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Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physicians' Education Resource®, LLC designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


CONTINUING EDUCATION CREDIT (Pharmacists, Nurses, Nurse Practitioners, and Physician Assistants):
You will receive a certificate of attendance for the CME-certified sessions (those designated for AMA/PRA Category 1 Credits™) which may be submitted to state licensing boards for determination of credit reciprocity (conversion to CEUs).

Acknowledgment of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

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Medical Crossfire®: Mutational Testing Through Multiple Lines of NSCLC Therapy

Medical Crossfire®: Mutational Testing Through Multiple Lines of NSCLC Therapy


PER Pulse™ Recap

Resources

Medical Crossfire®: Mutational Testing Through Multiple Lines of NSCLC Therapy
Earn up to 1.5 AMA PRA Category 1 Credits™
This activity aims to update oncology healthcare professionals who participate in the multidisciplinary treatment of patients with lung cancers by providing expert guidance, interpretation, and opinions on the importance and impact of epidermal growth factor receptor (EGFR) and molecular testing through multiple lines of therapy and emerging technologies that can assist in this regard.

PER Pulse™ Recap
Medical Crossfire®: Mutational Testing through Multiple Lines of NSCLC Therapy reviews molecular testing in patients with lung cancer, deciding on frontline therapy for patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer, and managing acquired resistance to EGFR tyrosine kinase inhibitors. This activity features case vignettes and expert advice on patient management.



PER Pulse™ Recap

PER Pulse™ Recap
 


1 of 3
PER Pulse™ Recap
Overview of Molecular Testing: Current and Future Directions

Medical Crossfire®: Mutational Testing through Multiple Lines of NSCLC Therapy reviews molecular testing in patients with lung cancer, deciding on frontline therapy for patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer, and managing acquired resistance to EGFR tyrosine kinase inhibitors. This activity features case vignettes and expert advice on patient management. This first of 3 PER Pulse™ Recaps focuses on issues related to tissue acquisition, including which patients to test and how to expedite  molecular test results.

Below are some clinical pearls from the expert discussion panel:

  • Adequate tissue acquisition: While the multidisciplinary partners, such as the pulmonologist, the interventional radiologist, and the surgeon, know how much tissue is needed to make the diagnosis of lung cancer, it is crucial to also obtain enough tissue for molecular testing at the same time.
  • Deciding which patients to test: Experts favor molecular testing on all patients with suspected lung cancer, as it can be costlier to request the tests at a later time. Particularly with small biopsy specimens, it may be difficult to exclude alternative diagnoses, such as adenosquamous histology in an apparent squamous-cell specimen. Molecular testing, in addition to providing therapeutically relevant information, can also yield diagnostically relevant information.
  • Approaches to obtaining molecular information rapidly: The experts on this panel have access to multigene, next-generation sequencing panels that can yield information on several hundred genes. Results from these multigene panels can take approximately 1 month, however; so, quicker tests are used for some molecular aberrations with corresponding approved agents (eg, polymerase chain reaction testing for EGFR mutations and immunohistochemistry tests for anaplastic lymphoma kinase (ALK) gene rearrangements).

2 of 3
PER Pulse™ Recap
The FrontLine Decision in EGFR Mutation-Positive Advanced NSCLC

Medical Crossfire®: Mutational Testing through Multiple Lines of NSCLC Therapy reviews molecular testing in patients with lung cancer, deciding on frontline therapy for patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer, and managing acquired resistance to EGFR tyrosine kinase inhibitors (TKIs). This activity features case vignettes and expert advice on patient management. This second of 3 PER Pulse™ Recaps focuses on selecting initial therapy for patient with non-small-cell lung cancer and sensitizing EGFR mutations.

Below are some clinical pearls from the expert discussion panel:

  • Approach to frontline therapy: Several EGFR TKIs are available that have shown improved progression-free survival and response compared to chemotherapy in patients with EGFR mutation-positive lung cancer. For patients who have the T790M resistance mutation de novo, or those with EGFR exon 20 insertions, first-line chemotherapy is recommended, rather than an EGFR TKI. The roles of exon 19 deletions, bevacizumab, and third-generation EGFR TKIs are still under investigation in the frontline setting, and the patient’s goals of care should also be part of the discussion.
  • Timing of first follow-up visit: Most of the experts would arrange to have the patient visit 2 weeks after beginning therapy, as this would help advance the newly established patient-physician relationship. Having the first visit at 4 weeks is also reasonable, as this allows time to obtain a fuller picture of the efficacy and adverse events with therapy.
  • Timing of the first scan: Experts would request a computed tomography scan (without positron emission tomography) 8 weeks after starting therapy.

3 of 3
PER Pulse™ Recap
Beyond Disease Progression in the Patient Previously Treated with EGFR TKIs

Medical Crossfire®: Mutational Testing through Multiple Lines of NSCLC Therapy reviews molecular testing in patients with lung cancer, deciding on frontline therapy for patients with epidermal growth factor receptor (EGFR) mutation-positive lung cancer, and managing acquired resistance to EGFR tyrosine kinase inhibitors (TKIs). This activity features case vignettes and expert advice on patient management. This third of 3 PER Pulse™ Recaps focuses on managing acquired resistance in patients receiving treatment with an EGFR TKI.

Below are some clinical pearls from the expert discussion panel:

  • General approaches to acquired resistance: A positron emission tomography scan and brain magnetic resonance imaging scan are recommended to determine the overall disease burden. Additionally, patient symptoms are a key factor, and experts would consider continuing treatment for an asymptomatic patient in order to obtain the most benefit from each line of therapy.
  • Approach to biopsy at the time of progression: This decision must be individualized. Some patients may want a biopsy as soon as progression is seen. If the patient is asymptomatic and continues on the same therapy, however, a later biopsy may be preferable, particularly if considering a clinical trial, many of which will require a recent biopsy. 
  • Managing T790M-negative progression: In the absence of a clinical trial, the experts would currently recommend chemotherapy if T790M-negative disease is confirmed.
  • Transitioning between the first-line EGFR TKI and subsequent therapy: Due to the risk of tumor flare, experts would continue the TKI until starting the next line of therapy outside of a clinical trial.
  • The role of plasma-based molecular tests: Plasma-based testing is approved in Europe for patient selection for first-line therapy with gefitinib. In the setting of acquired resistance, plasma biopsies can also be of use, particularly if there is insufficient tissue, and results can be obtained within 72 hours. If plasma testing yields a negative result for T790M, experts would request additional tissue to confirm.


Physicians' Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is not approved for AMA PRA Category 1 Credit™.

Supported by an educational grant from AstraZeneca.






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