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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 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support

This activity is supported by educational grants from EMD Serono, Inc. and Pfizer, Inc.

Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours


Release Date: November 9, 2018
Expiration Date: November 9, 2019
Media: Internet - based

Activity Overview

This activity, Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours, will provide you with clinically important information about immune checkpoint inhibitors (ICPis) that you can use in the management of your patients with solid tumours. Listen to experts as they share clinical pearls regarding the incorporation of ICPis into their clinics. Topics will include the rationale for use of these agents, current and emerging strategies for selecting patients who can benefit from this approach, and placement of current data sets into the context of the treatment landscape. Moreover, you’ll learn about the identification, recognition, and management of immune-related toxicities. Start now to gain insights into this cutting-edge treatment approach.

Benefits of Completing Activity

Benefits of participating in the online activity, Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours:

  • Enhanced understanding of why immune checkpoint inhibitors (ICPis) are clinically important across a wide range of tumour types
  • Improved competence of integrating ICPis into the management of your patients with solid tumours
  • Increased ability to incorporate appropriate strategies to mitigate immune-related adverse events associated with ICPis
  • Deepened knowledge of the clinical data sets supporting the use of ICPis, including in the management of brain metastases and as a part of combination approaches

Acknowledgement of Commercial Support

This activity is supported by educational grants from EMD Serono, Inc. and Pfizer, 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 program is directed toward US & Ex-US medical oncologists, surgeons, pharmacists, physician assistants, and oncology nurses who treat or are involved in the treatment of patients with cancer.

Educational Objectives

Upon completion of this activity, you should be better prepared to:

  • Describe the rationale for the application of immunotherapeutic strategies to the management of solid tumors
  • Discuss biomarkers and patient characteristics which may be used to identify patients who may benefit from the use of a checkpoint inhibitor, or be eligible for clinical trials evaluating novel immunotherapeutic strategies
  • Apply clinical trial evidence to manage a variety of solid tumors in the context of evolving single-agent and combination immunotherapeutic strategies, including how these data may inform sequencing decisions
  • Utilize evidence from clinical trials and practical experience to proactively identify and mitigate the impact of immune-related adverse events (irAEs) among patients who receive immunotherapeutic approaches to treat their cancer

Faculty, Staff, and Planners' Disclosures

Faculty

Caroline Robert, MD, PhD
Head, Dermatology Unit
Department of Medicine
Gustave Roussy and Paris Sud University
Villejuif Grand-Paris, France
 

Disclosure: Consultant/Advisory Boards: Bristol-Myers Squibb, Novartis, Roche, Amgen, Merck, Pierre Fabre

Laurence Albiges, MD, PhD
Head, Genito-urinary Tumor Unit
Department of Cancer Medicine
Gustave Roussy
Villejuif Grand-Paris, France
 

Disclosure: Advisory Board: Novartis, Amgen, Bristol-Myers Squibb, Ipsen, Roche, Pfizer, Astellas, Merck

The staff of Physicians’ Education Resource®, LLC 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™ Recaps

1 of 3
PER Pulse™ Recap


The online continuing medical education (CME) activity, Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours, featured 2 renowned oncologists, Caroline Robert, MD, PhD, and Laurence Albiges, MD, PhD, discussing recent advances and best practices with immune checkpoint inhibitor (ICPi) therapy for patients with solid tumours. This activity includes video clips of the expert faculty, in which they share their insights regarding the usefulness of this approach, as well as their expertise in the management of patients receiving ICPi therapy.
 
This first of 3 PER Pulse™ Recaps reviews the use of ICPi therapy for patients with metastatic melanoma. Below are some highlights from the activity, featuring video clips from Prof. Robert:

  • Melanoma, which historically has had few treatment options, was the first tumour type to receive an indication for ICPi, with the approval of the CTLA-4 inhibitor ipilimumab by the US Food and Drug Administration (FDA) and the European Commission (EC) in 2011, and the Japan Ministry of Health, Labor and Welfare in 2015.
  • The addition of nivolumab to ipilimumab in a randomized study of 142 patients with untreated advanced melanoma showed significant improvements in both objective response rate (ORR) and progression-free survival (PFS; both P <.001). Moreover, prolonged overall survival was reported in patients receiving this combination compared with ipilimumab alone in the CheckMate 067 trial in a similar population of patients with untreated advanced melanoma (37.6 vs 19.9 months; P <.001).
    • The interim results of this trial, showing improvements in ORR and PFS with the combination (P <.001), led to FDA approval of frontline nivolumab plus ipilimumab in patients with advanced melanoma.
    • Prof. Robert explained that, while the improved outcomes with the combination therapy are attractive, they must be balanced by the increased toxicity of the combination, which sometimes can be serious and/or permanent. She shared that she provides careful patient education about the risks and benefits, and she offers the combination to patients who find the risk-versus-benefit profile acceptable, have good performance status and are likely to tolerate the increased toxicity of the combination regimen.
  • Ipilimumab has also been combined with the oncolytic virus, talimogene laherparepvec (T-VEC), which works by infecting and killing tumour cells, and is already approved as a single agent in metastatic melanoma by both the FDA and the EC. In a phase II trial of advanced melanoma, ipilimumab plus T-VEC showed significant improvement in ORR compared with ipilimumab alone (39% vs 18%; P =.002).
    • Prof. Robert said that she and other melanoma experts are looking forward to the results of a phase III trial testing pembrolizumab plus T-VEC in advanced melanoma (NCT02263508).
  • Finally, recent studies have shown promising results with ICPis in the control of intracranial tumours. In a phase II trial of metastatic melanoma, neurologically asymptomatic patients treated with ipilimumab had a disease control rate of 24% in the brain and 27% outside of the brain. Moreover, in a recent study of nivolumab and ipilimumab in patients with neurologically asymptomatic melanoma and at least 1 brain metastasis, the rate of intracranial ORR was 56%, including 26% complete responses.
    • Prof. Robert discussed her approach of using ICPi therapy to treat patients with BRAF wild-type melanoma with multiple brain metastases. Furthermore, she disclosed that she has had promising success with this approach, including some patients treated with immunotherapy who have lived for years free of their brain metastases.  


2 of 3
PER Pulse™ Recap

 
The online continuing medical education (CME) activity, Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours, featured 2 renowned oncologists, Caroline Robert, MD, PhD, and Laurence Albiges, MD, PhD, discussing recent advances and best practices with immune checkpoint inhibitor (ICPi) therapy for patients with solid tumours. This activity includes video clips of the expert faculty, in which they share their insights regarding the usefulness of this approach, as well as their expertise in the management of patients receiving ICPi therapy.
 
This second of 3 PER Pulse™ Recaps reviews the use of ICPi therapy for patients with metastatic renal cell carcinoma (RCC). Below are some highlights from the activity, featuring video clips from Dr. Albiges:

  • In the United States, nivolumab plus ipilimumab is approved for use in intermediate- or poor-risk, untreated advanced RCC, based on its improvement in overall survival (OS) in the CheckMate 214 trial against the then-standard-of-care (SoC) therapy, sunitinib (hazard ratio [HR], 0.63; P <.001).
    • Dr. Albiges pointed out that, while this indication is not yet approved in Europe, all of the guidelines for the treatment of advanced RCC—both in the United States and in Europe—classify this combination as the new frontline SoC for patients with intermediate- or poor-risk RCC.
  • 3 additional phase III ICPi-containing combination regimens may change the treatment landscape for RCC in the near future:
    • The IMmotion151 trial combined ICPis with angiogenesis inhibition. In this frontline metastatic RCC trial, atezolizumab plus bevacizumab produced a significant improvement in progression-free survival (PFS) compared with sunitinib in both the overall population (HR, 0.83; P =.0219) and in the PD-L1–positive subgroup (HR, 0.74; P =.0217).
    • Another trial, JAVELIN Renal 101, combined the PD-L1 inhibitor avelumab with the tyrosine kinase inhibitor axitinib compared with sunitinib monotherapy in frontline advanced RCC. The combination produced a significant improvement in PFS in both the overall population (HR, 0.69; P =.0001) and in the PD-L1–positive subgroup (HR, 0.61; P <.0001). 
    • A similar trial, KEYNOTE-426, using pembrolizumab plus axitinib compared with sunitinib monotherapy in first-line RCC, reported positive results in a recent press release, citing significant improvements in both PFS and OS with the combination regimen.
    • Dr. Albiges listed other ICPi-containing regimens of interest that are under investigation for RCC, including cabozantinib plus nivolumab and lenvatinib plus pembrolizumab.


3 of 3
PER Pulse™ Recap

  
The online continuing medical education (CME) activity, Advances in™ Immuno-Oncology: Considerations for the Use of Checkpoint Inhibitors Across Solid Tumours, featured 2 renowned oncologists, Caroline Robert, MD, PhD, and Laurence Albiges, MD, PhD, discussing recent advances and best practices with immune checkpoint inhibitor (ICPi) therapy for patients with solid tumours. This activity includes video clips of the expert faculty, in which they share their insights regarding the usefulness of this approach, as well as their expertise in the management of patients receiving ICPi therapy.
 
This third of 3 PER Pulse™ Recaps reviews the management of immune-related adverse events (irAEs) in patients receiving ICPi therapy. Below are some highlights from the activity, featuring video clips from both Prof. Robert and Dr. Albiges:

  • Disruption of the ICP molecules’ role in the maintenance of immunologic homeostasis is believed to promote autoimmune-like, T-cell–mediated toxicities that negatively impact a variety of organ systems, including dermatologic, gastrointestinal (GI), endocrine, and pulmonary systems.
  • Most irAEs develop within 12 weeks of treatment initiation, but the onset of some AEs can be delayed for many months. The irAEs are generally reversible with proper management, and while the majority are grade 1 or grade 2 in intensity, some can be severe or even fatal.
  • Use of ICPis can result in common toxicities, such as rash, pruritus, diarrhea, colitis, hypophysitis, and thyroiditis.
    • Prof. Robert pointed out the need to rapidly rule out infection as the cause of a toxicity in patients on ICPi therapy, and cited the very different management approaches of immune-related colitis (in which steroid therapy would be used) versus infectious colitis (in which steroids would need to be avoided). She also stressed the importance of consulting with a gastroenterologist in severe cases of GI toxicity.
    • She added that debilitating fatigue sometimes occurs in patients taking ICPi therapy and is currently difficult to manage.
  • Because of the wide spectrum of irAEs across so many organ systems, some of which may be severe and/or permanent, Dr. Albiges stressed 2 points: (1) patients need to be educated on the critical need to immediately report any new clinical symptoms so that oncologists can determine the necessary course of action; and (2) oncologists should surround themselves with appropriate specialists, such as endocrinologists and neurologists, in order to appropriately and efficiently manage these irAEs.
  • Both Prof. Robert and Dr. Albiges pointed to neurological irAEs as among the most challenging irAEs to manage. Prof. Robert specifically called out Guillain-Barré syndrome, whereas Dr. Albiges mentioned both fatigue and asthenia.

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