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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 (CME) 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.

Physicians' Education Resource®, LLC, is approved by the California Board of Registered Nursing, Provider #16669, for 1.5 Contact Hours.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AbbVie, Astellas and Medivation, Inc., a Pfizer company, Exelixis, Inc. Genomic Health, Inc., Ferring Pharmaceuticals, Inc., Incyte, and Sanofi Genzyme.

Community Practice Connections™: New York GU™: 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies


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

 

Activity Overview

In this case-based online activity, you will engage with renowned physicians Daniel P. Petrylak, MD, Leonard G. Gomella, MD, and David I. Quinn, MD, MBBS, PhD, and uncover their management approaches for patients with prostate and other genitourinary (GU) malignancies. The content and interviews are based on presentations delivered in March 2018 at New York GU™: 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies. Working through the cases, you can compare your approach with that of the physician faculty and review the evidence base underpinning the treatment decisions taken.

As a busy oncologist engaged in the daily management of patients with prostate cancer, clear cell renal carcinoma, and urothelial carcinoma, this activity affords a unique opportunity to apply an added layer of information to the ongoing care of your patients.

These are some of the clinical pearls and highlights from the activity:

  • Genomic testing in prostate cancer can yield superior predictive performance for early clinical metastasis compared with other methodologies, including assays of individual genes, multigene groups, and clinicopathologic features.
  • Management of toxicities associated with immune checkpoint inhibitors requires careful assessment and monitoring of patients, as some immune-related adverse events may present late in the treatment course, in some cases even months or potentially years after treatment discontinuation.
  • For patients with M1 castration-resistant prostate cancer, many National Comprehensive Cancer Network category 1 recommended treatment options are available, including abiraterone plus prednisone, docetaxel, enzalutamide, or radium-223 for cases with symptomatic bone metastases. Patient-level and disease characteristics can help to guide treatment decisions for these patients with advanced disease.

Acknowledgment of Commercial Support

This activity is supported by educational grants from AbbVie, Astellas and Medivation, Inc., a Pfizer company, Exelixis, Inc. Genomic Health, Inc., Ferring Pharmaceuticals, Inc., Incyte, and Sanofi Genzyme.

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, surgical, and radiation oncologists involved in the treatment of patients with GU malignancies. Urologists, fellows, nurse practitioners, nurses, physician assistants, pharmacists, researchers, nuclear medicine physicians, and other healthcare professionals interested in the treatment of GU malignancies may also participate.

Learning Objectives

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

  1. Outline the use of patient- and disease-specific characteristics to inform clinical decision making in the management of patients with GU malignancies
  2. Discuss current strategies and practice-changing evidence for the management of patients with GU malignancies across multiple lines of care
  3. Explain how to proactively mitigate expected treatment-related toxicities associated with immunotherapeutic and targeted approaches to treat GU cancers
  4. Apply emerging clinical trial data for the management of GU malignancies in the context of changing treatment paradigms in the field

Faculty, Staff, and Planners' Disclosures

Faculty

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: Agensys, AstraZeneca, Bayer, Clovis, Dendreon, Eli Lilly, Endocyte, Genentech, Innocrin, Johnson & Johnson, MedImmune, Medivation, Merck, Millennium, Novartis, Pfizer, Progenics, Roche Laboratories, Sanofi Aventis, Sotio; Consultant: AstraZeneca, Bayer, Bellicum, Dendreon, Exelixis, Ferring, Johnson & Johnson, Medivation, Millennium, Pfizer, Roche Laboratories, Sanofi Aventis; Bellicum, Tyme.

Leonard G. Gomella, MD, FACS
The Bernard W. Godwin Professor of Prostate Cancer
Chairman, Department of Urology
Associate Director, Jefferson Kimmel Cancer Center
Clinical Director Jefferson Kimmel Cancer Center Network
Thomas Jefferson University
Philadelphia, PA

Disclosure: Consultant: Astellas, Bayer, MDxHealth, Janssen, Merck, Pfizer

David I. Quinn, MD, PhD, FRACP, FACP
Medical Director, Norris Cancer Hospital and Clinics
Head, Genitourinary Medical Oncology
Associate Professor of Medicine,
Keck School of Medicine at USC
Los Angeles, CA

Disclosure: Grant/Research Support: Millennium, Genentech, GlaxoSmithKline; Astellas, Bayer, Pfizer, Novartis, Bristol-Myers Squibb, Genentech, Merck, EMD Serono, Exelixis, Peloton, Vertex, Tendron, AstraZeneca

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)

The live continuing medical education (CME) activity, 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, was held on March 24, 2018, in New York City. Expert faculty joined Co-Chairs, Daniel P. Petrylak, MD, and Leonard G. Gomella, MD, to discuss the management of genitourinary (GU) malignancies, by incorporating the use of chemotherapeutic and local therapies, androgen-deprivation therapies, targeted therapies, radiopharmaceuticals, and immunotherapies into the treatment milieu.
 
This first of 3 PER Pulse™ Recaps will focus on the use of genomic testing to inform treatment decisions in patients with localized prostate cancer. Below are some highlights from the meeting:
 
Dr. Gomella notes that one of the key benefits of genomic testing in patients with prostate cancer is to individualize treatment through analyzing their risk scores, thereby reducing overtreatment in low-risk patients.

“We recognize the fact that just routinely radiating every man after radical prostatectomy, we are going to overtreat a lot of them, and subject them to unnecessary postoperative complications, such as bladder neck contracture or prolonged problems with erectile dysfunction.”
 — Leonard G. Gomella, MD

For the initial treatment of localized prostate cancer, several factors contribute to informed decision making, including stage, Gleason grade, PSA level, age, health status, and patient factors that include past medical history (Figure).



Along with improvements in biopsy techniques and imaging, genomic tests may offer predictive value, in estimating the potential of tumor progression. The use of genomics to aid in treatment decision making based on risk stratification scores is becoming increasingly important. Genomic testing can contribute to providing patients with optimal care while minimizing the risks associated with unnecessary treatment. Commercially available tests, such as Prolaris, Decipher, and Oncotype DX, have all been studied and validated for potential prognostic value following radical prostectomy.1   
 
Reference
  1. Boström PJ, Bjartell AS, Catto JW, et al. Genomic predictors of outcome in prostate cancer. Eur Urol. 2015;68(6):1033-1044. doi: 10.1016/j.eururo.2015.04.008.
For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived New York GU™: 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies.


PER Pulse Recap (2 of 3)

As a follow-up to the live continuing medical education (CME) activity, 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, held on March 24, 2018, in New York City, this second of 3 PER Pulse™ Recaps will focus on treatment of metastatic urothelial carcinoma (mUC). Below are some highlights from the meeting featuring Dr. Petrylak:
 
Checkpoint inhibition therapy is associated with significant antitumor activity in advanced UC, both as an initial therapy in cisplatin-ineligible patients and in patients with cisplatin-pretreated disease. For patients with mUC, however, PD-L1 expression should not be considered a definitive marker of response to treatment with checkpoint inhibitors.

“For those patients who are platinum-ineligible, and who receive atezolizumab, PD-L1 expression does not seem to predict for response. In patients who are platinum-experienced, it does seem to have a correlation, although there are patients who don’t have PD-L1 staining who do respond.”   — Daniel P. Petrylak, MD

The National Comprehensive Cancer Network (NCCN) guidelines1 stratify treatment for patients with mUC based on eligibility for cisplatin therapy. A significant proportion of patients are not candidates for cisplatin-based chemotherapy due to renal impairment or other comorbidities.
 
Cisplatin-Eligible
 
For patients with mUC who are eligible for cisplatin, NCCN guideline‒preferred regimens are gemcitabine and cisplatin or dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) with growth factor support. Both options are category 1 recommendations. 
 
Cisplatin-Ineligible
 
For patients with mUC who are ineligible for cisplatin therapy due to renal impairment, NCCN guideline‒preferred first-line systemic treatment options include treatment with atezolizumab, pembrolizumab, or gemcitabine and carboplatin. Participation in a clinical trial is recommended.
 
Reference
1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Bladder Cancer. Version 4.2018. https://www.nccn.org/professionals/physician_gls/PDF/bladder.pdf. Accessed June 12, 2018.
 
For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived New York GU™: 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies.


PER Pulse Recap (3 of 3)

As a follow-up to the live continuing medical education (CME) activity, 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies, held on March 24, 2018, in New York City, this third of 3 PER Pulse™ Recaps will focus on treatment of advanced clear cell renal cell carcinoma (ccRCC). Below are some highlights from the meeting featuring Dr. Quinn:
 
For patients with ccRCC who have progressed following first-line treatment options, second-line treatment options are considered.

“Second-line treatment options axitinib, cabozantinib, lenvatinib + everolimus, and nivolumab all have activity at various levels. I think that nivolumab and cabozantinib both have overall survival advantage compared to active agents in that setting, so I would pick one of those.”  
 — David I. Quinn, MBBS, PhD

In a recent review of novel second-line treatment options for patients with mRCC, both nivolumab and cabozantinib demonstrated overall survival (OS) advantages compared with everolimus.1
 
Nivolumab
 
CheckMate 25,2 a phase III trial of nivolumab versus everolimus in 821 patients with metastatic ccRCC demonstrated significantly increased median OS in the nivolumab group ((25.0 vs 19.6 months). The hazard ratio (HR) for mortality was 0.73 (98.5% CI, 0.57-0.93; P =.002), favoring treatment with nivolumab.
 
Cabozantinib
 
The METEOR study3 investigated the efficacy of cabozantinib versus everolimus as second-line treatment in 658 patients with metastatic ccRCC. There was a trend toward increased OS for cabozantinib (HR for mortality, 0.67 [95% CI, 0.51‑0.89]; P =.005), but statistical significance was not reached.
 
Data supporting second-line options in ccRCC are maturing, and both nivolumab and cabozantinib have yielded promising OS results to date for patients with ccRCC.
 
References
1. von Klot CA, Merseburger AS, Kuczyk MA. Novel therapeutic options for second-line therapy in metastatic renal cell carcinoma. Mol Clin Oncol. 2016;4:903-908. DOI: 10.3892/mco.2016.856.
 
2. Motzer RJ, Escudier B, McDermott DF, et al. Nivolumab versus everolimus in advanced renal‑cell carcinoma. N Engl J Med. 2015;373:1803‑1813. DOI: 10.1056/NEJMoa1510665.
 
3. Choueiri TK, Escudier B, Powles T, et al. Cabozantinib versus everolimus in advanced renal‑cell carcinoma. N Engl J Med. 2015;373:1814‑1823. DOI: 10.1056/NEJMoa1510016.
 
For additional commentary about these topics and others, visit www.gotoper.com to access more resources from the archived New York GU™: 11th Annual Interdisciplinary Prostate Cancer Congress® and Other Genitourinary Malignancies.







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