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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.

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

Acknowledgment of Commercial Support

This activity is supported by educational grants from Celgene, Lilly, Sirtex, and Taiho Oncology, Inc.

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


Community Practice Connections™: 1st Annual School of Gastrointestinal Oncology™ - PER Pulse™ Recap
PER Pulse™ Recap

Resources

Community Practice Connections™: 1st Annual School of Gastrointestinal Oncology™
Earn up to 2.0 AMA PRA Category 1 Credits
Community Practice Connections: 1st Annual School of Gastrointestinal Oncology™ consists of a series of brief interviews with noted thought leaders exploring questions from the community physician perspective. The video interviews address decision points in the clinical vignettes, as well as questions commonly faced in the community oncology practice setting.

PER Pulse™ Recaps
The 1st Annual School of Gastrointestinal Oncology™ (SOGO™), which was held April 23, 2016, presented the latest data on the multidisciplinary management of patients with gastrointestinal cancers, including colorectal cancer (CRC), gastric cancer, pancreatic cancer, hepatocellular carcinoma, and others.



PER Pulse™ Recap

PER Pulse™ Recap
 


1 of 3
PER Pulse™ Recap
Options for the Treatment of Colorectal Cancer Beyond Disease Progression

The 1st Annual School of Gastrointestinal Oncology™ (SOGO™), which was held April 23, 2016, presented the latest data on the multidisciplinary management of patients with gastrointestinal cancers, including colorectal cancer (CRC), gastric cancer, pancreatic cancer, hepatocellular carcinoma, and others. This first of 3 PER Pulse™ Recaps from SOGO™ centers on the options for patients with CRC after disease progression.

Wells Messersmith, MD, professor and co-division head of the Division of Medical Oncology at the University of Colorado, focused his presentation, “Beyond Progression in Relapsed Colorectal Cancer,” primarily on biologic agents rather than chemotherapy agents, starting with a discussion of the approved antiangiogenic agents and their pivotal studies in recurrent CRC: bevacizumab in the TML trial, ziv-aflibercept in the VELOUR trial, and ramucirumab in the RAISE trial. He pointed out that each of these agents produced meaningful, but modest, benefit, and none have the advantage of a biomarker to aid patient selection.

Next, he discussed the use of epidermal growth factor receptor (EGFR) antibodies, cetuximab and panitumumab, in the second-line setting, showing through a presentation of the ASPECCT data, which directly compared these 2 agents, that there are few clinical differences, citing schedule and reimbursement as the 2 most relevant distinctions in this setting.

Moving on, Dr Messersmith covered 2 agents with modest survival benefits in the third line: regorafenib, a multitargeted tyrosine kinase inhibitor, and TAS-102, a cytotoxic agent combined with a thymidine phosphorylase inhibitor.

Finally, he introduced the concept of microsatellite instability (MSI) and explained that patients with MSI-high tumors may derive more benefit from the immunotherapy agents on the horizon for CRC, including pembrolizumab and other immune checkpoint inhibitors.


2 of 3
PER Pulse™ Recap
Recent Updates in Hepatocellular Carcinoma

The 1st Annual School of Gastrointestinal Oncology™ (SOGO™), which was held April 23, 2016, presented the latest data on the multidisciplinary management of patients with gastrointestinal cancers, including colorectal cancer, gastric cancer, pancreatic cancer, hepatocellular carcinoma (HCC), and others. This second of 3 PER Pulse™ Recaps from SOGO™ centers on the current treatment options for patients with HCC.

Below are some clinical pearls and interesting facts from Ghassan Abou-Alfa, MD's lecture, "Recent Updates in Treating Hepatocellular Carcinoma":

  • Sorafenib, which is the only standard of care currently available for HCC, can be administered carefully (at one-half the approved dose) to patients with elevated bilirubin levels up to 3 times the upper limit of normal.
  • Response to sorafenib can initially be mistaken for tumor progression because sorafenib can result in tumor necrosis, which naturally causes tumor expansion. Therefore, tumor necrosis should be measured, in addition to measuring tumor size, when assessing response to sorafenib.
  • Dr Abou-Alfa urged attendees to enroll their patients with HCC in the numerous open immunotherapy clinical trials because of its promise in this difficult-to-treat patient population. Not only does HCC have a strong preclinical rationale (high expression of PD-1 and PD-L1, and a correlation of these measures with poor outcome), but early trial data show promising responses (nivolumab in a phase I/II advanced HCC trial demonstrated an overall response rate of 19% and stable disease rate of 48%). Nivolumab is currently in phase III testing in a head-to-head trial with sorafenib in the first-line setting.

3 of 3
PER Pulse™ Recap
Neoadjuvant Therapy for Pancreatic Cancer

The 1st Annual School of Gastrointestinal Oncology™ (SOGO™), which was held April 23, 2016, presented the latest data on the multidisciplinary management of patients with gastrointestinal cancers, including colorectal cancer, gastric cancer, pancreatic cancer, hepatocellular carcinoma, and others. This third of 3 PER Pulse™ Recaps from SOGO™ centers on a debate held by Michael Choti, MD, MBA, and Douglas Evans, MD on whether radiation should be added to neoadjuvant chemotherapy for pancreatic cancer.

Dr Evans presented evidence for the use of neoadjuvant radiation, saying it has been unfairly abandoned because of the ESPAC-1 trial, which claimed inferior survival of patients receiving chemoradiation compared with chemotherapy alone. ESPAC-1 was poorly designed and conducted, having no requirement for preoperative imaging or postoperative staging, no reporting of resection margins, and 12%-17% of enrolled patients were not analyzed.

Dr Evans provided 2 reasons for using neoadjuvant chemoradiation:

  1. Some patients are not healthy enough for adjuvant chemotherapy, so neoadjuvant radiation therapy is preferable.
  2. There is evidence that radiation therapy reduces local recurrence rate versus no radiation therapy.

Dr Choti, who argued for the use of neoadjuvant chemotherapy alone, offered the following arguments:

  1. Radiation is effective at "mopping up" local disease left behind from improperly performed surgeries, but when surgeries are performed correctly, recurrence is typically distant.
  2. Radiation therapy can only address one of several rationales for neoadjuvant therapy in pancreatic cancer: sterilization of the tumor periphery, allowing increased R0 (margin-negative) resection (the other 4 rationales are related to systemic therapy).
  3. Although the surgical quality of ESPAC-1 was poor, that should have increased the need for radiation therapy and highlighted its usefulness, which the study failed to do.


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 educational grants from Celgene, Lilly, Sirtex, and Taiho Oncology, Inc.

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





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