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Accreditation/ Credit Designation

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

These activites are not approved for AMA PRA Category 1 Credit™.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from Lilly.

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


Medical Crossfire®: Translating Recent Data Into Informed Sequencing Decisions in Advanced Non–Small Cell Lung Cancer PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap



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First-Line Therapy of Metastatic Squamous Lung Cancer

Medical Crossfire®: Translating Recent Data into Informed Sequencing Decisions in Advanced Non–Small Cell Lung Cancer featured nationally recognized lung cancer experts. The program chair, David R. Gandara, MD, along with faculty, Edward Garon, MD; Suresh Ramalingam, MD; and Karen L. Reckamp, MD, discussed updated treatment options over multiple lines of therapy for patients with advanced non–small cell lung cancer (NSCLC).

This first of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on first-line therapeutic options for patients with advanced, squamous NSCLC:

  • A major change in lung cancer therapeutic algorithms occurred in 2016 with the introduction of pembrolizumab, the immune checkpoint inhibitor, as the first-line standard of care in patients whose tumors have a PD-L1 expression ≥50%. This applies to squamous and nonsquamous histologies, although it is not indicated for patients with oncogene-driven lung cancer.
  • For patients whose tumors do not meet the ≥50% PD-L1 expression requirement, platinum-based chemotherapy remains the standard of care. Several regimens are available, including gemcitabine/platinum with or without necitumumab, paclitaxel/carboplatin, and nab-paclitaxel/carboplatin.


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PER Pulse™ Recap

Subsequent Lines of Therapy in Metastatic Squamous Lung Cancer

Medical Crossfire®: Translating Recent Data into Informed Sequencing Decisions in Advanced Non–Small Cell Lung Cancer featured nationally recognized lung cancer experts. The program chair, David R. Gandara, MD, along with faculty, Edward Garon, MD; Suresh Ramalingam, MD; and Karen L. Reckamp, MD, discussed updated treatment options over multiple lines of therapy for patients with advanced non–small cell lung cancer (NSCLC).

This second of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on the management of patients with squamous NSCLC whose disease progresses after first-line therapy:

  • For patients who received chemotherapy in the first-line setting, immunotherapy has become the standard of care based on phase III trials demonstrating superior overall survival with antibodies to PD-1 or PD-L1 compared with the previous standard of docetaxel. Several immunotherapeutic options are available, including nivolumab, pembrolizumab, and atezolizumab.
  • In patients who received immunotherapy in the first-line setting, platinum-based chemotherapy may be considered. The options would be similar to the frontline setting and include gemcitabine/platinum with or without necitumumab, paclitaxel/carboplatin, and nab-paclitaxel/carboplatin.
  • Following chemotherapy-based and immunotherapy-based lines of therapy, docetaxel with or without ramucirumab may be considered based on patient and disease characteristics. In patients with squamous NSCLC, single-agent afatinib is indicated after platinum-based chemotherapy.

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PER Pulse™ Recap

Subsequent Lines of Therapy in Metastatic Nonsquamous Lung Cancer

Medical Crossfire®: Translating Recent Data into Informed Sequencing Decisions in Advanced Non–Small Cell Lung Cancer featured nationally recognized lung cancer experts. The program chair, David R. Gandara, MD, along with faculty, Edward Garon, MD; Suresh Ramalingam, MD; and Karen L. Reckamp, MD, discussed updated treatment options for patients with advanced non–small cell lung cancer (NSCLC) over multiple lines of therapy.

This third of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on the management of patients with nonsquamous NSCLC whose disease progresses after first-line therapy:

  • For patients with oncogene-driven disease, the use of all available targeted therapies is preferred prior to switching to chemotherapy or immunotherapy:
    • For NSCLC driven by mutations in the epidermal growth factor receptor (EGFR) gene, osimertinib is indicated in patients with progressive disease and the T790M resistance mutation.
    • For patients whose disease is driven by rearrangements in the anaplastic lymphoma kinase gene, ceritinib and alectinib are currently available upon disease progression with first-line crizotinib.
  • After available targeted therapies have been exhausted, platinum-based chemotherapy may be considered. Following disease progression on a platinum-based regimen, limited data are available, but subset analyses of phase III trials showed a lack of overall survival benefit with immunotherapy compared with docetaxel in patients with EGFR mutations. Therefore, docetaxel with or without ramucirumab may be considered following progression on platinum-based chemotherapy, with immunotherapy reserved as subsequent treatment.
  • In patients with no identified actionable oncogenic driver, treatment after progression on first-line therapy would be similar to that of patients with squamous NSCLC, although afatinib is not approved in this setting for patients with nonsquamous histology.




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