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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 2.0 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 an educational grant from AstraZeneca.

Emerging Immuno-Oncology Strategies and Combinations

Release Date: October 31, 2017
Expiration Date: October 31, 2018
Media: Internet - based

 

Activity Overview

This Clinical Interchange™ features an expert panel discussion of noteworthy clinical data on immune checkpoint inhibitors. Practice-changing data and emerging immunotherapeutic strategies for cancers of the lung, head and neck, and bladder are summarized, along with expert discussions on the clinical application of these data and the evolving landscape of selective biomarkers. This program also includes a case-based discussion on the management of immune-related adverse events.

Acknowledgment of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

CME Activity Table of Contents

  • Introduction and Background of Immunotherapy
  • Segment 1: Evolving Treatment Paradigms With the Use of Immuno-Oncology Strategies for the Management of Non–Small Cell Lung Cancer
  • Segment 2: Clinical Applications of Immuno-Oncology in the Multimodal Management of Head and Neck Squamous Cell Carcinoma
  • Segment 3: How Immuno-Oncology Strategies Are Changing Treatment Paradigms in Bladder Cancer
  • Segment 4: What Have We Learned About the Biomarkers and Resistance?
  • Segment 5: Case-Based Panel Discussion: Managing Patients and Toxicities/Closing Remarks

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 CMEcertificate, 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 certificate upon completion of these steps.

Target Audience

This educational activity is directed toward medical oncologists and fellows who treat patients with cancer. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals are also invited to participate.

Educational Objectives

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

  • Explain clinically unmet needs in the management of non–small cell lung cancer, head and neck squamous cell carcinoma (HNSCC), and bladder cancer
  • Describe how the immune system can be harnessed to treat cancer and the mechanistic rationale for the application of checkpoint inhibition strategies to target specific solid tumors
  • Interpret recent findings from clinical trials conducted with immuno-oncology strategies for the treatment of lung cancer, HNSCC, and bladder cancer
  • Describe the current status of biomarkers as a method to personalize care with the use of immuno-oncology strategies
  • Evaluate methods to mitigate treatment-related toxicities via proactive mitigation and management of immune-related adverse events (irAEs)

Faculty, Staff, and Planners' Disclosures

Chair

Roy S. Herbst, MD, PhD
Ensign Professor of Medicine (Medical Oncology)
Professor of Pharmacology
Chief of Medical Oncology
Yale Cancer Center and Smilow Cancer Hospital
Associate Director for Translational Research
Yale Cancer Center
Yale School of Medicine
New Haven, CT

Disclosure: Grant/Research Support: Genentech, Merck. Consultant: AstraZeneca, Eli Lilly, Genentech/Roche, Merck, Pfizer

Faculty

Hossein Borghaei, DO, MS
Chief, Division of Thoracic Medical Oncology
Fox Chase Cancer Center
Philadelphia, PA
 
 

Disclosure: Grant/Research Support: Millennium, Celgene, Merck. Consultant: BMS, Lilly, Pfizer, AstraZeneca, Novartis, Celgene, Genentech, EMD-Serono, Merck, Trovagene. Other Support: DSMB for University of Pennsylvania.

Daniel Petrylak, MD
Professor of Medicine (Medical Oncology) and of Urology
Co-Director, Signal Transduction Research Program
Director, Prostate and GU Medical Oncology
Director, Prostate Cancer Translational Research Group
Yale Cancer Center
New Haven, CT

Disclosure: Grant/Research Support: Oncogenix, Progenics, Johnson & Johnson, Merck, Millennium, Celgene, Dendreon, Sanofi, Agensys, Eli Lilly, Roche Laboratories. Consultant: Bayer, Bellicum, Dendreon, Sanofi Aventis, Johnson & Johnson, Exelixis, Ferring, Millennium, Medivation, Pfizer, Roche Laboratories, Tyrne Pharmaceuticals. Stock/ Shareholder: Bellicum, Tyme

Tanguy Seiwert, MD
Medical Oncologist
Assistant Professor of Medicine
The University of Chicago Medicine
Chicago, IL
 

Disclosure: Honoraria: Amgen, AstraZeneca, BMS, Eisai, Eli Lilly, Merck, EMD-Serono, Innate, Jounce

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 CMEactivities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CMEactivity 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 CMEactivity 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 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)

Immunotherapeutic Strategies for Patients With Advanced Bladder Cancer
 
This first of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with advanced bladder cancer.
 
Several antibodies to PD-1 or PD-L1 have been approved for patients with advanced bladder cancer (Table). These approvals are notable because they occurred in the span of approximately 1 year.
 
Table. Approved Immune Checkpoint Inhibitors in Advanced Bladder Cancer
Setting Antibodies (in alphabetical order)
First-line, cisplatin ineligible
  • Atezolizumab
  • Pembrolizumab
Cisplatin pretreated
  • Atezolizumab
  • Avelumab
  • Durvalumab
  • Nivolumab
  • Pembrolizumab
 
Future directions in bladder cancer include combination regimens, such as a combined immune checkpoint blockade that is being explored in the DANUBE trial, and immunotherapy with chemotherapy being investigated in the IMvigor130 study. Immunotherapy in the adjuvant setting is also under investigation. Additionally, antiangiogenic agents have demonstrated activity in patients with platinum-pretreated disease: in the phase III RANGE trial, the addition of ramucirumab to docetaxel demonstrated an improvement in progression-free survival compared with placebo plus docetaxel (4.07 vs 2.76 months; P = .0118).
 
For additional commentary about this topic and the Clinical Interchange: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations Across Lung, Head and Neck, and Bladder Cancers symposium, please visit www.gotoper.com.


PER Pulse Recap (2 of 3)

Immunotherapeutic Advances in Non–Small Cell Lung Cancer
 
This second of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with NSCLC.
 
In patients with newly diagnosed metastatic NSCLC, immunotherapy is now standard of care in patients with a PD-L1 expression level ≥50%, based on the phase III KEYNOTE-024 trial results. Updated results continue to show superior overall survival (OS) with pembrolizumab compared with chemotherapy (30.0 vs 14.2 months; P = .002). For patients with nonsquamous histology, pembrolizumab with carboplatin/pemetrexed is also an option regardless of PD-L1 expression, based on the phase II KEYNOTE-021 trial results. Immunotherapy has also demonstrated efficacy in patients with locally advanced NSCLC: in the phase III PACIFIC trial, durvalumab improved progression-free survival (PFS) compared with placebo in patients with unresectable stage III NSCLC who did not experience disease progression following concurrent chemoradiation therapy (16.8 vs 5.6 months; P < .001).
 
Combination immunotherapy has demonstrated activity in early-phase trials in patients with NSCLC and is currently under investigation in phase III trials. Simultaneous blockade of PD-L1 and CTLA-4 is being investigated in the MYSTIC and CheckMate 227 trials. Full results of these trials are to come; the MYSTIC trial did not meet its PFS endpoint, but is continuing to evaluate the co-primary endpoint of OS.
 
For additional commentary about this topic and the Clinical Interchange: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations Across Lung, Head and Neck, and Bladder Cancers symposium, please visit www.gotoper.com.


PER Pulse Recap (3 of 3)

Immunotherapeutic Approaches in Head and Neck Cancer
 
This third of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with HNSCC.
 
For patients with platinum-pretreated recurrent or metastatic HNSCC, 2 anti–PD-1 antibodies, pembrolizumab and nivolumab, are approved as treatment. Pembrolizumab received accelerated approval based on the phase Ib KEYNOTE-012 trial results. The subsequent phase III KEYNOTE-040 trial of pembrolizumab versus single-agent therapy showed a trend toward improved overall survival (OS) with pembrolizumab; however, statistical significance was not achieved due to a P <.0175 being required for significance. The phase III CheckMate 141 trial results did demonstrate an OS benefit with nivolumab compared with single-agent therapy, leading to full approval for nivolumab.
 
As in other tumor types, future directions for the investigation of immunotherapy in HNSCC include combinations and treating earlier stages of disease. The combination of anti–PD-L1 and anti–CTLA-4 antibodies as first-line therapy is being explored in the phase III CheckMate 651 and KESTREL studies. Inhibitors of indoleamine-pyrrole 2,3-dioxygenase, such as epacadostat, have demonstrated activity in combination with immune checkpoint inhibitors, and the phase III CheckMate 9NA/ECHO-310 trial is examining the combination of nivolumab, epacadostat, and platinum/5-fluorouracil as first-line therapy in patients with recurrent/metastatic HNSCC. Finally, trials such as KEYNOTE-412 and JAVELIN Head and Neck 100 are exploring the role of immunotherapy in patients with locally advanced disease.
 
For additional commentary about this topic and the Clinical Interchange: Translating Research to Inform Changing Paradigms: Assessment of Emerging Immuno-Oncology Strategies and Combinations Across Lung, Head and Neck, and Bladder Cancers symposium, please visit www.gotoper.com.







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