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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.

Physicians' Education Resource®, LLC is approved by the California Board of Registered Nursing, Provider #16669 for 2.0 Contact Hours.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

Community Practice Connections™: Evolving Applications of Immuno-Oncology Strategies: New Approaches, New Combinations, and New Ways to Care for Lung, Head and Neck, and Bladder Cancers

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

 

Activity Overview

Evolving Applications of Immuno-Oncology Strategies: New Approaches, New Combinations, and New Ways to Care for Lung, Head and Neck, and Bladder Cancers features a summary of clinical evidence guiding best practices in the use of immunotherapies for the treatment of patients with solid tumors. Key data leading to approval of immunotherapies will be presented, along with future directions, including combinations, new immunotherapeutic targets, and the investigation of immunotherapy in earlier stages of disease. Approaches to the mitigation and management of immune-related adverse events will also be discussed. Interactive clinical vignettes are followed by short video interviews with leading experts in the management of patients with lung, head and neck, and bladder cancer. The video interviews address decision points in the clinical vignettes, as well as questions commonly faced in the community oncology practice setting.

Acknowledgement of Commercial Support

This activity is supported by an educational grant from AstraZeneca.

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 activity is directed toward medical oncologists. Nurse practitioners, nurses, physician assistants, pharmacists, researchers, and other health care professionals interested in the treatment of cancer are also invited to participate.

Learning Objectives

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

  1. Detail specific anti–CTLA-4, anti–PD-1, and anti–PD-L1 mechanistic approaches in the context of their developmental rationale to target solid tumors
  2. Apply evidence on single-agent/combination immuno-oncology strategies, and explain their impact on decision making in the evolving fields of lung cancer, head and neck squamous cell cancer (HNSCC), and bladder cancer
  3. Delineate practical methods to individualize the application of immuno-oncology strategies based on PD-L1 testing results
  4. Develop multidisciplinary action steps to proactively mitigate the impact of immune-related adverse events in patients who receive checkpoint inhibitors for the treatment of non–small cell lung cancer (NSCLC), HNSCC, and bladder cancer

Faculty, Staff, and Planners' Disclosures

Faculty

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

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

Julie R. Brahmer, MD, MSc
Interim Director, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Bayview Campus
Associate Professor of Oncology
Sidney Kimmel Comprehensive Cancer Center
Baltimore, MD

Disclosure: Grant Research Support: Bristol-Myers Squibb, MedImmune/AstraZeneca, Merck; Consultant: Bristol Myers Squibb (uncompensated), Celgene, Eli Lilly, Merck

Robert L. Ferris, MD, PhD
UPMC Endowed Professor and Chief
Division of Head and Neck Surgery
Associate Director for Translational Research
Co-Leader, Cancer Immunology Program
Co-Director, Tumor Microenvironment Center
University of Pittsburgh Cancer Institute
Pittsburgh, PA

Disclosure: Grant Research Support: AstraZeneca/MedImmune, Bristol-Myers Squibb, Merck, VentiRx Pharmaceuticals; Other: Amgen, AstraZeneca/MedImmune, EMD Serono, Eli Lilly, Merck, Pfizer

Daniel P. Petrylak, MD
Professor of Medicine (Medical Oncology) and Urology
Director, Prostate and GU Medical Oncology
Director, Prostate Cancer Translational Research Group
Yale Cancer Center
New Haven, CT

Disclosure: Grant Research Support: OncoGeneX, Progenics, Johnson & Johnson, Merck, Millennium Pharmaceuticals, Dendreon, sanofiaventis, Agensys, Eli Lilly, Roche Laboratories; Consultant: Bayer, Bellicum Pharmaceuticals, Dendreon, sanofi-aventis, Johnson & Johnson, Exelixis, Ferring, Millennium Pharmaceuticals, Medivation, Pfizer, Roche Laboratories, Tyme Technologies; Shareholder: Bellicum Pharmaceuticals, Tyme Technologies

Jeffrey S. Weber, MD, PhD
Deputy Director
Laura and Isaac Perlmutter Cancer Center
Professor of Medicine
NYU Langone Medical Center
New York, NY

Disclosure: Grant Research Support: Bristol-Myers Squibb, Novartis, GlaxoSmithKline, Merck, Amgen; Consultant: Bristol-Myers Squibb, Glaxo Smith-Kline, Merck, Genentech, AstraZeneca, EMD Serono, Amgen, Novartis; Shareholder: Celldex Therapeutics, CytomX Therapeutics

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 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 Recap™

PER Pulse Recap (1 of 3)

This first of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with NSCLC, as discussed by Dr Brahmer.
 
Recent approvals have established immune checkpoint inhibition as a first-line standard of care for patients with advanced NSCLC. Results of the phase III KEYNOTE-024 trial demonstrated superior efficacy with pembrolizumab compared with standard platinum-based chemotherapy in patients with a PD-L1 expression level of ≥50%. In patients with nonsquamous NSCLC, results of the randomized phase II KEYNOTE-21 study led to the approval of pembrolizumab plus carboplatin/pemetrexed as first-line therapy regardless of PD-L1 expression. The combination of pembrolizumab and chemotherapy is being explored further in the phase III KEYNOTE-189 trial. These 2 approvals come shortly after the approval of the checkpoint inhibitors nivolumab, pembrolizumab, and atezolizumab for patients with platinum-pretreated disease.
 
Other immunotherapy-based combinations are being explored. The combination blockade of PD-L1 and CTLA-4 has demonstrated activity in early phase trials and is in phase III investigation, including MYSTIC and CheckMate 227. In July 2017, it was reported that the MYSTIC trial did not meet the co-primary endpoint of progression-free survival (PFS); follow-up is ongoing to assess overall survival.
 
Additionally, immunotherapy is being assessed in earlier stages of disease. In May 2017, it was announced that the phase III PACIFIC trial examining immunotherapy in patients with stage III NSCLC met its primary endpoint of PFS; this trial randomized patients who did not progress after chemoradiation to receive either durvalumab or placebo. In the neoadjuvant setting, nivolumab has been explored in a phase II trial, with major pathologic responses observed.


PER Pulse Recap (2 of 3)

This second of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with bladder cancer, as discussed by Dr Petrylak.
 
In the span of approximately 1 year (May 2016 – May 2017), 5 immune checkpoint inhibitors were approved for patients with advanced bladder cancer. For patients who are not eligible for cisplatin-based therapy, atezolizumab and pembrolizumab were approved as initial therapy. In patients with cisplatin-treated disease, atezolizumab, nivolumab, durvalumab, avelumab, and pembrolizumab have been approved as single-agent therapy.
 
Combinations with immunotherapy are being investigated in phase III trials, including immunotherapy-immunotherapy (DANUBE) and immunotherapy-chemotherapy (IMvigor130). Furthermore, research in immunotherapy is extending to earlier stages of bladder cancer. The phase III IMvigor010 and CheckMate 274 trials will evaluate immunotherapy as adjuvant therapy following resection, while the phase I/II DUART trial is combining immunotherapy with radiation therapy in patients with unresectable, locally advanced bladder cancer.


PER Pulse Recap (3 of 3)

This third of 3 PER Pulse Recaps reviews key developments in immunotherapy for patients with HNSCC, as discussed by Dr Ferris.
 
Current approved immune checkpoint inhibitors in HNSCC are indicated for patients with platinum-pretreated, recurrent/metastatic (R/M) disease. Pembrolizumab received accelerated approval based on results from the phase Ib KEYNOTE-012 trial, while nivolumab received full approval based on overall survival data from the phase III CheckMate 141 trial comparing nivolumab to standard therapy (methotrexate, docetaxel, or cetuximab).
 
Future directions for the investigation of immunotherapy in HNSCC include the first-line setting in patients with R/M disease and the use of immunotherapy in earlier stages of disease. The phase III KESTREL and CheckMate 651 trials are comparing immunotherapy-immunotherapy combinations to platinum/5-fluorouracil/cetuximab (the standard EXTREME regimen). For patients with locally advanced disease, the phase III KEYNOTE-412 and JAVELIN Head and Neck 100 trials are evaluating the addition of immunotherapy to chemoradiation therapy.
 
For additional commentary about this topic and the Evolving Applications of Immuno-Oncology Strategies: New Approaches, New Combinations, and New Ways to Care for Lung, Head and Neck, and Bladder Cancers symposium, please visit www.gotoper.com.







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