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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 live activity for a maximum of 2.0 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 2.0 Contact Hours.

Acknowledgment of Commercial Support

This activity is supported by educational grants from Bayer Healthcare Pharmaceuticals and Eisai, Inc.

Archived Version of a Live Webcast: Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma

Release Date: May 31, 2018
Expiration Date: May 31, 2019
Media: Internet - based

 

Activity Overview

PER Global®, LLC, the global affiliate of Physicians’ Education Resource®, LLC, (PER®) is pleased to present the CME-certified online activity titled Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma. This innovative activity is an archived version of the live-streamed interactive webcast held on May 10, 2018 and led by internationally recognized hepatocellular carcinoma (HCC) experts Arndt Vogel, MD, PhD; Ghassan K. Abou-Alfa, MD; and A. Ruth He, MD, PhD.

This online activity will aid you in using an evidence-based approach to the management of HCC in light of the rapidly evolving therapeutic landscape. You will hear the 3 HCC experts discuss and debate these key topics:

  • Pathogenesis and natural history of HCC
  • Diagnosis and initial management of HCC, including standard and emerging therapies
  • Rationale for and current data on immunotherapy for HCC
  • Choosing and sequencing therapy for recurrent/refractory HCC

The faculty also presents some of their own most interesting cases to highlight important management issues, including frontline treatment decisions, sequencing of therapies, and managing immune-related adverse events.

Join us online for Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma, which will bring medical conference‒caliber education to the convenience of your screen!

Acknowledgment of Commercial Support

This activity is supported by educational grants from Bayer Healthcare Pharmaceuticals and Eisai, Inc.

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 towards medical oncologists who treat or manage patients with HCC. Nurse practitioners, nurses, physician assistants, and other healthcare professionals involved in the treatment and management of patients with HCC are also invited to participate.

Learning Objectives

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

  • Determine the mechanistic rationale for targeted and immunotherapeutic drug development in the setting of HCC
  • Describe outcomes from key clinical trials conducted in patients with HCC that investigated strategies for frontline and subsequent lines of therapy
  • Utilize a case-based approach to place recent trial findings into their proper clinical context, and apply key evidence to optimize sequencing in multiple lines of care for patients with HCC
  • Identify strategies to mitigate the impact of commonly encountered treatment-related toxicities in the management of patients with HCC

Faculty, Staff, and Planners' Disclosures

Moderator

Arndt Vogel, MD, PhD
Professor of Gastrointestinal Oncology
Hannover Medical School
Hannover, Germany
 
 

Disclosure: No relevant financial relationships with commercial interests to disclose.

Faculty

Ghassan K. Abou-Alfa, MD
Medical Oncologist, Gastrointestinal Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY
 
 

Disclosure: Grant/Research Support: Agios, Array, AstraZeneca, Bayer, BMS, Casi, Celgene, Exelixis, Genentech, Incyte, Lilly, MabVax, MedImmune, Momenta, Novartis, OncoMed Pharmaceuticals, Roche; Consultant: Agios, Amgen, Antengene, Aptus, Aslan, Astellas, AstraZeneca, Bayer, BMS, Boston Scientific, CARsgen, Celgene, Casi, CytomX, Daiichi Sankyo, Debio, Delcath, Eisai, Exelixis, Gilead, Halozyme, Inovio, Ipsen, Merck, Onxeo, PCI Biotech, Roche, Sanofi, Servier, Silenseed, Sillajen, Sirtex, Yakult

A. Ruth He, MD, PhD
Associate Professor of Medicine
Georgetown University
Washington, DC
 
 

Disclosure: Consultant: Merck; Speakers Bureau: Bayer, BMS

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® or any of the companies that provided commercial support for this activity.

PER Pulse™ Recap

PER Pulse Recap (1 of 3)

This first of 3 PER Pulse™ Recaps reviews the diagnosis and initial management of HCC. Below are some highlights from the webcast segment featuring Dr. Abou-Alfa:
  • In the United States, patients with cirrhosis are recommended to have ultrasound screening for HCC twice per year. Some other patients with chronic, active hepatitis B infection, including men of African or Asian descent, should also have regular screening.
  • However, several difficulties with screening were mentioned:
    • Despite its widespread use, alpha-fetoprotein is no longer recommended as a routine HCC surveillance test.
    • Ultrasound screening can be difficult in patients with fatty liver disease because they are often obese.
    • Patients with viral hepatitis often are unaware of their disease, so they do not receive screening.
    • Patients with alcoholic liver disease often do not regularly see physicians.
  • Most physicians use the Barcelona Clinic Liver Cancer (BCLC) staging system, but as Dr. Abou-Alfa pointed out, BCLC has a limited ability to predict survival. At his institution, they use Cancer of the Liver Italian Program (CLIP) for patients with hepatitis C infection and Chinese University Prognostic Index (CUPI) for those with hepatitis B infection.
  • Sorafenib remains the only approved systemic therapy for first-line unresectable HCC, although lenvatinib has demonstrated noninferior overall survival and improved progression-free survival and response rate when compared with sorafenib in the phase III REFLECT trial. It is currently being considered for regulatory approval for HCC in the United States and Europe, and was approved in Japan for this indication in March 2018.
  • There is some suggestion that although it has activity in both subsets, sorafenib may be more active in patients with HCC who have hepatitis C infection compared with hepatitis B infection. The experts agreed that more research is needed on this topic.
  • As more therapies are approved, tumor biology will be a driver for treatment decisions, making biopsies crucial to the optimal management of patients with HCC.
 
For additional commentary about this topic and the Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma activity, please visit www.gotoper.com


PER Pulse Recap (2 of 3)

This second of 3 PER Pulse™ Recaps discusses the rationale for and current data on immunotherapy for HCC. Below are some highlights from the webcast segment featuring Dr. He:
  • The liver is a highly immunosuppressive environment creating tolerance, a fact that is exploited during HCC pathogenesis.
  • The programmed cell death 1 (PD-1)/programmed death ligand-1 (PD-L1) pathway is immunosuppressive, and one of its mechanisms is to prevent apoptosis of inhibitory regulatory T cells. Other inhibitory cell types in the HCC microenvironment include myeloid-derived suppressor cells, tumor-derived macrophages, and invariant natural killer cells.
  • Immune-related adverse events are a concern with immunotherapy, although they are relatively uncommon in the HCC population. They can occur in any organ of the body, requiring clinicians to be on alert to identify, monitor for, and manage these toxicities.
  • Nivolumab recently received accelerated approval in the United States for the second-line treatment of HCC, and is also the focus of a first-line trial versus sorafenib in patients with HCC (CheckMate 459).
  • Pembrolizumab is currently under investigation in the second-line setting, as well.
  • The HIMALAYA study is a large, first-line, phase III HCC trial testing durvalumab versus durvalumab + tremelimumab (anti-PD-1 and anti-cytotoxic T-lymphocyte‒associated protein 4 [CTLA-4]) versus sorafenib.
  • Immunotherapy is not yet approved in Europe for HCC.
  • Dr. He discussed a patient of hers who had been discontinued from nivolumab after 15 months of therapy due to an immune-related adverse event of hepatitis. This patient had been off therapy for more than 18 months with no progression.
 
For additional commentary about this topic and the Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma activity, please visit www.gotoper.com


PER Pulse Recap (3 of 3)

This third of 3 PER Pulse™ Recaps summarizes the selection and sequencing of therapy for recurrent/refractory HCC. Below are some highlights from the webcast segment featuring Professor Vogel:
  • Despite the similarities in molecular structure between sorafenib and regorafenib, these drugs are different enough to permit good outcomes with regorafenib in patients who have already been treated with sorafenib.
  • Dr He said that, in her experience, patients who develop hand-foot skin reaction while taking sorafenib are also likely to develop it with regorafenib, but that the same is not true for diarrhea (patients are not necessarily likely to have diarrhea with regorafenib just because they had it with sorafenib).
  • The RESORCE trial enrolled patients who had been treated with and tolerated sorafenib and treated them subsequently with regorafenib. This was a randomized, placebo-controlled, phase III trial, and it demonstrated a survival advantage for regorafenib over placebo of 2.8 months.
  • In this trial, patients had a median overall survival from start of sorafenib treatment (followed by regorafenib) of 26 months, which Professor Vogel called impressive.
  • Professor Vogel presented one of his patients that he has treated through 4 lines of therapy over the course of nearly 3 years, something made possible only by the recent expansion of the HCC armamentarium. This patient’s treatment sequence was sorafenib followed by regorafenib, followed by nivolumab, followed by lenvatinib. Other fourth-line regimens recommended by Dr. Abou-Alfa and Dr. He were cabozantinib, chemotherapy, and fibroblast growth factor receptor inhibitors (in the context of a clinical trial).
  • Professor Vogel pointed out that in Europe, lenvatinib will likely gain approval only in the first line; regorafenib must be used after sorafenib; and sorafenib can be used in any line of therapy. Clinicians will use this information when making sequencing decisions.
 
For additional commentary about this topic and the Virtual Current Trends™: Global Perspectives on Emerging Data in Hepatocellular Carcinoma activity, please visit www.gotoper.com.








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