b'Response Rates for Waldenstrm Macroglobulinemia Improve With Use ofNew First-Line, Better-Tolerated Treatments As the number of first-line treatments for Waldenstrm Macroglobulinemia increased, older adults experienced marked improvements in survival Among older patients, median progression-free survival improved from 28.3 months in the early era to 63.3 months in the modern era, according to a new study. Younger patients, on the other hand, showed almost no improvement.By Jennifer MarquezSALTLAKECITYNotmuchisknownaboutpronounced in rare cancers such as WM. In addition, Waldenstrm macroglobulinemia (WM), a rare typeolder adults, those with comorbidities and racial and of cancer that originates in white blood cells. In theethnicminoritiesarefrequentlyunderrepresented United States, only 1,000 to 1,500 people are diag- in clinical trials. This creates an unmet knowledge nosed with WM each year. Yet over the last decade,gapthatprovidersandpatientsmustnavigateas patients diagnosed with lymphoid malignancies suchthey consider how clinical trial evidence applies to as WM have benefited from the introduction of sev- thema gap that a new study aims to help close. 2eral new anticancer therapiesnamely Bruton tyro- The study, published in the journal Cancers, fol-sine kinase (BTK) inhibitors like ibrutinib, acalabru- lowed 166 younger (ages 70 or younger) and 152 tinib and zanubrutinib, as well as BCL2 inhibitorsolder (over 70) WM patients who received first-line like venetoclax. treatmentbetweenJanuary2006andApril2019 ThesetherapieshavejoinedexistingtreatmentsintheVHA.Theresearchersexaminedtreatment suchasimmunotherapy(rituximab),proteasomepractices and patient outcomes both before (2006-inhibitors (bortezomib, ixazomib, carfilzomib) and2012) and after (2013-2019) newer treatments were even older treatments such as bendamustine. 1 introduced.Although none of these treatments can cure WM,Studiesofreal-worldpracticesandoutcomes the availability of more options with varying ther- allowprovidersandpatientstolearnmoreabout apeutictargetswhichreducesthelikelihoodofwhat treatments the broader community of provid-cross-treatment resistanceallows patients and pro- ers is utilizing and what outcomes are achievable viderstousenumeroustreatmentsthroughouttheoutside the confines of strict clinical trial protocols, disease course, prolonging the ability to control thesaid study author Ahmad Halwani, assistant profes-disease and hopefully improving overall survival. Asor of medicine at the University of Utah and a staff broader landscape of therapies also affords greaterphysician and clinical researcher at the George E. opportunity to personalize treatment depending onWhalen Veterans Health Administration in Salt Lake patient characteristics and tolerances. City. When real-world studies are conducted in set-Still, there is much to learn about how the intro- tings such as the VA, they also provide insight into ductionofnewertreatmentshasaffectedreal- the practices and outcomes that occur in underrepre-world treatment patterns and outcomes among WMsented patient groups.patients,particularlyolderadults.OnlyasmallThatstudyfoundthat,duringthemodernera, fraction of cancer patients is eligible and elects totheproportionofolderpatientswithacomplete participate in clinical trials, a fact that is even moreresponse or partial response to treatment (known as Continued on Page 38 u33'