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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.

Acknowledgement of Commercial Support

This activity is supported by educational grants from Exelixis, Inc., and Prometheus Laboratories Inc.

Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma


Release Date: August 30, 2018
Expiration Date: August 30, 2019
Media: Internet - based

Activity Overview

Clinical decision making in the setting of metastatic renal cell carcinoma (RCC) has dramatically changed in the past few years. Recent and pending approvals of new agents and combinations, as well as expanded indications, have raised questions about how rational treatment planning can be used to match the optimal strategy to the patient. At the same time, accumulating real-world experience with newer agents and emerging trial data continue to refine state-of-the-art care in RCC. Most recently, the frontline, metastatic, clear cell RCC setting has evolved with the introduction of new options and the prospect of administering initial therapy to patients who have already received an adjuvant tyrosine kinase inhibitor strategy. This activity is designed to address your key questions related to RCC management via discussion of data and real-world patient cases by a multidisciplinary faculty of internationally recognized experts in RCC. Adverse event management and future directions in the field are also addressed and considered throughout the program in the context of the program theme, to help you individualize patient care. Foremost, this program aims to provide you with cutting-edge practical guidance that can be applied immediately to your clinical practices.
 
This case-based educational activity features video interviews with renowned experts in RCC who share their perspectives on evidence-based state-of-the-art management strategies designed to meet the specific needs of oncologists who treat patients with genitourinary (GU) cancers. Throughout the activity, the faculty lead participants through an in-depth exploration of the latest data and their clinical implications.

Acknowledgement of Commercial Support

This activity is supported by educational grants from Exelixis, Inc., and Prometheus Laboratories 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 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 certificate upon completion of these steps.


Target Audience

This educational program is directed toward medical oncologists interested in the treatment of RCC. Nurse practitioners, physician assistants, nurses, and other healthcare professionals involved in the treatment and management of patients with RCC are also invited to participate.

Learning Objectives

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

  • Explain the biology and molecular genetics of RCC and the mechanistic rationale for targeted therapies
  • Evaluate practice-changing trials in RCC and the potential influence of recent clinical data on multiple lines of treatment for patients with metastatic RCC
  • Apply best practices to proactively identify and mitigate treatment-related toxicities in metastatic RCC
  • Integrate knowledge of patient characteristics and single-agent and combination strategies to inform treatment decisions that optimize outcomes for patients with metastatic RCC

Faculty, Staff, and Planners' Disclosures

Faculty

Toni K. Choueiri, MD
Director, Lank Center for Genitourinary Oncology
Director, Kidney Cancer Center
Senior Physician, Dana-Farber Cancer Institute
Jerome and Nancy Kohlberg Professor, Medicine, Harvard Medical School
Boston, MA

Disclosure: Grant/Research Support: AstraZeneca, Bristol-Myers Squibb, Exelixis, Genentech, GlaxoSmithKline, Merck, Novartis, Peloton Therapeutics, Pfizer, Roche, Tracon Pharmaceuticals, Eisai; Consultant: AstraZeneca, Bayer, Bristol-Myers Squibb, Cerulean Pharma, Eisai, Foundation Medicine Inc, Exelixis, Genentech, Roche, GlaxoSmithKline, Merck, Novartis, Peloton Therapeutics, Pfizer, Prometheus Laboratories, Corvus Pharmaceuticals, Ipsen Group.

Bernard Escudier, MD
Chair, Genitourinary Oncology Committee
Institut Gustave Roussy, Villejuif
Paris, France
 
 

Disclosure: Consultant: Bristol-Myers Squibb, Pfizer, Novartis, Ipsen Group, Roche

Robert A. Figlin, MD, FACP
Steven Spielberg Family Chair in Hematology Oncology
Professor of Medicine and Biomedical Sciences
Director, Division of Hematology/Oncology
Deputy Director, Integrated Oncology Service Line
Deputy Director, Samuel Oschin Comprehensive Cancer Institute
Cedars-Sinai Medical Center
Los Angeles, CA

Disclosure: Grant/Research Support: Peloton Therapeutics, Bristol-Myers Squibb, Argos Therapeutics, Exelixis, Merck; Consultant: Pfizer, CB Therapeutics.

Thomas Powles, MBBS, MRCP, MD
Clinical Professor of Genitourinary Oncology
Experimental Cancer Medicine Centre
Barts Cancer Institute
Barts and The London School of Medicine
London, UK

Disclosure: Grant/Research Support: AstraZeneca, Roche; Speaker’s Bureau: AstraZeneca, Roche, Bristol-Myers Squibb, Pfizer, Novartis, Exelixis, Ipsen Group, Eisai.

Brian I. Rini, MD, FACP
Professor of Medicine, Lerner College of Medicine
Leader, GU Program
Department of Hematology and Medical Oncology
Cleveland Clinic Taussig Cancer Institute
Cleveland, OH

Disclosure: Grant/Research Support: Pfizer, Merck, Genentech; Consultant: Merck, Pfizer.

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 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 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™

1 of 3

Insights from Brian Rini, MD—PER Pulse™ Recap: Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma

In this continuing medical education (CME)–certified activity, Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma, program chair, Toni K, Choueiri, MD, and expert faculty, including Bernard Escudier, MD; Robert A. Figlin, MD; Thomas Powles, MBBS, MRCP, MD; and Brian I. Rini, MD—discuss recent clinical data and treatment decisions in advanced renal cell carcinoma (RCC), based on clinical vignettes.

This first of 3 PER Pulse™ Recaps summarizing the online program focuses on evidence-based, practical guidance regarding clinical decision making for patients with high-risk, nonmetastatic RCC who then progress to metastatic clear cell RCC with good risk status by the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model.1,2 Below are some highlights from the activity featuring Dr Rini:

  • Discussion of Dr Rini’s approach toward a patient who presented with high-risk nonmetastatic RCC, which includes discussion and shared decision making with his patient about the relative risks and benefits of observation, adjuvant sunitinib, or enrollment in an adjuvant clinical trial
  • Overview of published results from trials of tyrosine kinase inhibitors as adjuvant therapy for high-risk RCC, including the positive S-TRAC trial3 of sunitinib and differences in the trial designs and populations that may have contributed to the negative results of the PROTECT, ASSURE, and ATLAS trials4-6 (eg, inadequate dosing)
  • His approach toward a patient with relatively indolent recurrence of kidney cancer 3 years after nephrectomy, with lung involvement—he considers whether the patient should be observed

“To summarize the adjuvant landscape, adequately dosed TKIs can reduce disease-free recurrence in patients at high risk after resection of their high-risk renal cancer. However, that relatively modest benefit comes at a cost of toxicity.”

 — Brian I. Rini, MD

References

  1. Heng DY, Xie W, Regan MM, et al. Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J Clin Oncol. 2009;27(34):5794-5799. doi: 10.1200/JCO.2008.21.4809.
  2. Heng DYC, Xie W, Regan MM, et al. External validation and comparison with other models of the International Metastatic Renal-Cell Carcinoma Database Consortium prognostic model: a population-based study. Lancet Oncol. 2013;14(2):141-148. doi: 10.1016/S1470-2045(12)70559-4.
  3. Ravaud A, Motzer RJ, Pandha HS, et al; S-TRAC Investigators. Adjuvant sunitinib in high-risk renal-cell carcinoma after nephrectomy. N Engl J Med. 2016;375(23):2246-2254. doi: 10.1056/NEJMoa1611406.
  4. Motzer RJ, Haas NB, Donskov F, et al; PROTECT investigators. Randomized phase III trial of adjuvant pazopanib versus placebo after nephrectomy in patients with locally advanced renal cell carcinoma. J Clin Oncol. 2017;35(35):2916-2923. doi: 10.1200/JCO.2017.73.5324.
  5. Haas NB, Manola J, Uzzo RG, et al. Adjuvant sunitinib or sorafenib for high-risk, non-metastatic renal-cell carcinoma (ECOG-ACRIN E2805): a double-blind, placebo-controlled, randomised, phase 3 trial. Lancet. 2016;387(10032):2008-2016. doi: 10.1016/S0140-6736(16)00559-6.
  6. Pfizer provides update on phase 3 trial of axitinib as adjuvant treatment for patients at high risk of renal cell carcinoma recurrence after surgery [news release]. New York, NY: Pfizer; April 10, 2018. press.pfizer.com/press-release/pfizer-provides-update-phase-3-trial-axitinib-adjuvant-treatment-patients-high-risk-re. Accessed July 24, 2018.

For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma.


2 of 3

Insights from Thomas Powles, MBBS, MRCP, MD—PER Pulse™ Recap: Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma

As a follow-up to this continuing medical education (CME)–certified activity, Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma, this second of 3 PER Pulse™ Recaps summarizing the online program focuses on evidence-based, practical guidance regarding clinical decision making for patients with poor-risk metastatic renal cell carcinoma (mRCC) who are eligible for nephrectomy, including discussion of recently approved first-line therapies and clinical trial results. Below are some highlights from the activity featuring Dr Powles:

  • Discussion of Dr Powles’ approach toward frontline treatment for a 65-year-old man who presents with poor-risk mRCC eligible for nephrectomy and important factors influencing treatment selection for this patient population
  • An overview of recently approved first-line agents for the treatment of poor- and intermediate-risk advanced RCC, including cabozantinib and combination nivolumab/ipilimumab
  • Recently reported results from the phase III noninferiority CARMENA trial that evaluated survival in patients with newly diagnosed mRCC who received sunitinib vs surgery followed by sunitinib, showing median overall survival of 18.4 months in the sunitinib-only arm and 13.9 months in the nephrectomy plus sunitinib arm1,2

“The immuno-oncology field has come into frontline space with immune combinations. They are slightly more difficult to give than single-agent immune therapy, with different toxicity profiles. And there is an important education piece for clinicians, supportive healthcare professionals, and importantly, the patients.”

 — Thomas Powles, MBBS, MRCP, MD

References

  1. Mejean A, Escudier B, Thezenas S, et al. CARMENA: cytoreductive nephrectomy followed by sunitinib versus sunitinib alone in metastatic renal cell carcinoma—results of a phase III noninferiority trial. Presented at: 2018 American Society of Clinical Oncology Annual Meeting; June 1-5, 2018; Chicago, IL. Abstract LBA3. abstracts.asco.org/214/AbstView_214_220283.html.
  2. Mejean A, Ravaud A, Thezenas S, et al. Sunitinib alone or after nephrectomy in metastatic renal-cell carcinoma. N Engl J Med. 2018;379(5):417-427. doi: 10.1056/NEJMoa1803675.

For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma.

3 of 3

Insights from Robert A. Figlin, MD—PER Pulse™ Recap: Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma

As a follow-up to this continuing medical education (CME)–certified activity, Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma, this third of 3 PER Pulse™ Recaps summarizing the online program focuses on evidence-based, practical guidance regarding clinical decision making for patients with advanced clear cell renal cell carcinoma (RCC) who have previously received first-line VEGF tyrosine kinase inhibitor (TKI) therapy. Below are some highlights from the activity featuring Dr Figlin:

  • Discussion of Dr Figlin’s approach toward treatment selection and sequencing through multiple lines of therapy for a 51-year-old man with advanced clear cell RCC who received first-line VEGF TKI therapy
  • A review of the challenges in selecting therapy across the disease continuum for advanced clear cell RCC and clinical gaps that need to be bridged by future research
  • Overview of key factors to consider with choosing therapy for this patient population, including current trial data, new first-line therapeutic options (eg, cabozantinib and nivolumab-ipilimumab), European and US guideline recommendations, treatment personalization, and tolerability (Figure)1-4

Figure.

“Although we don’t have a biomarker to predict, as with other tumors, whether it’s mutational burden or PD-L1 status in kidney cancer, I still think that immuno-oncology approaches are valid.”

 — Robert A. Figlin, MD

References

  1. FDA grants regular approval to Cabometyx for first-line treatment of advanced renal cell carcinoma. FDA website. www.fda.gov/drugs/informationondrugs/approveddrugs/ucm589842.htm. Updated December 19, 2017. Accessed August 3, 2018.
  2. FDA approves nivolumab plus ipilimumab combination for intermediate or poor-risk advanced renal cell carcinoma. FDA website. www.fda.gov/drugs/informationondrugs/approveddrugs/ucm604685.htm. Updated April 16, 2018. Accessed August 3, 2018.
  3. NCCN Clinical Practice Guidelines in Oncology. Kidney Cancer, version 4.2018. National Comprehensive Cancer Network website. nccn.org/professionals/physician_gls/pdf/kidney.pdf. Published April 23, 2018. Accessed August 3, 2018.
  4. Powles T, Albiges L, Staehler M, et al. Updated European Association of Urology guidelines: recommendations for the treatment of first-line metastatic clear cell renal cancer. Eur Urol. 2018;73(3):311-315. doi: 10.1016/j.eururo.2017.11.016.

For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived Community Practice Connections™: Matching Treatment to Patient in an Ever-Changing Era for the Management of Advanced Renal Cell Carcinoma.







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