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 1.0 AMA PRA Category 1 Credit™. 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 AstraZeneca and Celgene Corporation.

Clinical Vignettes™: Addressing Challenging Clinical Scenarios in Lung Cancer

Release Date: December 24, 2019
Expiration Date: December 24, 2020
Media: Internet - based

Activity Overview

Clinical decision-making for management of patients with lung cancer has changed dramatically over the past few years, with guideline updates every few months and new therapies rapidly transforming treatment paradigms. With recent approvals of targeted and immunotherapeutic strategies, community oncologists face compounding complexity in the decision-making process each time they consider treatment options— and their associated adverse event profiles—for their patients with lung cancer.

This online Clinical Vignette Series educational activity consists of clinical cases and video clips featuring short, expert interviews with oncologists providing evidence-based guidance and perspectives on lung cancer management. This activity will discuss therapeutic decision-making for patients with unresectable stage III NSCLC, metastatic NSCLC with or without actionable mutations, and extensive-stage small-cell lung cancer. The overarching goal of this program is to offer you expert opinions on typical patients with lung cancer that you can integrate immediately into your practice.

Benefits of Participating

By participating in this program, you will learn:

  • How experts approach treatment decisions for a wide range of lung cancer cases
  • How to apply new clinical trial data to guide treatment decisions
  • How to proactively identify and mitigate toxicities related to systemic lung cancer therapies
  • How to optimize outcomes for your patients with lung cancer through informed treatment planning

Acknowledgement of Commercial Support

This activity is supported by educational grants from AstraZeneca and Celgene Corporation.

Instructions for This Activity and Receiving Credit

  • You will need to log in 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 video/content until you finish the presentation.
  • At the end of the activity, “Educational Content/Videos” will be available for your reference.
  • In order to receive a CME Certificate, you 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.” You may immediately download a CME Certificate upon completion of these steps.

Target Audience

This educational activity is directed toward medical oncologists, radiation oncologists, thoracic surgeons, and pulmonologists involved in the treatment and management of patients with lung cancer. Fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other healthcare professionals interested in the treatment of lung cancer may also participate.

Learning Objectives

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

  • Apply key data sets that require consideration in the management of real-world clinical scenarios encountered in the management of lung cancers
  • Detail methods to identify, manage, and proactively mitigate the impact of treatment-related toxicities on outcomes in the management of lung cancer cases
  • List key planned/ongoing clinical trials in the field investigating emerging strategies for the care of patients with lung cancers

Faculty, Staff, and Planners’ Disclosures

Faculty

Mark G. Kris
Mark G. Kris, MD
Attending Physician, Thoracic Oncology Service
William and Joy Ruane Chair in Thoracic Oncology
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Consultant: AstraZeneca, Pfizer; Other: Travel: AstraZeneca, Genentech.

Alexander E. Drilon
Alexander E. Drilon, MD
Clinical Director, Early Drug Development Service
Associate Attending Physician, Thoracic Oncology Service
Memorial Sloan Kettering Cancer Center
New York, NY

Disclosures: Consultant: Medscape, OncLive®, PeerVoice, Tyra Biosciences, Targeted Oncology™, MORE Health, Foundation Medicine, PeerView, AstraZeneca, Genentech/Roche, Bayer, Ignyta, Loxo Oncology, TP Therapeutics, Pfizer, Blueprint Medicines, Takeda, Helsinn Therapeutics, BeiGene, Hengrui Therapeutics, Exelixis, Wolters Kluwer, PharmaMar.

Roy S. Herbst
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 Cancer Center Director for Translational Research
Yale School of Medicine
New Haven, CT

Disclosures: Grant Research Support: AstraZeneca, Eli Lilly and Company, Merck and Company; Consultant: AbbVie Pharmaceuticals, ARMO BioSciences, AstraZeneca, Biodesix, Bristol-Myers Squibb, Eli Lilly and Company, EMD Serono, Genentech/Roche, Genmab, Halozyme Therapeutics, Heat Biologics, Infinity Pharmaceuticals, Loxo Oncology, Merck and Company, Nektar, Neon Therapeutics, NextCure, Novartis, Pfizer, Sanofi, Seattle Genetics, Shire PLC, Spectrum Pharmaceuticals, Symphogen, Tesaro, Tocagen; Other: Junshi Biosciences, Board of Directors (nonexecutive/independent).

The staff of Physicians' Education Resource®, LLC (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 activities. In compliance with ACCME guidelines, PER® requires everyone who is in a position to control the content of a CME 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 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 activity is for continuing medical education purposes only and is not meant to substitute for the independent clinical judgment of a physician relative to diagnostic or treatment 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 the company that provided commercial support.

PER Pulse™ Recaps

1 of 3

Clinical Vignettes™: Addressing Challenging Clinical Scenarios in Lung Cancer is a continuing medical education (CME)-certified program. For this program, Mark G. Kris, MD; Alexander E. Drilon, MD; and Roy S. Herbst, MD, PhD, provide expert guidance and perspectives in a case-based discussion on lung cancer management.

This first of 3 PER Pulse™ Recaps summarizing the online activity focuses on therapeutic decision-making for patients with metastatic squamous non–small cell lung cancer (NSCLC) without actionable mutations. Below are some highlights from the activity featuring Dr Mark Kris.

  • Two anti–PD-1/PD-L1 agents, pembrolizumab and atezolizumab, have been approved as first-line treatment of advanced NSCLC
  • Pembrolizumab monotherapy is approved for patients with PD-L1 expression ≥50% and with chemotherapy in patients with PD-L1 >1% and either squamous or nonsquamous histology1-3
  • Atezolizumab is approved in combination with bevacizumab and carboplatin/paclitaxel and in combination with nab-paclitaxel and carboplatin in patients with previously untreated, metastatic, nonsquamous NSCLC regardless of PD-L1 expression4,5
  • In a phase III trial, nab-paclitaxel had efficacy equivalent to paclitaxel in patients with nonsquamous histology, and efficacy superior to paclitaxel in those with squamous histology6

“Albumin-bound paclitaxel does not contain the allergy-causing solvents that are found in paclitaxel, which means the risk of hypersensitivity reactions is virtually zero. Those of you who practice oncology know how disruptive hypersensitivity reaction is: It is absolutely frightening to the patient and their family. It is absolutely frightening to the nursing staff who are trying to care for and comfort patients, and it’s frightening to the oncologists as well.”
— Mark Kris, MD

References

  1. Reck M, Rodríguez-Abreu D, Robinson AG, et al; KEYNOTE-024 Investigators. Pembrolizumab versus chemotherapy for PD-L1–positive non–small-cell lung cancer. N Engl J Med. 2016;375(19):1823-1833. doi: 10.1056/NEJMoa1606774.
  2. Paz-Ares L, Luft A, Vicente D, et al; KEYNOTE-407 Investigators. Pembrolizumab plus chemotherapy for squamous non–small-cell lung cancer. N Engl J Med. 2018;379(21):2040-2051. doi: 10.1056/NEJMoa1810865.
  3. Gandhi L, Rodríguez-Abreu D, Gadgeel S, et al; KEYNOTE-189 investigators. Pembrolizumab plus chemotherapy in metastatic non–small-cell lung cancer. N Engl J Med. 2018;378(22):2078-2092. doi: 10.1056/NEJMoa1801005.
  4. Socinski MA, Jotte RM, Cappuzzo F, et al; IMpower150 Study Group. Atezolizumab for first-line treatment of metastatic nonsquamous NSCLC. N Engl J Med. 2018;378(24):2288-2301. doi: 10.1056/NEJMoa1716948.
  5. West H, McCleod M, Hussein M, et al. Atezolizumab in combination with carboplatin plus nab-paclitaxel chemotherapy compared with chemotherapy alone as first-line treatment for metastatic nonsquamous non–small-cell lung cancer (IMpower130): a multicentre, randomised, open-label, phase 3 trial. Lancet Oncol. 2019;20(7):924-937. doi: 10.1016/S1470-2045(19)30167-6.
  6. Socinski MA, Bondarenko I, Karaseva NA, et al. Weekly nab-paclitaxel in combination with carboplatin versus solvent-based paclitaxel plus carboplatin as first-line therapy in patients with advanced non–small-cell lung cancer: final results of a phase III trial. J Clin Oncol. 2012;30(17):2055-2062. doi: 10.1200/JCO.2011.39.5848.

2 of 3

Clinical Vignettes™: Addressing Challenging Clinical Scenarios in Lung Cancer is a continuing medical education (CME)-certified program. For this program, Mark G. Kris, MD; Alexander E. Drilon, MD; and Roy S. Herbst, MD, PhD, provide expert guidance and perspectives in a case-based discussion on lung cancer management.

This second of 3 PER Pulse™ Recaps summarizing the online activity focuses on therapeutic decision-making for patients with EGFR-mutated metastatic NSCLC. Below are some highlights from the activity featuring Dr Roy Herbst:

  • Results from the phase III FLAURA trial have demonstrated superiority of a third-generation EGFR tyrosine kinase inhibitor (TKI), osimertinib, over gefitinib and erlotinib in patients with previously untreated EGFR-mutated NSCLC1,2
  • Median progression-free survival (PFS) was prolonged by more than 8 months for patients treated with osimertinib compared with gefitinib or erlotinib (18.9 vs 10.2 months)
  • Median overall survival (OS) was significantly longer in the osimertinib arm versus the comparator arm (38.6 versus 31.8 months)

“In the United States where we have the full approval, we use osimertinib in the frontline setting. Why not use the best drug which produces the best PFS and OS? And it’s the most well tolerated as first-line therapy for this disease.”
— Roy Herbst, MD, PhD

References

  1. Soria JC, Ohe Y, Vansteenkiste J, et al; FLAURA Investigators. Osimertinib in untreated EGFR-mutated advanced non–small-cell lung cancer. N Engl J Med. 2018;378(2):113-125. doi: 10.1056/NEJMoa1713137.
  2. Ramalingam SS, Vansteenkiste J, Planchard D, et al; FLAURA Investigators. Overall survival with osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med. 2020;382(1):41-50. doi: 10.1056/NEJMoa1913662.

3 of 3

Clinical Vignettes™: Addressing Challenging Clinical Scenarios in Lung Cancer is a continuing medical education (CME)-certified program. For this program, Mark G. Kris, MD; Alexander E. Drilon, MD; and Roy S. Herbst, MD, PhD, provide expert guidance and perspectives in a case-based discussion on lung cancer management.

This third of 3 PER Pulse™ Recaps summarizing the online activity focuses on therapeutic decision-making for patients with unresectable stage III NSCLC. Below are some highlights from the activity featuring Dr Mark Kris:

  • In the phase III PACIFIC trial, median overall survival (OS) remained not reached at ~3 years for patients who had received 1 year of durvalumab following concurrent chemoradiation therapy versus 29 months with placebo1,2
  • At 3 years, 57% of patients treated with durvalumab and 44% with placebo were still alive1,2
  • Since its approval for unresectable stage III NSCLC, durvalumab after concurrent chemoradiation has become the standard of care for this patient population3

“At the conclusion of chemotherapy and radiation, there’s really only one treatment, and that’s durvalumab. People should get 1 year of durvalumab, and I believe that’s become a worldwide standard of care already.”
— Mark Kris, MD

References

  1. Antonia SJ, Villegas A, Daniel D, et al; PACIFIC Investigators. Overall survival with durvalumab after chemoradiotherapy in stage III NSCLC. N Engl J Med. 2018;379(24):2342-2350. doi: 10.1056/NEJMoa1809697.
  2. Gray JE, Villegas AE, Daniel DB, et al. Three-year overall survival update from the PACIFIC trial. J Clin Oncol. 2019;37(15 suppl; abstract 8526). doi: 10:1200/JCO.2019.37.15_suppl.8526.
  3. NCCN Clinical Practice Guidelines in Oncology. Non-Small Cell Lung Cancer, version 2.2020. National Comprehensive Cancer Network website. nccn.org/professionals/physician_gls/pdf/nscl.pdf. Published December 23, 2019. Accessed January 2, 2020.

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