published: October 2019

Abstract
Abstract 4707
Over the past 15 years, optimal treatment for multiple myeloma (MM) has undergone dramatic changes. Novel therapies have led to unprecedented response rates and improved survival. Active therapies are now being combined with good efficacy; however, combination therapy often alters the toxicity profile as well as therapy options at relapse. Because there are a number of active regimens for newly diagnosed MM, healthcare professionals must stay abreast of the most current information in order to make optimal patient care decisions. An interactive, case-based education series focusing on MM treatment was conducted at hospitals, medical centers, cancer centers, medical practices, and community dinner venues throughout the United States. The target audience for this program was hematologists, hematologist-oncologists, medical oncologists, oncology specialty pharmacists, and allied healthcare professionals charged with the care of patients with MM. From April 2010 to November 2011, 94 live 1-hour education activities were implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) and Accreditation Council for Pharmacy Education (ACPE). After the initial 69 activities, which educated 1360 healthcare professionals including 809 physicians, outcomes assessments were expanded. The remaining 25 activities reached 440 healthcare providers including 256 physicians. Practice pattern, knowledge, and competence were assessed via case vignettes prior to and immediately following each educational activity using an audience response system. Case vignette surveys completed 6 weeks following each activity evaluated practitioner performance. The median number of responses per question for the first 69 activities was 413 at baseline, 223 immediately following each activity, and 44 at 6 weeks. For a young ISS stage III patient with few comorbidities and normal cytogenetics, practitioners favored induction therapy combining a proteasome inhibitor and immunomodulatory agent, with 56% of practitioners selecting either a thalidomide/bortezomib- or lenalidomide/bortezomib-based regimen at baseline. Preference for combination therapy increased after the educational activity to 75% (+19% shift). The majority favored a bortezomib/lenalidomide-based treatment plan (45% at baseline and 67% post-education). Subgroup analysis found a similar trend for the physician target audience with 45% of physicians at baseline and 67% immediately following the education selecting a lenalidomide/bortezomib-based regimen. Follow-up at 6 weeks found 68% of respondents opted for a combined regimen. For the final 25 activities, the case vignette was altered from normal cytogenetics to t(4;14), and participants were asked a series of questions on cytogenetics and MM treatment. For the t(4;14) patient, baseline use of a combined lenalidomide/bortezomib regimen was similar to the first 69 activities (48% for total audience, 49% for physicians). Upon education 84% of the total audience and 76% of physician opted for a lenalidomide/bortezomib-based regimen. The majority of practitioners (81% of the total audience and 82% of physicians) reported that cytogenetic information affected their treatment approach, and 94% were able to identify high-risk cytogenetics. When asked to select induction therapy for an elderly transplant-ineligible MM patient with comorbidities, there was little consensus and education did not result in a significant change in practice pattern. The most commonly identified barrier to applying activity content into clinical practice was treatment side effects. Overall, these data suggest that among community practitioners, combination induction therapy with a proteasome inhibitor and immunomodulatory agent is preferred for a young transplant eligible patient and cytogenetic information is being incorporated into treatment selection. Education of current data impacts treatment selection, increasing the number of practitioners selecting combination therapy. Treatment of frail elderly patients remains a challenge. Practice patterns varied for elderly MM before and after the educational activity. Participants identified treatment side effects as the most common barrier, and further education on the management of these side effects, especially in elderly MM, is needed.

Disclosures:
Fagerlie: Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Heintz:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Haas:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding. Stacy:Onyx Pharmaceuticals, Inc: Research Funding; Celgene Corporation: Research Funding; Millennium: The Takeda Oncology Company: Research Funding.