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Accreditation/Credit Designation

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 1.0 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 1.0 Contact Hours.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Lilly.

For further information concerning Lilly grant funding, visit www.lillygrantoffice.com.

Community Practice Connections™: Oncology Best Practice™ Decision Points in Advanced NSCLC: Assessing Treatment Options Beyond Disease Progression

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

 

Activity Overview

The management of patients with advanced non-small cell lung cancer (NSCLC) who have progressed following prior-platinum-based therapies represents an important educational need among practitioners who care for patients with lung cancer. Although our improved understanding of actionable tumor characteristics has assisted to inform clinical decision-making concerning the use of certain targeted agents, treatment selection for patients who have progressed but who do not have activating mutations is more complex. Clinical status and biomarker information may be used to inform therapeutic selection, but it is also important that practitioners understand results from key trials that have been conducted in patients who have progressed on or after platinum-based approaches. Current treatment options in this regard include immune checkpoint inhibitors, single agent chemotherapy, ramucirumab plus docetaxel, and EGFR tyrosine-kinase inhibitors.

This is an area in lung cancer treatment for which there have been multiple therapeutic developments in recent years. As new biomarkers and patient characteristics continue to emerge that assist clinicians to predict responsiveness to particular approaches, practitioners will need updates that allow them optimize outcomes in these most difficult-to-treat settings of lung cancer management. Education in this regard should focus on the evidence that informs therapeutic selection in post-platinum treated relapsed advanced NSCLC, circumstances that should guide switching of therapies, and methods to proactively manage treatment-related adverse events.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from Lilly.

For further information concerning Lilly grant funding, visit www.lillygrantoffice.com.

CME/CE Activity Table of Contents

  • A Patient With Chemotherapy-Pretreated, Nonsquamous NSCLC
  • A Patient With Chemotherapy-Pretreated, Squamous NSCLC
  • A Patient With Immunotherapy-Pretreated, Squamous NSCLC
  • A Patient With EGFR TKI and Chemotherapy-Pretreated NSCLC

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 online activity is directed toward oncologists interested in the treatment of patients with lung cancer. Fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of lung cancer may also participate.

Learning Objectives

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

  • Assess testing methods that should be applied to inform clinical decision-making for patients with advanced NSCLC who have progressed following platinum-based chemotherapy
  • Describe landmark clinical trials that have evaluated patients with advanced NSCLC who have progressed on platinum-based therapeutic approaches
  • Explain strategies to proactively address treatment-related adverse events in patients with advanced NSCLC
  • Construct an algorithm based on clinical and biomarker information for the management of patients who have progressed following platinum-based chemotherapy in either front-line treatment or following front-line immunotherapy

Faculty, Staff, and Planners' Disclosures

Faculty

Edward Garon, M.D., MS
Associate Professor, Department of Medicine; Hematology-Oncology
David Geffen School of Medicine at UCLA
Los Angeles, CA
 
 

Disclosure: AstraZeneca, Boehringer-Ingelheim, BMS, Genentech, Eli Lilly, Merck. Mirati, Novartis and Pfizer

Benjamin P. Levy, MD
Clinical Director of Medical Oncology
Johns Hopkins Sidney Kimmel Cancer Center
Sibley Memorial Hospital
Washington, DC
 

Disclosure: Celgene, Astra-Zeneca, Eli-Lilly, Genentech, Pfizer, Merck

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 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

PER Pulse Recap (1 of 3)

Treatment Options for Previously Treated Squamous NSCLC
 
This series of Oncology Best Practice features key lung cancer experts Edward B. Garon, MD, MS, and Benjamin P. Levy, MD, addressing best practices for the management of patients with previously treated metastatic non–small cell lung cancer (NSCLC), as well as emerging therapeutic paradigms. This first of 3 PER Pulse Recaps from the Oncology Best Practice series focuses on treatment options for patients with advanced squamous NSCLC whose disease has progressed after first-line therapy.
 
  • For patients who progress after first-line platinum-based chemotherapy, category 1 recommendations in national guidelines incorporate single-agent immunotherapy, including nivolumab, pembrolizumab, or atezolizumab; a PD-L1 expression of ≥1% is required for second-line pembrolizumab. Docetaxel/ramucirumab is a category 2A recommendation, and in patients whose disease was refractory to first-line therapy, an exploratory analysis showed that these patients received clinical benefit with this combination compared with docetaxel/placebo.
  • For patients whose disease progresses after first-line, single-agent immunotherapy, national guidelines recommend platinum-based chemotherapy.
 
 
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice Decision Points in Advanced NSCLC: Assessing Treatment Options in the Second Line and Beyond.


PER Pulse Recap (2 of 3)

Oncology Best Practice Decision Points in Advanced NSCLC: Assessing Treatment Options in the Second Line and Beyond
 
Second-Line Treatment Options for Oncogenic Driver-Negative, Nonsquamous NSCLC
 
This series of Oncology Best Practice features key lung cancer experts Edward B. Garon, MD, MS, and Benjamin P. Levy, MD, addressing best practices for the management of patients with previously treated, metastatic non–small cell lung cancer (NSCLC), as well as emerging therapeutic paradigms. This second of 3 PER Pulse Recaps from the Oncology Best Practice series focuses on second-line options for patients with nonsquamous NSCLC and no actionable oncogenic drivers.
 
  • For patients whose disease progresses after first-line platinum-based chemotherapy, single-agent therapy with an immune checkpoint inhibitor (nivolumab, pembrolizumab, or atezolizumab) is a category 1 recommendation in national guidelines; a PD-L1 expression of ≥1% is required for second-line pembrolizumab. Other potential options are pemetrexed, if not previously received, or docetaxel with or without ramucirumab.
  • For patients whose disease progresses after first-line, single-agent immunotherapy, national guidelines recommend platinum-based chemotherapy.
 
 
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice Decision Points in Advanced NSCLC: Assessing Treatment Options in the Second Line and Beyond.


PER Pulse Recap (3 of 3)

Oncology Best Practice Decision Points in Advanced NSCLC: Assessing Treatment Options in the Second Line and Beyond
 
Subsequent Therapy for Patients with EGFR Mutation-Positive NSCLC
 
This series of Oncology Best Practice features key lung cancer experts Edward B. Garon, MD, MS, and Benjamin P. Levy, MD, addressing best practices for the management of patients with previously treated metastatic non–small cell lung cancer (NSCLC), as well as emerging therapeutic paradigms. This third of 3 PER Pulse Recaps from the Oncology Best Practice series focuses on subsequent therapeutic options for patients with NSCLC and mutations in the epidermal growth factor receptor (EGFR) gene.
 
  • The experts’ recommendation is to offer available EGFR tyrosine kinase inhibitors (TKIs); patients who progress on a first- or second-generation EGFR TKI would receive testing for the T790M resistance mutation. If the patient’s disease is positive for T790M, then osimertinib would be appropriate, while standard platinum-based chemotherapy is recommended for T790M-negative disease progression, assuming a lack of other mechanisms of resistance, such as MET gene amplification.
  • The treatment algorithm for patients with EGFR mutation–positive NSCLC continues to evolve, as osimertinib is under review for use in the first-line setting.
  • In patients with EGFR mutation–positive NSCLC whose disease progresses after platinum-based chemotherapy, both immunotherapy and docetaxel with or without ramucirumab are potential approaches; however, subset analyses of trials comparing immunotherapy with docetaxel have shown a lack of overall survival benefit with immunotherapy in patients with EGFR mutations.
 
 
For additional commentary about this topic and others, visit www.gotoper.com to access downloadable slides from Oncology Best Practice Decision Points in Advanced NSCLC: Assessing Treatment Options in the Second Line and Beyond.








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