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

Physicians' Education Resource®, LLC designates this enduring material 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.

Physicians' Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1.5 Contact Hours.

Resources

PER Pulse™ Recaps highlight key elements of the Community Practice Connections™: Working Group to Optimize Outcomes in EGFR-mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care online CME activity.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

Community Practice Connections™: Working Group to Optimize Outcomes in EGFR-mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care

Release Date: June 30, 2017
Expiration Date: June 30, 2018
Media: Internet - based

 

Activity Overview

Community Practice Connections™: Working Group to Optimize Outcomes in EGFR-mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care features a summary of clinical evidence guiding best practices in the treatment of patients with non–small-cell lung cancer (NSCLC) and mutations in the epidermal growth factor receptor (EGFR) gene, as well as case-based discussions of adverse event management, compliance with oral therapies, and counseling of patients awaiting molecular test results. Interactive clinical vignettes are followed by short video interviews with leading experts in the management of patients with EGFR mutation-positive NSCLC. The video interviews address decision points in the clinical vignettes, as well as questions commonly faced in the community oncology practice setting by nursing professionals engaged in the care of patients with lung cancers.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

Instructions for This Activity and Receiving Credit

  • You will need to login to participate in the activity.
  • Each presentation may contain an interactive question(s). You may move forward through the presentation; however, you may not go back to change answers or review videos/content until you finish the presentation.
  • At the end of the activity, “educational content/video files” will be available for your reference.
  • In order to receive a CME/CE certificate, participants must complete the activity.
  • Complete the posttest and pass with a score of 70% or higher, complete the evaluation and then click on request for credit. Participants may immediately download a CME/CE certificate upon completion of these steps.

Target Audience

This educational activity is directed toward nurses and other healthcare professionals with an interest in the treatment of lung cancers.

Learning Objectives

At the conclusion of this activity, you should be better prepared to:

  1. Explain current and emerging testing platforms in the context of emerging methods to overcome barriers associated with tumor biopsies in the field of lung cancer treatment
  2. Detail key counseling points to address with patients with lung cancer who are awaiting results from tumor tissue testing
  3. Describe current and emerging evidence concerning the use of EGFR-targeted strategies in frontline and relapsed advanced non–small-cell lung cancer (NSCLC) disease settings
  4. Apply best nursing practices to counsel patents with advanced NSCLC concerning the prevention, mitigation, and management of treatment-related toxicities

Faculty, Staff, and Planners' Disclosures

Faculty

Karen C. Lee, MSN, FNP-BC
Clinical Nurse Practitioner
Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: Consultant: Boehringer Ingelheim; Speakers Bureau: Pfizer, Bristol-Meyers Squibb, Boehringer Ingelheim, AstraZeneca

Benjamin P. Levy, MD
Assistant Professor, Johns Hopkins School of Medicine
Clinical Director, Johns Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital
Washington, DC
Medical Director, Thoracic Oncology Program
at SKCC at Sibley Memorial Hospital
Washington DC

Disclosure: Consultant: Celgene, AstraZeneca, Eli Lilly, Genentech, Pfizer, Merck Speakers Bureau: Eli Lilly, Genentech

Ann Culkin, RN, OCN
Department of Nursing
Office Practice Nurse, Ambulatory, Thoracic Service
Memorial Sloan Kettering Cancer Center
New York, NY
 

Disclosure: Consultant: Creative Educational Concepts, CE Program consultant

Alexander Drilon, MD
Clinical Director, Developmental Therapeutics
Assistant Attending Physician, Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center, New York, NY
 
 

Disclosure: Grant Research Support: Foundation Medicine; Other: Honoraria: Ignyta, Exelixis, Genentech/Roche, AstraZeneca, Blueprint Medicines, Loxo.

Jonathan W. Riess, MD, MS
Assistant Professor of Medicine
Division of Hematology and Oncology
UC Davis Comprehensive Cancer Center
Sacramento, CA
 

Disclosure: Grant Research Support: Merck, Novartis, Millennium; Consultant: Celgene, Ariad, Clovis Oncology, Medtronic, and Abbvie

Christine H. Teklehaimanote, MSN, GNP-BC, ACHPN
University of California
Davis Medical Center
Sacramento, CA
 
 

Disclosure: No relevant financial relationships to disclose

The staff of PER® have no relevant financial relationships with commercial interests to disclose.

Disclosure Policy and Resolution of Conflicts of Interest (COI)

As a sponsor accredited by the ACCME, it is the policy of PER® to ensure fair balance, independence, objectivity, and scientific rigor in all of its CME/CE activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME/CE activity to disclose all relevant financial relationships with commercial interests. The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that creates a COI.

Additionally, PER® is required by ACCME to resolve all COI. PER® has identified and resolved all COI prior to the start of this activity by using a multistep process.

Off-Label Disclosure and Disclaimer

This CME/CE activity may or may not discuss investigational, unapproved, or off-label use of drugs. Participants are advised to consult prescribing information for any products discussed. The information provided in this CME/CE activity is for continuing medical and nursing education purposes only, and is not meant to substitute for the independent clinical judgment of a physician or nurse relative to diagnostic, treatment, or management options for a specific patient’s medical condition. The opinions expressed in the content are solely those of the individual faculty members and do not reflect those of PER®.

PER Pulse™ Recap


1 of 3
PER Pulse™ Recap

Clinical Data With EGFR TKIs in Lung Cancer

The Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, which was held May 6, 2017, in conjunction with the 2017 Oncology Nursing Society Annual Meeting, updated oncology nurses and other practitioners on key lung cancer data sets, educating them on how this evidence can be interpreted in the context of evolving epidermal growth factor receptor (EGFR)-targeted treatment paradigms. In addition, this program provided expert guidance on how to proactively mitigate and manage treatment-related toxicities, navigate molecular testing concerns, and improve patient compliance. This first of 3 PER Pulse™ Recaps from this program focuses on recent and emerging clinical data with EGFR tyrosine kinase inhibitors (TKIs) in lung cancer.

  • Three EGFR TKIs, erlotinib, afatinib, and gefitinib are approved in the first-line setting for patients with EGFR-mutated non¬–small-cell lung cancer. All 3 of these TKIs have demonstrated improved outcomes (response rates, progression-free survival [PFS], and quality of life) compared with chemotherapy in this patient population.
  • In addition, osimertinib, a third-generation TKI that is currently approved for recurrent T790M-positive disease, is being tested in the frontline setting. Phase I data for frontline osimertinib in patients with EGFR-mutated disease demonstrated a median PFS of 19 months. The ongoing Phase III FLAURA trial is a head-to-head trial of osimertinib vs first-generation EGFR TKIs in this setting, and its results should indicate whether there should be a change in practice.
  • Combination therapies are also under investigation for this patient population. In a Japanese randomized phase II trial, the addition of bevacizumab to erlotinib in the first-line setting produced a 6.3-month improvement in median PFS. This combination, as well as the combination of afatinib + the anti-EGFR monoclonal antibody cetuximab are currently being investigated in phase III trials.
  • For patients whose disease progresses on first-line EGFR TKI therapy, molecular testing for the T790M resistance mutation prior to changing therapy is a standard approach. Liquid-based biopsies, with their procedural ease and rapid turnaround time, have demonstrated utility in this setting. For patients whose disease harbors the T790M mutation, osimertinib is approved. If molecular tests are negative for T790M, this diagnosis should be confirmed, particularly if obtained by a liquid-based biopsy. For these patients, platinum-based chemotherapy is an appropriate approach.

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, as well as downloadable slides summarizing results from the meeting. 


2 of 3
PER Pulse™ Recap

Toxicities of EGFR TKIs in Lung Cancer

The Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, which was held May 6, 2017, in conjunction with the 2017 Oncology Nursing Society Annual Meeting, updated oncology nurses and other practitioners on key lung cancer data sets, educating them on how this evidence can be interpreted in the context of evolving epidermal growth factor receptor (EGFR)-targeted treatment paradigms. In addition, this program provided expert guidance on how to proactively mitigate and manage treatment-related toxicities, navigate molecular testing concerns, and improve patient compliance. This second of 3 PER Pulse™ Recaps from this program focuses on the toxicities associated with EGFR tyrosine kinase inhibitors (TKIs) in non¬–small-cell lung cancer.

Ann Culkin, RN, OCN, office practice nurse at Memorial Sloan Kettering Cancer Center and Christine H. Teklehaimanote, MSN, NP, AOCNP from the University of California Davis Medical Center provided a number of management tips for the care of patients who experience mild acneiform rash in multiple locations during EGFR TKI therapy.

  • Acknowledge the emotional distress that some patients feel when they develop rash
  • Warn them prior to treatment initiation that rash is a common toxicity and give them a prescription for clindamycin topical solution upfront, so they can start treatment immediately upon developing the rash
  • Remind them to call the office if they feel the rash is not under control
  • Account for the distribution of rash when grading it
  • Recommend sunscreen for even minimal sun exposure (eg, walking from a car into a building)
  • Discover how patients are currently managing skin care
  • Provide education on several aspects of skin care, including the need to moisturize, which soaps to use, and how to care for fingernails and toenails
  • Consider combination therapy with clindamycin and pimecrolimus 1% cream

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, as well as downloadable slides summarizing results from the meeting. 


3 of 3
PER Pulse™ Recap

Role of Plasma Biopsies in Lung Cancer in 2017

The Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, which was held May 6, 2017, in conjunction with the 2017 Oncology Nursing Society Annual Meeting, updated oncology nurses and other practitioners on key lung cancer data sets, educating them on how this evidence can be interpreted in the context of evolving epidermal growth factor receptor (EGFR)-targeted treatment paradigms. In addition, this program provided expert guidance on how to proactively mitigate and manage treatment-related toxicities, navigate molecular testing concerns, and improve patient compliance. This third of 3 PER Pulse™ Recaps from this program focuses on the role of plasma biopsies in lung cancer in 2017.

Benjamin P. Levy, MD, assistant professor and clinical director at Johns Hopkins Sidney Kimmel Cancer Center, and Karen C. Lee, MSN, FNP-BC, clinical nurse practitioner at Memorial Sloan Kettering Cancer Center, discussed the clinical implications of different sources of biopsy from patients with advanced lung cancer.

Treatment-naïve disease
Dr Levy stated that tissue biopsy remains the gold standard for treatment-naïve disease, at the very least for making a histology diagnosis (eg, adenocarcinoma, squamous cell carcinoma). While it is ideal to also use tissue for molecular testing, often the amount of tissue available makes that impossible. In those circumstances, it is reasonable to use a plasma biopsy, also called a liquid biopsy, for molecular testing rather than waiting for a tissue rebiopsy. Plasma biopsies have the advantage of being less invasive, having a quicker turnaround time, and may be more attractive to someone who is reluctant to undergo a rebiopsy.

Ms Lee jumped in to share a patient case illustrating one way plasma biopsies are used at her institution. For a recent asymptomatic newly diagnosed patient, who had a high likelihood of harboring an EGFR sensitizing mutation due to his Asian ethnicity, adenocarcinoma histology, and never smoker status, his tissue biopsy was insufficient to perform molecular testing. In this case, his team sent off his plasma biopsy both for standard molecular testing, which has a turnaround time of 1 week or less, and next-generation sequencing, which is expected to take much longer (4-5 weeks). Therefore, if his standard molecular testing results are positive for a sensitizing EGFR mutation, he can quickly start on an EGFR TKI such as erlotinib. If results are negative and given that he is asymptomatic, they will wait for the sequencing results in order to plan treatment. This use of a plasma biopsy allows Ms Levy’s team to quickly obtain molecular testing without having to schedule a rebiopsy.

Treatment-refractory disease
Dr Levy discussed how the use of biopsies differs in the treatment-refractory setting for patients receiving first-line EGFR TKIs. Research has shown that patients progressing on an EGFR TKI who test positive for the EGFR resistance mutation T790M using a plasma biopsy are just as likely to respond to T790M-targeted therapy (such as osimertinib) as patients testing positive using a tissue biopsy. Therefore, he has no hesitation in using a plasma biopsy to test these patients for T790M. However, because research has shown a weaker correlation between patient outcomes with plasma and tissue biopsies when T790M results are negative, patients with T790M-negative results using a plasma biopsy need to be retested using a new tissue biopsy.

For additional commentary about these topics and others, visit www.gotoper.com for archived video of the Working Group to Optimize Outcomes in EGFR-Mutated Lung Cancers: Evolving Concepts for Nurses to Facilitate and Improve Patient Care, as well as downloadable slides summarizing results from the meeting. 







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